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What to Expect From Your 20-Week Ultrasound

"When's Sara's not writing you can find her hanging out with teenagers at her day job as a counselor and with her own son and daughter. With a B.S. in Exercise Science and a M. Ed. in counseling, she enjoys writing about health, wellness...

Your 20-week ultrasound is exciting — here's what you need to know

When you’re pregnant, the anticipation and excitement you experience before each appointment often feels like the jitters you used to get as a kid the night before school started. With so much to learn, many parents head into the doctor’s office armed with dozens of questions and concerns about the health and well-being of both mother and baby.

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And while all prenatal appointments are important, there is one that tends to excite the parents-to-be more than others. Often referred to as the midpregnancy anatomy scan, or level-2 ultrasound, the 20-week appointment allows the doctor to see if everything is growing and developing properly, and it gives you the opportunity to potentially find out the sex of the baby, learn about any complications or concerns regarding the growing fetus and head home with a pretty awesome sonogram picture.

What to expect from the 20-week ultrasound

A prenatal ultrasound (also called a sonogram) is a noninvasive diagnostic test that uses sound waves to create a picture of how a baby is developing in the womb. It also looks at the placenta, uterus and other pelvic organs. According to the American College of Obstetricians and Gynecologists, the ultrasound allows your obstetrician-gynecologist or other health care professional to check the fetus's health and development, monitor your pregnancy and detect many congenital anomalies. A standard ultrasound can also provide information about the following:

  • The fetus’s position, movement, breathing and heart rate
  • An estimate of the fetus’s size and weight
  • The amount of amniotic fluid in the uterus
  • The location of the placenta
  • If the fetus is in the right position, the ultrasound might be able to tell the sex

“In addition to all of the medical necessities of this appointment, the 20 weeks sonogram is possibly the first time the patient will be able to visualize and recognize that there is a developing fetus in her uterus,” says Dr. Joseph Apuzzio of the Rutgers New Jersey Medical School and professor and vice chair of obstetrics, gynecology and women’s health.

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Apuzzio explains that the developing fetus is of such a size that fetal viewing at 20 weeks is much better than earlier in the pregnancy. This is reassuring to the patient, since she can see the fetal heart actually beating and can often see the fetus move arms and legs.

A few things to consider before the appointment

Of course, most parents-to-be are often excited to catch a glimpse of tiny fingers and toes or find out the sex; however, physicians and health care providers are primarily focused on the development of the baby.

“One of the things OBs are the most relieved about is a four-chamber heart and outflow tracts (a normally functioning heart),” says Dr. Kirsten B. Dummer, associate chief of cardiology at The Children’s Heart Clinic in Minnesota.

Other experts recommend patients understand the medical reasons for the scan, that anomalies can be found and that repeat ultrasound or further testing may be suggested (news the patient(s) can be totally unprepared for). This is why many physicians caution against bringing extra family members and friends to the appointment.

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And while most physicians are looking for things like normal size and growth of the fetus, a four-chamber heart, a normally formed brain and an intact spine — just like the parents-to-be — they also get excited about seeing tongues, swallowing movements, eyelashes, tiny hands and feet and watching the baby wave — all of which make for wonderful keepsake pictures for the family.

What about all of the questions during the appointment?

Apuzzio says that typically when the sonogram is performed, it must be interpreted and read later by an experienced physician who might or might not be present during the examination. He recommends that general questions be directed to the sonographer (who can usually answer). However, if there is a problem detected during the examination, the parents-to-be will need to wait for answers until the sonographer can consult with the reading physician. The good news is, Apuzzio says, that “most 20-week sonograms are normative,” so take a deep breath, relax and enjoy seeing your baby.

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