A prenatal or pregnancy ultrasound uses sound waves to create a picture of your baby on a screen. Radiologist use it to check on the health of your baby and detect certain pregnancy complications. Most people have two ultrasounds during pregnancy, but you may have more if your provider feels it’s medically necessary.

What is an ultrasound in pregnancy?

A prenatal ultrasound (or sonography) is a test during pregnancy that checks on the health and development of your baby. An radiologist performs ultrasounds during pregnancy for many reasons. Sometimes ultrasounds occur to check on your baby and make sure they’re growing properly. Other times your obstetrician / pregnancy care provider orders an ultrasound after they detect a problem.

During an ultrasound, sound waves are sent through your abdomen or vagina by a device called a transducer. The sound waves bounce off structures inside your body, including your baby and your reproductive organs. Then, the sound waves transform into images that your provider can see on a screenUltrasound doesn’t use radiation, unlike some other medical imaging tests, such as X-rays and CT scans.

Even though prenatal ultrasounds are safe, you should only have them when it’s medically necessary. If there’s no reason for an ultrasound (for example, if you just want to see your baby), PC PNDT Act 1996 not allow for it.

Prenatal ultrasounds may be called fetal ultrasounds or pregnancy ultrasounds. Your radiologist will talk to you about when you can expect ultrasounds during pregnancy based on your health history.

Why is a fetal ultrasound important during pregnancy?

An ultrasound is one of the few ways your radiologist can see and hear your baby. It can help them determine how far along you are in pregnancy, if your baby is growing properly or if there are any potential problems with the pregnancy. Ultrasounds may occur at any time in pregnancy depending on what your obstetrician is looking for.

What can be detected in a pregnancy ultrasound?

A prenatal ultrasound does two things:

1. Evaluates the overall health, growth and development of the fetus.
2. Detects certain complications and medical conditions related to pregnancy.

In most pregnancies, ultrasounds are positive experiences and radiologist don’t find any problems. However, there are times this isn’t the case and your radiologist detects birth disorders or other problems with the pregnancy.

Reasons why your provider performs a prenatal ultrasound are to:

1. To diagnose intra-uterine and / or ectopic pregnancy and confirm viability. Confirm you’re pregnant. Check for ectopic pregnancy, molar pregnancy, miscarriage or other early pregnancy complications.
2. Estimation of gestational age (Dating) and due date.
3. Detection of number of fetuses and their chorionicity.
4. Suspected pregnancy with IUCD in-situ or suspected pregnancy following contraceptive failure /
5. MTP failure.
6. Vaginal bleeding / leaking.
7. Follow up case of abortion.
8. Assessment of cervical canal and diameter of internal os.
9. Discrepancy between uterine size and period of amenorrhea.
10. Any suspected adnexal or uterine pathology / abnormality.
11. Detection of chromosomal abnormalities, fetal structural defect and other abnormalities andtheir follow-up.
12. To evaluate fetal presentation and position.
13. Assessment of liquor amnii.
14. Preterm labour / preterm premature rupture of membranes.
15. Evaluation of placental position, thickness, grading and abnormalities (Placenta praevia,
16. retroplacental hemorrhage, abnormal adherence etc.)
17. Evaluation of umbilical cord – presentation, insertion, nuchal encirclement, numbers of vesselsand presence of true knot.
18. Evaluation of previous Caesarean Section scars.
19. Evaluation of foetal growth parameters, foetal weight and foetal well being.
20. Color flow mapping and duplex doppler studies.
21. Ultrasound guided procedures such as medical termination of pregnancy, external cephalicversion etc. and their follow-up.
22. Adjunct to diagnostic and therapeutic invasive interventions such as chorionic villi sampling (CVS), amniocenteses, fetal blood sampling, fetal skin biopsy, amnio-infusion, intrauterineinfection, placement of shunts etc.
23. Observation of intra-partum events.
24. Medical / surgical conditions complicating pregnancy.
25. Research studies in recognised institutuions.
26. Examine your pelvic organs like your uterus, ovaries and cervix.
27. Detect problems with your baby’s organs, muscles or bones.

Ultrasound is also an important tool to help providers screen for congenital conditions (conditions your baby is born with). A screening is a type of test that determines if your baby is more likely to have a specific health condition. Your radiologist also uses ultrasound to guide the needle during certain diagnostic procedures in pregnancy like amniocentesis or CVS (chorionic villus sampling).

An ultrasound is also part of a biophysical profile (BPP), a test that combines ultrasound with a nonstress test to evaluate if your baby is getting enough oxygen.

How many ultrasounds do you have during your pregnancy?

Most pregnant people have three or four ultrasounds during pregnancy. However, the number and timing vary depending on your obstetrician / pregnancy care provider and if you have any health conditions. If your pregnancy is high risk or if yourobstetrician / provider suspects you or your baby has a health condition, they may suggest more frequent ultrasounds.

When do you have your first prenatal ultrasound?

The timing of your first ultrasound varies depending on your provider. Some people have an early ultrasound (also called a first-trimester ultrasound or dating ultrasound). This can happen as early as seven to eight weeks of pregnancy. Providers do an early ultrasound (as early as six weeks) through your vagina (transvaginal ultrasound). Early ultrasounds do the following:

1. Confirm pregnancy (by detecting a heartbeat).
2. Localization of pregnancy whether in uterus (normal) or outside uterus (Abnormal location / ectopic pregnancy).
3. Check for multiple fetuses.
4. Measure the size of the fetus.
5. Help confirm gestational age and due date.

Some providers perform your first ultrasound closer to 12 (11-13) weeks of pregnancy (Level I / NT NB Scan).

18-20-week ultrasound (anatomy scan)

You can expect an ultrasound around 18 to 20 weeks in pregnancy. This is known as the anatomy ultrasound or 20-week ultrasound. During this ultrasound, your radiologist can detect birth disorders like cleft palate or find serious conditions related to your baby’s brain, heart, bones or kidneys. If your pregnancy is progressing well and with no complications, your 20-week ultrasound may be your last ultrasound during pregnancy. However, if your provider detects a problem during your 20-week ultrasound, they may order additional ultrasounds.

How soon can you see a baby on an ultrasound?

Pregnancy care providers can detect an embryo on an ultrasound as early as six weeks into the pregnancy. An embryo develops into a fetus around the eighth week of pregnancy.

If your last menstrual period isn’t accurate, it’s possible that it may be too early to detect a fetal heart rate.

Which ultrasound is most important during pregnancy?

All ultrasounds during pregnancy are important. Your obstetrician / pregnancy care provider uses ultrasound to tell them important information about your pregnancy.

Test Details

What are the two main types of pregnancy ultrasounds?

The two main types of pregnancy ultrasound are transvaginal ultrasound (TVS) and transabdominal ultrasound (TAS). Both use the same technology to produce images of your baby. Your radiologist performs a transvaginal ultrasound by placing a wand-like device inside your vagina. They perform an abdominal ultrasound by placing a device on the skin of your belly.

Transvaginal ultrasound

During a transvaginal ultrasound, your radiologist places a device inside your vaginal canal (similar to how you place a tampon). In early pregnancy, this ultrasound helps to detect a fetal heartbeat or determine how far along you are in your pregnancy (gestational age). Images from a transvaginal ultrasound are clearer in early pregnancy as compared to abdominal ultrasound. Transvaginal ultrasound is also used for better assessment of cervix, uterine artery assessment and for assessment of lower edge of placenta.

Abdominal ultrasound

Your radiologist performs an abdominal ultrasound by placing a transducer directly on your skin. Then, they move the transducer around your belly (abdomen) to capture images of your baby. Sometimes slight pressure has to be applied to get the best views. Rdiologist use abdominal ultrasounds after about 12 weeks of pregnancy.

Traditional ultrasounds are 2D. More advanced technologies like 3D or 4D ultrasound can create better images. This is helpful when your provider needs to see your baby’s face or organs in greater detail. Not all providers have 3D or 4D ultrasound equipment or specialized training to conduct this type of ultrasound.

Dating scan

If needed, a dating scan is usually done in the first trimester. It can be done any time during pregnancy.

This ultrasound is used to estimate your baby’s due date. It can also:

1. confirm if you are pregnant with one baby or multiple babies
2. check that your pregnancy is not ectopic (baby growing outside the uterus)

Nuchal translucency scan

The nuchal translucency scan (also called an NT scan) is done after 11 weeks and before 14 weeks of pregnancy.

The term ‘nuchal translucency’ refers to one of the key measurements taken during this ultrasound. This measurement will help your doctor to assess your baby’s chance of having a chromosomal condition, such as Down syndrome.

Similar to a dating ultrasound, this scan can also check your baby’s growth, estimate your due date and check the physical development of your baby.

Level II / Anomaly Scan / Morphology scan Targeted Imaging for Fetal Anomaly (TIFFA)

A morphology scan is an ultrasound scan usually done between 18 and 22 weeks of pregnancy.

This ultrasound can check the structure and growth of your baby’s body organs. Measurements made at the morphology scan help estimate your baby’s gestational age and size.

This scan can also check your baby’s heart rate and rhythm. The radiolgist can make sure your placenta is in a good position and measure the length of your cervix.

Your provider may recommend other types of ultrasounds. Examples of additional ultrasounds are:

1. Doppler ultrasound: This type of ultrasound checks how your baby’s blood flows through its blood vessels. Most Doppler ultrasounds occur later in pregnancy.
2. Fetal echocardiogram: This type of ultrasound looks at your baby’s heart size, shape, function and structure. Your radiologist may use it if they suspect your baby has a congenital heart condition, if you had another child that had a heart condition or if you have certain health conditions that warrant taking a closer look at the heart.

Formalities / paper work prior to Test?

A valid prescription from your obstetrician / pregnancy care provider.

What is a valid prescription for pregnancy /pregnancy relatedultrasound scan?

1. Should be carrying the name and age of patient.
2. Should be having both the name and address of referring doctor and his/her clinic.
3. Should be having stamp and MCI/HMC/state medical council registration number
4. Prescriptions can be given by registered MBBS and AYUSH doctors. Do not entertain prescription from quacks, RMPs, paramedical staff etc
5. Should be having a written Indication of ultrasound out of the 23 indications mentioned in form F.

What is the validity of online generated prescriptions?

Provided the soft copy of prescription is complete is all respect, including thedoctor’s name, stamp, address, and registration number, they are acceptable. However,some online prescription which do not include the obstetrician / pregnancy care provider stamp are notvalid.

(Suggestion: The referring gynecologist can take out print of online prescription, stamp itwith her seal, sign it and then take a photo and send it to the patient).

Sometime the prescription carries wrong name or misspelt name of patient (different from Id proof). Can that name be changed on prescription after countersigning by the patient/referring doctor?

If there is minor spelling error, make a note in prescription that the name in prescription is ‘GITA’ And in the Id card is ‘GEETA’ and they both are the same. Get is co- signed by the patient as well as Radiologist. Fill the name of Id in Form F and other records.

However, there should not be any gross mismatch; in that case either:

get a fresh prescription made by the referring doctor or Take ID of patient’s husband instead of patient.

Which are the valid ID documents for PCPNDT purpose?

With reference to notice from DGHS, Haryana dated 03/05/2012 (PNDT-12/053) following residential ID proofs are applicable:

a) Adhaar card/ Masked Aadhaar card (Any proof of residence)

b) PAN card

c) Passport (Can be used in case of foreign nationals)

d) Driving license

e) Copy of ration card

f) Voter ID card

g) Water and Electricity bill

h) Bank pass book

i) Office ID

j) Army card

k) Witness by ASHA worker

l) Certificate of laborer from factory owner/Bricklin owner or private organization

m) Certificate from member panchayat/Sarpanch/Municipal Councilor

n) Confirmed mobile number (Try to avoid taking using this option, though)

All these ID s are applicable Pan India. If permanent ID is from outside city, in theprintout of the residential address (provided from above list) -ask the patient towrite local address and get it signed by her.

Apart from patients own ID, who else ID can be taken for PC PNDT purpose?

Husband, Mother (of patient), Father (of patient). Patient has to attest and sign on the photocopy of id proof stating the relationship with the Id holder and mentioning that it is being submitted for PC-PNDT purpose.

How do I prepare for the test?

There’s no special preparation for an ultrasound. Some radiologist ask that you come with a full bladder and don’t use the restroom before the test. This helps them view your baby better on the ultrasound. You can bring a support person, but bringing children is discouraged as this is an important test that requires complete focus.

If your provider is performing a transvaginal ultrasound in your first trimester your radiologist ask that you come with a empty urinary bladder and use the rest room before test, you’ll put on a hospital gown or undress from the waist down.

What should I expect during a prenatal ultrasound?

You’ll lie on a padded examining table during the test. Most ultrasounds occur in a dimly lit room, which helps your radiologist see the screen. Your radiologist applies a small amount of water-soluble gel to the skin of your belly. The gel doesn’t harm your skin or stain your clothes, but it may feel cold. This gel helps transmit sound waves more efficiently, added function of gel is lubrication.

Next, the radiologist places a transducer on the skin of your abdomen. The transducer sends sound waves into your body, which reflect off internal structures, including your baby. The sound waves that reflect back create pictures on a screen. Your radiologist uses these images to take important measurements such as your baby’s head circumference and length. You may see them making lines on the screen or clicking a button to “freeze” certain angles.

There’s virtually no discomfort during a prenatal ultrasound. You may feel mild discomfort if you have to pee. The ultrasound test takes about 30 minutes to complete, depends on type of scan.

If you have a transvaginal ultrasound, the process is only different in that the transducer is inside your vagina and not on your belly.

What should I expect after a pregnancy ultrasound?

If you had an abdominal ultrasound, youwipe the gel off your belly. Radiologist print off some ultrasound pictures for you to take home with you.

In most cases, your radiologist may discuss what they see as they go along.

No video clip, mobile clip, CD of study will be provided. In case a print-out 2D & 3Dscan images are given.

What are the risks of prenatal ultrasounds?

Studies have shown ultrasounds are safe during pregnancy. There are no harmful side effects to you or your baby. There is no x-ray radiation in ultrasound.

Is it safe to do an ultrasound every month during pregnancy?

While ultrasounds are safe for you and your baby, most major medical associations recommend that radiologist should only do ultrasounds when the tests are medically necessary with a valid prescription from obstetrician / health care provider. If your ultrasounds are normal and your pregnancy is uncomplicated or low risk, repeat ultrasounds aren’t necessary.

What are the alternatives to ultrasound scans?

Your obstetrician / radiologist monitor your baby’s heartbeat and growth at your regular check-ups.

You could have a different blood test to find out if your baby is likely to have a genetic condition. This test is called non-invasive prenatal testing (NIPT). It can identify about 99% of babies with Down syndrome. NIPT also screens for other conditions. It is done after 10 weeks of pregnancy. You need to pay a fee to have this test.

Results and Follow-Up

What results do you get on a pregnancy ultrasound?

Your ultrasound results will be normal or abnormal. A normal result means your radiologist didn’t find any problems and that your baby is growing and developing normally. An abnormal result means your radiologist noticed something irregular. If they do, your radiologist will order additional ultrasounds or diagnostic tests to determine if something is wrong.

Occasionally, the ultrasound is incomplete if there’s difficulty seeing all the structures needed for that particular ultrasound. Your baby’s position or movement sometimes makes it difficult to see everything your provider needs to see. If this is the case, you’ll need a repeat ultrasound and they’ll try again.

There are some limitations to ultrasounds, so your provider may not find certain abnormalities until after birth.

What are reasons you need more ultrasounds during pregnancy?

There are several reasons your pregnancy care provider may order additional ultrasounds during your pregnancy. Some of these reasons include:

1. Problems with your ovaries, uterus, cervix or other pelvic organs.
2. Your baby is measuring small for their gestational age or your provider suspects IUGR (intrauterine growth restriction).
3. Problems with the placenta like placenta previa or placental abruption.
4. You’re pregnant with twins, triplets or more.
5. Your baby is breech.
6. You have too much amniotic fluid (polyhydramnios).
7. You have too little amniotic fluid (oligohydramnios).
8. You have a condition like gestational diabetes or preeclampsia.
9. Your baby has a congenital disorder.

Normal results on pregnancy ultrasounds can vary. Generally, a normal result means your baby appears healthy and your radiologist didn’t find any issues.

If the results of your ultrasound bring up any health concerns, you can talk to your doctor or midwife about further testing. You might be referred for diagnostic tests, such as:

1. Chorionic villus sampling
2. Amniocentesis

You can also visit to a genetic counsellor to talk through what your test results mean.

Why do some obstetrician / pregnancy providers schedule ultrasounds differently?

The number of ultrasounds you’ll have and when you have them can vary between obstetrician / providers. Every practice operates differently and some obstetrician / providers do things differently based on your health history or symptoms.

When does a pregnancy ultrasound determine sex?

Here pre-natal sex determination and disclosure of sex (Bot or Girl before birth) of fetus in not done. It is prohibited and punishable offence under PC & PNDT Act, 1996. Seeking / asking for the sex of the child is also prohibited and punishable offence under PC & PNDT Act, 1996.

Ultrasound is not indicated / advised / performed to determine the sex of fetus except for diagnosis of sex-linked diseases such as Duchene Dystrophy, Hemophilia A & B etc.

A note from Achyutam Ultrasound

An ultrasound during pregnancy can be both exciting and terrifying. Your obstetrician / pregnancy care provider uses ultrasound to get a better idea of how your baby is growing and developing. There are different types of ultrasounds, and the exact timing may vary depending on your obstetrician / provider. Most pregnant people have four ultrasounds - one in the early pregnancy, second in first trimester (Level I / NT NB Scan), third one in the second trimester (Level II / Anomaly Scan) and forth on in third trimester (Fetal well-being / Growth and Doppler scan). However, if there’s a potential complication or medical reason for more ultrasounds, your obstetrician / provider will order more as a precaution. Talk to your obstetrician / provider about the ultrasound schedule during pregnancy and what you can expect.

FAQ's

1. How important is Form F?

Form F filing is mandatory for all pregnant patients. It goes without saying that it should be complete and without errors. The authority should be able to contact the patient on basis on this form. All columns need to be filled and if any points are not applicable, please write NA or Not Applicable against that column, do not leave it blank. Forms should be maintained properly so that one can easily access it whenever asked for