Anatomy Scan Ultrasound – What to Expect

Your 20-week ultrasound is coming up!

For many expectant parents, this appointment stirs up a lot of feelings. Excitement. Curiosity. Maybe some nervousness too.

Understanding what this anatomy scan involves can help you feel more prepared. So let’s walk through it together.

What is an Anatomy Scan?

The anatomy scan ultrasound goes by a few names. You might hear it called the mid-pregnancy ultrasound or Level 2 ultrasound. 

But what is it, really?

It’s a detailed medical exam that checks how your baby is developing. This fetal anatomy scan has become a standard part of prenatal care. It gives your healthcare team (and you) a comprehensive look at your baby’s growth and development. 

Is this scan mandatory? 

It’s important to know: this scan is not mandatory. While many parents choose to have it, you always have the right to decline any test or procedure in pregnancy.

Some people opt out of the anatomy scan for personal, cultural, or emotional reasons—especially if they know they wouldn’t pursue further testing or interventions based on the results. Others may feel it could lead to unnecessary worry, particularly if minor or uncertain findings arise.

If you’re unsure whether it’s the right choice for you, talk to your provider or doula. Understanding the purpose and limitations of the scan can help you make an informed decision that aligns with your values and comfort level.

Here’s how it works:

Trained professionals use high-frequency sound waves to create detailed images of your baby. These images let them examine vital organs, measure growth, and assess overall development.

Yes, it’s exciting to see your baby…

But remember, this is primarily a medical assessment. Its main purpose is ensuring your baby’s well-being.

When is the Anatomy Scan Ultrasound Done?

Most providers schedule the 20-week ultrasound scan between 18 and 22 weeks of pregnancy. 

Why then?

Your baby has developed enough for organs and physical features to be clearly visible. But there’s still time to address any concerns that might come up.

Sometimes you might need to come back…

If certain areas aren’t visible that day due to the position your baby is in at the time, your provider might recommend returning in a week or two. 

This happens all the time. It’s nothing to worry about.

How is the Anatomy Scan Done?

The anatomy scan is non-invasive and painless. 

Here’s what to expect:

Your sonographer will put gel on your abdomen. Then, they’ll move a device called a transducer over your abdomen, capturing images from different angles. Typically, they ask you to have a full bladder. 

They’ll collect enough pictures to show you and the OB, who will analyze them. Your sonographer can show you images and may point out basic features, but they won’t provide a diagnosis or detailed findings—that will come from your provider.

How long does an anatomy scan take? 

Plan for 30 to 60 minutes. The exact time depends on your baby’s position and mood that day. Some babies show off. Others curl up and hide. 

What Does the Anatomy Scan Show?

The 20-week scan covers a lot. 

Your healthcare team examines:

• Major organs: Brain, heart (all four chambers), spine, kidneys, stomach, and bladder
• Limbs: Arms, legs, hands, and feet to check proper formation
• Placenta: Its location and health, screening for conditions like placenta previa
• Amniotic fluid: Making sure levels are normal
• Umbilical cord: Checking for normal blood flow and confirming that it contains three vessels—two arteries and one vein
• Cervix length: Measuring the cervix can help identify if there’s a higher risk for preterm labor, especially if it’s shorter than expected for this stage of pregnancy
• Overall growth: Measurements to confirm your due date and track development

Think of it as a detailed map of your baby’s current development. It helps your team ensure everything is progressing as expected.

Will You Find Out Your Baby’s Sex?

For many families, finding out the baby’s sex during the 20-week ultrasound gender check is a big moment.

If you want to know, this scan usually provides clear enough images. 

But remember…

You’re in control of this information.

You can:

• Find out during the appointment
• Have it written down for later
• Wait until birth

A few things to keep in mind:

Sex determination isn’t always 100% accurate. Sometimes your baby’s position makes it impossible to tell. 

And finding out can bring unexpected emotions…

Joy. Confusion. Even disappointment. 

All of these reactions? Completely normal.

It can help to take a moment before your appointment to reflect on what this information might bring up emotionally—for you, your partner, or your support people.

Having a doula means having someone who understands these complex feelings. Someone who can support you without judgment.

Pros and Benefits of the Anatomy Scan Ultrasound

The 20-week ultrasound offers benefits beyond just medical information:

• Peace of mind and connection: Seeing your baby move… maybe sucking their thumb or kicking… creates a profound bonding experience. Many parents find this visual confirmation deeply reassuring.
• Early identification: If there are concerns, finding them early allows time for more testing, specialist consultations, or adjusting your birth plan.
• Informed decisions: The information helps you and your team make informed choices about your care.
• Shared experience: Partners and support people can witness this milestone, strengthening their connection to the pregnancy.
• Growth confirmation: Measuring your baby confirms appropriate growth and can refine your due date.

Cons and Considerations of Routine Ultrasounds

While ultrasounds are generally considered safe and beneficial, let’s look at the full picture:

• Potential for anxiety: Sometimes the scan reveals unclear findings that need follow-up. These ‘soft markers’—minor findings that may or may not indicate a condition—might mean nothing… but can cause worry while you wait for answers.
• False positives: Occasionally, the scan suggests a concern that later proves unfounded. This can lead to unnecessary stress and more testing.
• Prolonged exposure:  While ultrasounds are a safe and essential tool during pregnancy, having too many without medical necessity may not be recommended. Some experts raise concerns about potential effects of prolonged or excessive exposure to ultrasound waves, although no conclusive evidence of harm has been found. That said, it may be best to stick to medically indicated ultrasounds and avoid non-medical “keepsake” scans unless advised by your healthcare provider. As with most things in pregnancy—more isn’t always better!
• Managing expectations: The anatomy scan can identify many conditions… but it can’t guarantee a “perfect” pregnancy or predict every outcome.

What happens at anatomy scan appointments varies. 

If something doesn’t feel right to you, speak up.

We’re Here For You

The anatomy scan is an important checkpoint in your pregnancy. It offers valuable insights into your baby’s development. 

Understanding what to expect… approaching it with realistic expectations… helps you make the most of the experience.

Whether this is your first pregnancy or not, each anatomy scan ultrasound is unique. 

Just like each baby.

Trust yourself. Ask questions. Remember you have the right to understand and participate fully in your care.

As you prepare, think about what support you might want. 

Having a doula or trusted support person can make a real difference. Your feelings, questions and concerns matter.

You deserve care that honors all of it.

The 20-week ultrasound is more than a medical procedure…

It’s a moment of connection. Discovery. Sometimes challenge.

Whatever it brings?

You have the strength to meet it. Especially when you’re surrounded by knowledgeable, compassionate support.

We’re here for you. Come talk to us!

Also check out: Gender Disappointment: You’re Not the Only One and Second Trimester Checklist