Whether the first child or fifth, starting the pregnancy journey can spark a range of emotions, from new and exciting to worrisome and overwhelming. The antenatal care team is here for you to provide support throughout your pregnancy with visits starting around 8 weeks of pregnancy. These visits are an opportunity to check on you and your baby’s health, as well as answer any questions you may have. For an overview of antenatal visits, see ‘I am pregnant – what happens now?’
Figure 1 – The timeline of antenatal appointments in the UK, diagram by Emma Hadley, inspired Your antenatal appointments – NHS.
Around 12 weeks and 20 weeks’ pregnancy, you will be offered antenatal, ultrasound scans. These are not mandatory but are highly recommended. Indeed, as well as enabling you to see your baby for the first time, these scans are important for checking on your baby’s health and screening for certain rare but serious conditions.
What happens during the scan?
An ultrasound scan is usually performed by a sonographer, a trained professional, in the local hospital’s ultrasound department. To help obtain good images, the sonographer may start by turning the lights off. They will then place a probe coated in jelly on your tummy – this may feel a little cold! – and apply some pressure to look for the baby. You should not feel any pain. The probe uses high-frequency sound waves to look at your baby through your tummy, providing a black and white image on the ultrasound device. There are no known risks to either mother or baby from having this scan. The appointment will last approximately 30 minutes. (1, 2) Figure 2 – 20-week scan – NHS
How should I prepare for the scan?
Drink plenty of water before the scan – having a full bladder will help the sonographer visualise the baby. Wear loose clothing so that you can pull your trousers down slightly and roll your shirt up above your tummy, to give the sonographer good access to your tummy. The sonographer will place some paper around the top of your trousers, so you don’t have to worry about getting jelly on your clothes! Finally, depending on local covid-19 regulations, you may be able to bring one person of choice with you to the appointment, but usually no children due to there being no childcare services on site. (2)
The 12-week scan
What are we looking for?
The first ultrasound scan takes place between 10 and 14 weeks of pregnancy. It marks the end of the first trimester, a time at which parents usually tell their friends and family the news. It is called the dating scan as it provides enough information to estimate the expected date of delivery. It also provides information on:
Figure 3: 12-week scan – NHS
- whether a heartbeat has been found and the baby is well
- the size and growth of the baby
- the number of babies: will you have twins?
- the position of your baby in your womb
- position of the placenta: a placenta praevia (low placenta) could mean you will need a caesarean if the placenta does not move before the birth of the baby
- the health of the baby: can any anomalies be seen, for example, spina bifida?
The results of these analyses will be provided straight after the scan. The sonographer may request a second opinion from a colleague if they are having trouble obtaining a clear image or are uncertain of the result. (2)
Most of the time, no anomalies are found, and you will continue your antenatal journey as planned. If anomalies are found, the doctor will set out an antenatal care plan, with extra monitoring and scans if you are having twins, for example. If your baby has severe, life-changing anomalies, you may wish to discuss the option of terminating the pregnancy. If no heartbeat was found, the doctor will provide support and information on the next steps in a miscarriage, discussed in my next article.
Other screening tests
At the 12-week appointment, you will also be offered a screening test for Down’s, Edward’s and Patau’s syndromes. This is called the combined test and is made up of 2 tests: a blood test and the nuchal translucency test, which uses the ultrasound image to measure the thickness of the fluid at the back of the baby’s neck. The test results will indicate the risk of your baby developing one of these syndromes. If your baby is at high risk, a further, diagnostic test will be offered. These screening tests will be discussed in more detail in a later article.
The 20-week scan is also called the mid-pregnancy, or anomaly scan. It usually takes place between 18 and 21 weeks of pregnancy. Like the 12-week scan, it is not mandatory but is highly recommended. At this appointment, you will also be offered screening tests for HIV, syphilis and hepatitis B. (2)
What are we looking for?
At the 20-week scan, the baby can be seen in more detail. Its bones, heart, brain, spinal cord, face, kidneys, and abdomen are carefully observed to rule out 11, rare conditions (anencephaly, open spina bifida, cleft lip, diaphragmatic hernia gastroschisis, exomphalos, serious cardiac abnormalities, bilateral renal agenesis, lethal skeletal dysplasia, Edward’s syndrome, Patau’s syndrome). That’s a mouthful for sure – don’t hesitate to ask the antenatal team any questions you may have, as well as take away information leaflets about these different conditions.
It might also be time to prepare your gender reveal! Yes, that’s right – in most hospitals, you can choose to find out the sex of the baby. This is not guaranteed with 100% accuracy, for example, if the baby is lying in an awkward position, but sonographers can usually have a pretty good idea. (2)
As for the 12-week scan, the sonographer may ask for a second opinion. Most scans are normal, and the antenatal care will proceed as planned. Remember that a normal scan does not exclude abnormalities at birth with 100% confidence, as some may be hard to pick up on an ultrasound scan. (3)
If an anomaly is picked up on a scan, your baby may need treatment or surgery as soon as they are born. In some rare but serious cases, no treatment is available, and the baby may die during pregnancy or soon after birth. A doctor will help and support you through these outcomes should this be the case. (2)
Can I have more than these 2 scans?
In some cases mentioned above, for example, having twins or being at higher risk of complications in pregnancy, you may be offered more scans to monitor you and your baby’s health throughout your pregnancy. However, women with straightforward pregnancies will only be offered 2 scans on the NHS. If you are worried and more scans would reassure you, you would have to seek out private healthcare. Although current evidence suggests that ultrasound scanning has no side effects for mother or baby, the NHS still advises not to unnecessarily scan unless more information is needed about your baby’s well being. (3)
- What happens at your 12-week scan? [Internet]. NCT (National Childbirth Trust). 2019 [cited 22 January 2022]. Available from: https://www.nct.org.uk/pregnancy/tests-scans-and-antenatal-checks/what-happens-your-12-week-scan
- Your pregnancy care [Internet]. nhs.uk. 2022 [cited 22 January 2022]. Available from: https://www.nhs.uk/pregnancy/your-pregnancy-care/
- Ultrasound Scans [Internet]. Tommy’s. 2018 [cited 22 January 2022]. Available from: https://www.tommys.org/pregnancy-information/im-pregnant/antenatal-care/ultrasound-scans
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