What To Expect During a Level II Ultrasound in Midpregnancy

A detailed anatomy ultrasound is recommended during pregnancy from 18 to 22 weeks. Sometimes also known as an anatomy scan, or anomaly scan, the aim of this imaging is for your provider to gather information about your baby's development.

This is typically a transabdominal ultrasound, as opposed to transvaginal scans of earlier ultrasounds during your pregnancy. Because this test is unlike any other performed in early pregnancy, it can be a nerve-wracking experience for expectant parents. But with a little bit of knowledge and preparation, it doesn't have to be.

Knowing what to expect during a level II ultrasound can help put your mind at ease and understand exactly what is happening throughout your appointment.

1

The Fetal Anatomy Survey

Pregnant woman holding an ultrasound photo

Blend Images / Getty Images

To begin the scan, the ultrasound technician (or in some cases your doctor) will have you lie down (preferably in a left tilt position) on the exam table. Next, an ultrasonic gel (which is warmed for your comfort) will be placed on your belly.

The technician or your physician will move the ultrasound transducer wand over your abdomen. You will feel them pressing on your belly, but it won't hurt you or your baby. However, if you do feel uncomfortable at any time during the scan, it's important to let your provider know.

During the ultrasound, fetal anatomy and size are assessed. The entire anomaly scan typically takes between 45 and 75 minutes from start to finish, and you often receive results with the same appointment. The size of your baby in comparison to other babies of the same gestational age, as well as the placenta will be evaluated to ensure your baby is developing properly.

What Is Included?

Between 18 and 22 weeks into your pregnancy, your baby will be large enough for your medical provider to see details of their organs and limbs from head to toe through an anatomy scan.

If you're having multiples, each fetus will receive their own scan. Sometimes, follow up ultrasounds for growth and reevaluation will be suggested based on the findings of the initial scan.

Barring any specific high-risk issues, the following areas are examined to rule out birth defects and other anomalies or red flags:

  • Evaluation of the brain (including ventricles, cerebellum, corpus callosum, and other key structures)
  • Neck (including nuchal fold thickness)
  • Face structures (palate, eyes, nose, lips, and ears)
  • Detailed heart and lung anatomy
  • Spine and ribs
  • Abdominal organs (stomach intestines, spleen, liver, gall bladder) and the abdominal wall
  • Limbs and digits
  • Genitals (if visible, can determine fetal sex)
  • Umbilical cord including vessels and insertion site
  • Placenta structure and location
  • Cervical length
  • Fetal position and movements
  • Amniotic fluid

Typically, the images produced by the ultrasound will appear on a screen where you and your provider or technician can see them. The images will be measured and recorded, and you may be given some printouts or a disc with the images to have as keepsakes.

Some hospitals or clinics will let you record the ultrasound session with a recording device, such as your cell phone camera. However, the rules around this vary from doctor to doctor. It's best to ask about specific guidelines before your appointment.

2

Fingers and Toes

23 Weeks 3D Ultrasound

Verywell / Lue and Krystal Vang

Moments after birth, the first thing many new parents do is count 10 tiny fingers and 10 tiny toes. However, ultrasound technology enables providers and parents alike to count fingers and toes before a baby is actually born.

The potential of seeing the details like the fingers and toes of your baby during the scan can be something that can offer some joy and peace of mind if you're feeling anxious about your scan.

However, actually being able to count each finger and toe in an ultrasound exam depends on how cooperative your baby is during the scan. If they're moving too much, it's possible that you may still have to wait until birth to count all fingers and toes individually.

3

Legs

3D Ultrasound Photos 24 Weeks Pregnant - Ultrasound Photos

Verywell / A. Phillips

Unlike the fingers and toes, it is very likely that you will be able to clearly see bigger areas like your baby's arms and legs on an ultrasound despite their movement.

During the scan, the ultrasound technician will measure your baby's thigh bone (femur), tibia, and fibula. These measurements help them calculate how well your baby is growing for his or her gestational age.

Sometimes it's also possible to see the baby kicking, which you may or may not feel at this point in your pregnancy—another potentially exciting moment to look forward to.

4

Arms

3D Twin Baby B - 18 Week Ultrasound

Verywell / M. Horn

In addition to looking at your baby's legs, the ultrasound technician will also measure the bones of the arms (radius, ulna). Depending on their position, you may see your baby waving their arms or sucking their thumb.

Some technicians may even be able to snap a still photo of your baby's arm waving or their thumb firmly planted in their mouth. This type of photo can become a cherished keepsake and way to remember the moment.

5

Brain and Stomach

Baby Brain Ultrasound

Verywell / K. Harrell

During the scan, the ultrasound technician will check your baby's internal structures, including their brain.

At this point in fetal development, the appearance of the brain often has a butterfly look. The ultrasound technician will be examining for the presence and anatomic landmarks of your baby's brain. They will also note any anomalies found, such as choroid plexus cysts.

The ultrasound technician will also look at your baby's stomach, urinary tract, kidneys, and other structures during the ultrasound.

While every provider is different, you can typically expect to be informed of any unusual findings or abnormalities before the conclusion of your appointment.

Although the potential of finding abnormalities within your baby's organs can be concerning, your provider will go over next steps with you if this occurs. If any problems are found, you will likely have further ultrasound exams that are usually conducted by specialists called perinatologists or maternal-fetal experts.

6

Spine

20 Week Spine Ultrasound

Verywell / K. Harrell

Your baby's spine will also be examined during the fetal anatomy survey. This is usually one of the most easily recognizable anatomical elements for parents as they watch the ultrasound.

The technician will confirm that your baby's spine and neural tube are completely formed and without cysts. Once again, if abnormalities are present, your provider will go over these issues with you—usually before the end of your appointment.

7

Heart

Baby Heart Ultrasound

Verywell / K. Harrell

During the ultrasound, the technician will look through your baby's heart to measure the fetal heart rate and look for any structural problems, such as defects in the ventricles and other heart anomalies. If they suspect a problem with your baby's heart, they will most likely recommend a fetal echocardiogram or fetal ECHO.

It's important to remember that a suspected issue found in an anatomy scan does not automatically mean that a problem actually exists. Sometimes the additional tests ordered are more comprehensive and can reveal that the suspected problem is either easily remedied, will be outgrown, or was just an abnormality that showed up in the initial scan, but is not concerning.

8

Placenta and Umbilical Cord

Placenta Ultrasound

Verywell / K. Harrell

During your anatomy scan, the technician will also closely examine the placenta. Confirming where the placenta is located helps the technician screen you for a condition called placenta previa.

An ultrasound exam also provides a good view of the umbilical cord to confirm that the cord functions properly. A normal umbilical cord has two arteries and one vein. The technician will check to see if you have a three-vessel or two-vessel cord (single umbilical artery).

Babies born with a two-vessel cord sometimes experience growth issues and other potential anatomic anomalies, so it's important to be aware of the cord's structure. However, most babies born with a two-vessel cord will have a fetal echocardiogram and be born perfectly healthy.

9

Sex of the Baby

17 Week Ultrasound Photo - It's a boy! - Ultrasound Photos

Verywell / J. Rauch

The part of your pregnancy during which you will have a level II ultrasound usually corresponds to when the sex of your baby will be visible. For some parents, learning their baby's sex is the most exciting moment of the entire ultrasound and something to look forward to.

The accuracy of this reveal depends on many factors, though, including the cooperation of your baby. If your baby is not cooperating, you may not be able to learn the sex during the anatomy scan.

If the technician does tell you the sex of your baby, asking how certain they are about their prediction can help ensure that you won't find out at birth that you were given incorrect information. While it is possible for the ultrasound to be wrong, it's more likely to be accurate at this point in your pregnancy compared to ultrasounds earlier in pregnancy (the first trimester).

10

3D Ultrasounds

18 week 3D ultrasound

Verywell / M. Horn

3D ultrasound (and even 4D ultrasound) is becoming more widely available and popular. Many parents find these detailed images to be more lifelike compared to the grainy black and white photos of the 2D pictures produced by a standard ultrasound.

While the prospect of having an image that gives you an idea of what your baby will look like once they're born is exciting, keep in mind that it can be difficult to obtain good quality 3D photographs. Talk to your practitioner about the benefits of 3D versus 2D for your fetal anomaly screen.

A Word From Verywell

Although the uncertainty of what will happen during a level II ultrasound can cause feelings of anxiousness or nervousness, it can help to think of an anatomy scan as an opportunity for reassurance that your baby is developing as they should. It's also the perfect opportunity to get a sneak peek of what your baby looks like prior to birth.

If unexpected issues are uncovered during the scan, your provider will be able to address these problems. Seeking support and knowledge throughout this process can help keep your mind at ease.

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