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What Does My USG Scan Report Indicate About The Baby's Health?
Question: Hi Doctor,
I am 20 weeks Pregnant and I am sending you my latest USG level 2 scan report. The Doc has advised me to go for an immediate amniocentesis as she sees I may be at a high risk of delivering a Down Syndrome effected baby. My double Marker Test and Quadraple marker test were all very normal. Do you find any markers for Down in my USG report? Please let me know, I am scared of the side effect of Amniocentesis and i am in great confusion regarding the health of my unborn baby.
The USG Level 2 report as follows :
USG Preg. Level 2/Anomaly 18-22 wks
Indication: Primigravida with 20weeks with previous USG
LMP : 04-01-2014
GA (LMP) : 20weeks 6days
Findings:-
Single live foetus with cephalic presentation at the time of scan.
Foetal cardiac activity regular (FHR = 146bpm).
Foetal movements present.
Neurospinal:
Foetal skull appears normal.
No anencephaly / encephalocele detected.
No evidence of gross facial anomaly (cleft lip / palate) detected.
Whole spine is visualized. No sacral agenesis noted.
No anomaly noted in spine.
No evidence of hydrocephalus.
Transverse atrial diameter measures 5.9mm (normal <10mm).
Transverse cerebellar diameter is 19.8mm.
Cisterna magna is 4.4mm.
Skin fold is 5.4mm.
Both nasal bones measuring 7.2mm.
Skeletal:
All 4 limbs visualized.
5 digits visualized in both hands.
No evidence of poly dactyle.
No evidence of clubfoot.
Middle phalanx of V finger of both hands visualized.
Heart:
Four chamber view appears normal.
No evidence of septal defect.
AV ratio is normal ( < 0.6).
No obvious chamber enlargement.
Right and left ventricular outflow tracts appear normal with normal crossing over of great vessels.
Arch of aorta and ductal arch visualized.
Chest:
No diaphragmatic hernia / sequestration.
Abdomen:
Stomach bubble is visualized and is normal in position.
No evidence of omphalocele.
No dilated echogenic bowel loops.
Name
Patient id
Age / Sex
Date of Birth
Referring Doctor
GNAGULY XXXXXXX MRS.
GN0000
30 / F
27/10/1983
Dr. XXXXXXX Sehgal
Accession Id
Exam Date
Exam Reg No
Reporting Time
Patient Class
0000
30/05/2014 at 18:28 IST
US0000
-
OP
GNAGULY XXXXXXX MRS.
USG Preg. Level 2/Anomaly 18-22 wks
ReportsResults of all investigations depend upon the quality of specimen received in the laboratory. All the results should be interpreted in conjunction with the clinical presentation and
other related investigations.
Renal:
Right renal pelvis measures 3.8mm.
Left renal pelvis measures 4.0mm.
No evidence of calyceal dilatation.
Echogenic bowel - II/III.
Liqour : Adequate
Placenta: Position - Posterior, upper segment
Grade- II
Umblical : Numbar of vessels = 03
Abdominal insertion normal.
Foetal Parameters:
LMP : 04-01-2014
AGE : 20weeks 6days
EDD by LMP : 20-10-2014
BPD measures 4.41cm corresponding to 19weeks 3days
HC measures 16.6cm corresponding to 19weeks 3days
AC measures 14.8cm corresponding to 20weeks 1day
FL measures 2.9cm corresponding to 19weeks 0day
HL measures 2.8cm corresponding to 19weeks 0day
Composite G. Age by USG : 19weeks 4days
EDD by Avg. GA : 11-10-2014
Estimated Foetal Wt. : 299gms +/- 44gms.
Cervix : Cervix measures 3.4cm in length.
Internal os closed.
Right uterine artery : RI = 0.60 and PI = 1.01
Left uterine artery : RI = 0.77 and PI = 1.74
IMPRESSION: Single live foetus of 19weeks 4days duration.
Declaration of the doctor/person conducting Ultrasound/Image scanning.
I, DR. XXXXXXX XXXXXXX (Name of the doctor conducting ultrasound) declare that while conducting ultrasound/
image scanning on Mrs. XXXXXXX Gnaguly (Name of pregnant woman). I have neither detected nor disclosed the
sex of the foetus in any manner.
DR. XXXXXXX XXXXXXX
CONSULTANT – FETAL MEDICINE
I am 20 weeks Pregnant and I am sending you my latest USG level 2 scan report. The Doc has advised me to go for an immediate amniocentesis as she sees I may be at a high risk of delivering a Down Syndrome effected baby. My double Marker Test and Quadraple marker test were all very normal. Do you find any markers for Down in my USG report? Please let me know, I am scared of the side effect of Amniocentesis and i am in great confusion regarding the health of my unborn baby.
The USG Level 2 report as follows :
USG Preg. Level 2/Anomaly 18-22 wks
Indication: Primigravida with 20weeks with previous USG
LMP : 04-01-2014
GA (LMP) : 20weeks 6days
Findings:-
Single live foetus with cephalic presentation at the time of scan.
Foetal cardiac activity regular (FHR = 146bpm).
Foetal movements present.
Neurospinal:
Foetal skull appears normal.
No anencephaly / encephalocele detected.
No evidence of gross facial anomaly (cleft lip / palate) detected.
Whole spine is visualized. No sacral agenesis noted.
No anomaly noted in spine.
No evidence of hydrocephalus.
Transverse atrial diameter measures 5.9mm (normal <10mm).
Transverse cerebellar diameter is 19.8mm.
Cisterna magna is 4.4mm.
Skin fold is 5.4mm.
Both nasal bones measuring 7.2mm.
Skeletal:
All 4 limbs visualized.
5 digits visualized in both hands.
No evidence of poly dactyle.
No evidence of clubfoot.
Middle phalanx of V finger of both hands visualized.
Heart:
Four chamber view appears normal.
No evidence of septal defect.
AV ratio is normal ( < 0.6).
No obvious chamber enlargement.
Right and left ventricular outflow tracts appear normal with normal crossing over of great vessels.
Arch of aorta and ductal arch visualized.
Chest:
No diaphragmatic hernia / sequestration.
Abdomen:
Stomach bubble is visualized and is normal in position.
No evidence of omphalocele.
No dilated echogenic bowel loops.
Name
Patient id
Age / Sex
Date of Birth
Referring Doctor
GNAGULY XXXXXXX MRS.
GN0000
30 / F
27/10/1983
Dr. XXXXXXX Sehgal
Accession Id
Exam Date
Exam Reg No
Reporting Time
Patient Class
0000
30/05/2014 at 18:28 IST
US0000
-
OP
GNAGULY XXXXXXX MRS.
USG Preg. Level 2/Anomaly 18-22 wks
ReportsResults of all investigations depend upon the quality of specimen received in the laboratory. All the results should be interpreted in conjunction with the clinical presentation and
other related investigations.
Renal:
Right renal pelvis measures 3.8mm.
Left renal pelvis measures 4.0mm.
No evidence of calyceal dilatation.
Echogenic bowel - II/III.
Liqour : Adequate
Placenta: Position - Posterior, upper segment
Grade- II
Umblical : Numbar of vessels = 03
Abdominal insertion normal.
Foetal Parameters:
LMP : 04-01-2014
AGE : 20weeks 6days
EDD by LMP : 20-10-2014
BPD measures 4.41cm corresponding to 19weeks 3days
HC measures 16.6cm corresponding to 19weeks 3days
AC measures 14.8cm corresponding to 20weeks 1day
FL measures 2.9cm corresponding to 19weeks 0day
HL measures 2.8cm corresponding to 19weeks 0day
Composite G. Age by USG : 19weeks 4days
EDD by Avg. GA : 11-10-2014
Estimated Foetal Wt. : 299gms +/- 44gms.
Cervix : Cervix measures 3.4cm in length.
Internal os closed.
Right uterine artery : RI = 0.60 and PI = 1.01
Left uterine artery : RI = 0.77 and PI = 1.74
IMPRESSION: Single live foetus of 19weeks 4days duration.
Declaration of the doctor/person conducting Ultrasound/Image scanning.
I, DR. XXXXXXX XXXXXXX (Name of the doctor conducting ultrasound) declare that while conducting ultrasound/
image scanning on Mrs. XXXXXXX Gnaguly (Name of pregnant woman). I have neither detected nor disclosed the
sex of the foetus in any manner.
DR. XXXXXXX XXXXXXX
CONSULTANT – FETAL MEDICINE
Brief Answer:
I don't think Amniocentesis is required.
Detailed Answer:
Hi XXXXXXX
Thanks for consulting me.
I have read your ultrasound report in detail & I can't justify the recommendation of amniocentesis.
Only suspicious feature was an echogenic bowel, which alone is not an enough indication of amniocentesis.
As your previous ultrasound reports & your Down's screening were all normal, I think you are not at a high risk of Down syndrome & the risks of amniocentesis may be higher then the ultrasound based risk. Specially if you are scared of loosing the baby.
One thing that I would like to recommend you is that you should take a second opinion from a consultant Gynecologist. Visit the doctor personally with all your screening results. ( as I have not seen them)
If possible get another ultrasound from a level three or tertiary level sinologist & see what comes the report.
In my opinion you should only carry out the 4 weekly ultrasound follow up & hope for the best.
wish you all the best.
Take care.
I don't think Amniocentesis is required.
Detailed Answer:
Hi XXXXXXX
Thanks for consulting me.
I have read your ultrasound report in detail & I can't justify the recommendation of amniocentesis.
Only suspicious feature was an echogenic bowel, which alone is not an enough indication of amniocentesis.
As your previous ultrasound reports & your Down's screening were all normal, I think you are not at a high risk of Down syndrome & the risks of amniocentesis may be higher then the ultrasound based risk. Specially if you are scared of loosing the baby.
One thing that I would like to recommend you is that you should take a second opinion from a consultant Gynecologist. Visit the doctor personally with all your screening results. ( as I have not seen them)
If possible get another ultrasound from a level three or tertiary level sinologist & see what comes the report.
In my opinion you should only carry out the 4 weekly ultrasound follow up & hope for the best.
wish you all the best.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply Doc, I will go ahead and consult another Gynecologist. I just got to know from my hospital that this report was discrepant and while performing my USG they had said that the baby had echogenic bowel, increased nuchal skin fold and mild renal pylectasis, I went ahead and did a Amniocentesis. I am attaching the Fish report here :
There is no Down Syndrome risks as per report.
Now my question is , all the markers that were seen in the report (USG) are they of concern or they will cure of its own while the baby grows in the womb? Can skin fold, echogenic bowel and renal dilation be cured? Is this a normal level 2 USG finding? Or will my baby still have problems? Please advise!
I am changing my hospital and Doc rightaway as I feel this discrepancy in USG reports is of concern.
There is no Down Syndrome risks as per report.
Now my question is , all the markers that were seen in the report (USG) are they of concern or they will cure of its own while the baby grows in the womb? Can skin fold, echogenic bowel and renal dilation be cured? Is this a normal level 2 USG finding? Or will my baby still have problems? Please advise!
I am changing my hospital and Doc rightaway as I feel this discrepancy in USG reports is of concern.
Brief Answer:
Good to know that your amniocentesis is normal
Detailed Answer:
Hi XXXXXXX
Thanks for your question.
I have seen your ultrasound report again & I can't see anything of concern other than the fore mentioned Echogenic bowel.
Normal nuchal fold thickness at this stage of pregnancy is 6mm. So, yours was well within normal limits. Not at all abnormal.
I can't see any abnormality in your fetal kidneys on the first place. There is no indication of any follow up as far as fetal kidneys are concerned.
As far as echogenic bowel is concerned, This may be a marker for several fetal disorders. However, most cases have no underlying abnormality and have normal outcomes.
So, It is often associated with normal fetuses, but sometimes it may be a marker of aneuploidy, intrauterine growth retardation (IUGR), bleeding, cystic fibrosis (CF), congenital viral infections, and thalassemia, but as you had first trimester Down syndrome screening which is considered to be up to 97% accurate for excluding the possibility of Down syndrome & there was nothing else abnormal. So, I did not recommend amniocentesis unless a tertiary level sonologist recommends so or a consultant Gynecologist recommend it.
Echogenic bowel in the third trimester is a relatively common finding with uncertain clinical significance. Technical factors are very important to comment on echogenic bowel & observer error is very common. So, to go ahead for amniocentesis based upon a single ultrasound finding done by a sonologist of unknown expertise is too much of a risk then the potential benefit.
Anyway you took the risk, it was your right & choice. I am happy that your results are normal (although I was unable to open the attachment).
I agree with your plans of changing the Gynecologist. The only care you need special based upon your ultrasound scan is serial scanning & follow up of fetal growth. Show your baby to a Paediatrician after birth to relieve your concerns.
Wish you all the best.
Take care.
Good to know that your amniocentesis is normal
Detailed Answer:
Hi XXXXXXX
Thanks for your question.
I have seen your ultrasound report again & I can't see anything of concern other than the fore mentioned Echogenic bowel.
Normal nuchal fold thickness at this stage of pregnancy is 6mm. So, yours was well within normal limits. Not at all abnormal.
I can't see any abnormality in your fetal kidneys on the first place. There is no indication of any follow up as far as fetal kidneys are concerned.
As far as echogenic bowel is concerned, This may be a marker for several fetal disorders. However, most cases have no underlying abnormality and have normal outcomes.
So, It is often associated with normal fetuses, but sometimes it may be a marker of aneuploidy, intrauterine growth retardation (IUGR), bleeding, cystic fibrosis (CF), congenital viral infections, and thalassemia, but as you had first trimester Down syndrome screening which is considered to be up to 97% accurate for excluding the possibility of Down syndrome & there was nothing else abnormal. So, I did not recommend amniocentesis unless a tertiary level sonologist recommends so or a consultant Gynecologist recommend it.
Echogenic bowel in the third trimester is a relatively common finding with uncertain clinical significance. Technical factors are very important to comment on echogenic bowel & observer error is very common. So, to go ahead for amniocentesis based upon a single ultrasound finding done by a sonologist of unknown expertise is too much of a risk then the potential benefit.
Anyway you took the risk, it was your right & choice. I am happy that your results are normal (although I was unable to open the attachment).
I agree with your plans of changing the Gynecologist. The only care you need special based upon your ultrasound scan is serial scanning & follow up of fetal growth. Show your baby to a Paediatrician after birth to relieve your concerns.
Wish you all the best.
Take care.
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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