Anomaly Scan Disclaimer

Maharashtra College of Radiology
CONDITIONS OF REPORTING FOR ULTRASOUND ANOMALY SCAN
What is Ultrasound?
An ultrasound uses high frequency sound waves to create an image of internal body structures. It creates
pictures of a baby in the womb and the mother's reproductive organs when done in pregnancy.
Three-Dimensional Ultrasonography
3D ultrasonography is an advance in imaging technology where the volume of a target anatomic region can
be displayed in three orthogonal planes (sagittal, transverse & coronal planes) and in various rendered
formats. It is used for additional evaluation of fetal facial anomalies, neural tube defects, fetal tumors, and
skeletal malformations. Abnormalities of the fetal hard palate particularly the secondary palate, can be
1
challenging to evaluate with 2D ultrasonography and requires 3d for proper evaluation .
Safety of Ultrasound
So far, there have been no reports of documented short-term or long-term adverse fetal effects for
diagnostic ultrasound procedures, including duplex Doppler imaging. However, we believe fetal exposure
time should be minimized using the lowest possible USG exposure settings needed to obtain diagnostic
information, following the ALARA principle (As Low as Reasonably Achievable).
Ministry of Health & Family Welfare (MOHFW) guidelines on use of Ultrasonography during
Pregnancy
“After reviewing the literature and considering available resources and feasibility, it has been decided that
one obstetric ultrasound should be done during pregnancy between 18 and 19 weeks of pregnancy as part
of routine Ante Natal Care (ANC) package. Additional ultrasound examinations can be done if clinically
indicated.”
Second trimester anomaly scan:

USG in the second trimester is used to perform fetal measurements (of fetal head, abdomen, thigh bone
and arm bone) and determine gestational age; evaluate the liquor (fluid around baby) and the placenta
(afterbirth). The fetal anomaly scan is a detailed scan done at 18-22 weeks during which each part of the
fetal anatomy is examined to see that the baby is developing normally. Special attention is paid to the brain,
face, spine, heart (basic evaluation), stomach, bowel, kidneys and long bones of limbs. However, counting
of fingers/ toes and assessment of external ears is not a part of routine anomaly scan. This scan usually
takes reasonable time and occasionally you will be asked to wait longer to allow your baby to move into a
more favorable position for better scanning.
Fetal echo is a dedicated study for detailed evaluation of the heart and is done separately (wherever
indicated) around 22-24 weeks when visualization of fetal heart is better.
Detection of anomalies:
Most babies are healthy; however some babies may have structural abnormalities that cause physical or
mental limitation. Ultrasonography can be used to diagnose many major fetal anomalies but there is a
significant variability in the sensitivity of routine ultrasonography for detection of various fetal anomalies. In
a review of 36 studies that included more than 900,000 fetuses, sensitivity of detecting fetal anomalies was
approximately 40% (<15% to >80%)2 . Even in expert hands, some fetal CNS anomalies may be difficult or
impossible to diagnose in utero3.
Approximately half of the major abnormalities that cause serious difficulties will be seen on a scan,
the other half will not. This means that even if your scan is normal there is still a small chance that your
baby can have a problem.
Below is a table of different types of abnormality, and how likely scanning is to identify each problem.
Problem Nature of the problem Chance of being

detected (%)
Spina Bifida Open spinal cord 90
Anencephaly Absence of top of head 99
Hydrocephalus Excess fluid within the brain 60
(may present late in pregnancy)
Major congenital heart defects 50
Diaphragmatic hernia Defect in muscle separating chest 60
and abdomen
Exomphalos / Gastrochisis Defect in abdominal wall 90
Major kidney problems Missing or abnormal kidneys 85
Bone Dysplasia Bone abnormalities 62
Orofacial clefts Abnormal facies 73
Down's Syndrome 40
Cerebral palsy Never Seen
Autism Never Seen
Late onset or evolving anomalies

Some anomalies like congenital diaphragmatic hernia / hydrocephalus / microcephaly / club foot / intestinal
obstructive anomalies/ certain heart defects etc., may not be seen until later in your pregnancy. These
include
Brain- Microcephaly, Ventriculomegaly, Corpus callosal agenesis, Partial Corpus callosal agenesis,
Vein of Galen Malformation
Face - Micrognathia, Retrognthia
Heart - Coarctation of aorta, Hypoplastic left heart syndrome, Hypoplastic right heart
syndrome,bstein' anomaly, Atrial septal defect, Ventricular septal defect, Partial Anomalous
pulmonary venous Connections
Thorax- Adenomatoid lung malformation CPAM), ongenitalhigh airway obstruction syndrome
(CHAOS), Pulmonary Sequestration, Pleural effusion, Tracheo- esophageal atresia.
Abdomen- Diaphragmatic Hernia Oesophageal atresia, Duodenal atresia, Jejunal atresia, Anorectal
malformation, Mesenteric yst, Gonadal cyst
Bone- Achondroplasia, Craniosynostosis
Syndromes- Downs'syndrome
Practical considerations:
Despite a protocol driven comprehensive study, some anomalies can be missed in antenatal ultrasound
scan. Under some circumstances a normal ultraound finding may be misinterpreted as an anomaly.
The quality of the scan image also depends on many factors, including the position of the baby, amniotic
fluid volume, fetal movements and maternal abdominal wall thickness. For example, it will be more difficult
to see the baby clearly if the mother is overweight because the fat in the mother' abdominal wall absorbs the
ultrasound energy and degrades the images. Multiple regnanciesmay also cause difficulties in ultrasound
examination due to fetal positon and overlap.
Review scans for under-filled stomach/bladder or for position change to enable assessment of face / heart /
spine may be needed. Disparity in final diagnosis can occur due to technical pitfalls like False Positive and
False Negative result. A positive test result maye indicative of the potential presence of an anomaly and has
to be confirmed with further tests during the course of pregnancy. A negative test result does not rule out the
development or detection of an anomaly at a later dte. ence, only the report should not be taken as final
diagnosis but should be correlated clinically with /or other investigations. In case of disparity between report
and clinical evaluation, second opinion is always advisable before taking a decision o commencing final
treatment.
If any scan reveals a serious problem, your clinician will make you aware of the possible options (treatment
or termination). This may mean a baby needs surgery or treatment after birth, or even surgery while it is still
in th uterus.
Disclaimer
Patient' identity is based on her own declaration.
This investigation has been done as per request of the referring doctor.
Proper history with all details of previous pregnancy / children with problem have been provided.
We have red the above information and understand the implications.
The information provided is as per current literature available cited infra.
ICRI as made every effort to ensure that conditions of reporting are as per available references, neither
the Society or any of its employees or members accepts any liability for the consequences of any
inaccurate or misleading data, opinions or statements.
Place: Date:
Signature of womenundergoing the pregnancy scan
Signature of husband/ accompanying person
REFERENCES:
1. Pettit KE, Tran NV, Pretorius DH. Ultrasound evaluation of the fetal face and neck. In: Norton ME,
Scoutt LM, Feldstein VA, editors. Callen' Ultrasonography in Obstetrics and Gynecology.
Philadelphia: Elsevier2017. P. 243-271
2. Ultrasound in pregnancy. Committee on Practice Bulletins—bstetrics and American Institute of
Ultrasound in Medicine. Obsterics & Gynecology 2016128(6): e241-e256.
3. Pilu G. Ultrasound evaluation of the fetal central nervous system. In: Norton ME, Scoutt M,
Feldstein VA, editors. Callen's Ultrasonography in Obstetrics and Gynecology. Philadelphia:
Elsevier2017. P. 220-242
4. Smith RP, Titmarsh S, Overton TG. Improving patients'knowledge of the fetal anomaly scan.
Ultrasound Obstet Gynecol 200424: 740–4
5. Screening Tests for you and your baby. https://www.gov.uk/government/publications/screening-tests-
for-you-and-your-baby. Published 3 May 2019. Accessed online 31.05.2019.
6. Schramm T, Gloning KP, Minderer S et al: Prenatal sonographic diagnosis of skeletl dysplasias,
Ultrasound Obstet Gynecol 200934:160-170
7. Maarse W, Pistorius L, et al. Diagnostic accuracy of transabdominal ultrasound in detecting prenatal
cleft lip and palate: a systematic review. Ultrasound Obstet Gynecol 201035:495-502
8. Berman DR, Treadwell MC. Ultrasound evaluation of the fetal thorax. In: Norton ME, Scoutt LM,
Feldstein VA, editors. Callen's Ultrasonography in Obstetrics and Gynecology. Philadelphia:
Elsevier2017. P. 346-370
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Maharashtra College of Radiology

CONDITIONS OF REPORTING FOR ULTRASOUND ANOMALY SCAN

Second trimester anomaly scan:

Problem Nature of the problem Chance of being

Late onset or evolving anomalies

Signature of womenundergoing the pregnancy scan

Signature of husband/ accompanying person

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