8 essential questions to ask at your 20-week anatomy scan appointment
Ready to see that tiny nose? It's finally time for that big ultrasound you've been waiting for.
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The 20-week appointment marks the halfway point of your pregnancy, making it a milestone in its own right. You’ve spent the past five months building and growing a human, and now you’re halfway through, mama. Remember your first prenatal appointment? That was ages ago!
At this point, you might be waiting with bated breath to get a visual of your baby’s growth—to get a glimpse of that cute button nose in profile, or even to find out your baby’s assigned sex or get an updated due date. And now’s your chance.
Going in with a sense of what’s happening — and a short list of questions that actually matter — can help you feel less like a passive observer and more like someone who knows what to do with the information they’re getting. Here’s how to make the most of it.
What happens during the anatomy scan?
The anatomy scan — also called the 20-week ultrasound, level 2 ultrasound, or anomaly scan — typically happens between 18 and 22 weeks of pregnancy. It’s performed by a trained sonographer and usually takes 45 minutes to an hour, sometimes longer if baby isn’t cooperating with positioning.
The scan may begin with a transvaginal ultrasound probe to get a clear view of your uterus, ovaries, and cervix, then move to an external transducer on your abdomen. The sonographer will move the wand across your belly (yes, with that warm gel) while capturing detailed images and measurements. Most of the time, they’re focused on the screen and may not narrate everything in real time — which is normal. You can always ask questions.
Your partner or support person is generally welcome at this appointment. If you’re bringing older kids, check with your provider’s office beforehand, since some prefer the room to stay quiet and focused during the scan.
What does the 20-week anatomy scan look for?
The 20-week scan is an important diagnostic and screening tool. While you’re lying on the table, the technician will be taking sonogram photos and measurements of both your anatomy and your baby’s and logging them all into a chart for your doctor to review.
The ultrasound technician performing your scan may start with a vaginal ultrasound probe to get a good view of your uterus, ovaries and cervix, then move to an external probe to better view the baby, plus your placenta and its location, as well as the umbilical cord.
With an external ultrasound transducer (wand), the technician will move the probe over your abdomen (here’s where that warm jelly comes in) and look at your baby’s overall size, plus their face, spine, limbs and internal organs, such as their brain, heart, lungs, kidneys, as well as their genitalia, and the amount of amniotic fluid present.
The technician will also be looking for potential markers of genetic disorders, such as Down syndrome or trisomy 18 or 21.
How common is bad news at the 20-week scan?
Most anatomy scans are reassuring. According to OB-GYN experts, approximately 3 to 5 percent of 20-week fetal ultrasounds show a finding that needs further evaluation. Many of those findings are minor — things like soft markers or small kidney findings that often resolve on their own.
In more significant cases, like a suspected heart defect or cleft lip, your care team will walk you through exactly what they saw, what it means, and what happens next. That might look like a follow-up scan, a referral to a maternal-fetal medicine specialist, or additional testing. You won’t be left wondering.
It’s also worth knowing that not every condition is detectable at 20 weeks — this scan is comprehensive, but it isn’t a guarantee. Continuing with regular prenatal care throughout your pregnancy remains important regardless of results.
Questions to ask at your anatomy scan
The sonographer can’t always share diagnostic interpretations in real time — that’s your doctor’s job at the follow-up — but there’s still plenty worth asking while you’re in the room. Here’s what’s worth having on your list.
Are all the organs and structures visible and looking normal?
Some sonographers will walk you through everything as they go; others work more quietly. It’s completely reasonable to ask for a real-time check-in: “Is everything you’re seeing looking okay?” They may not be able to give you a full diagnostic read, but most will let you know if things appear typical or if they’ll be flagging something for your doctor to review.
How is baby measuring, and is my due date still accurate?
The anatomy scan includes a series of measurements — head circumference, abdominal circumference, femur length — that give your provider a clearer picture of baby’s growth and whether the estimated due date needs any adjustment. If baby is measuring a little ahead or behind, it doesn’t automatically mean something is wrong, but it’s good information to have before you see your OB or midwife.
Where is my placenta located?
Placenta location matters. If it’s low-lying or covering the cervix — a condition called placenta previa — your provider will want to monitor it. In many cases, the placenta moves upward as the uterus grows, but it’s something your care team will keep an eye on. The anatomy scan is one of the first opportunities to get a clear read on this.
How do the amniotic fluid levels look?
Amniotic fluid levels are part of what the sonographer checks, and they’re an indicator of kidney function and overall fetal wellbeing. Too much (polyhydramnios) or too little (oligohydramnios) can sometimes signal that something needs monitoring. Most of the time, levels are perfectly normal — but it’s a worthwhile question.
Does everything about the heart look okay?
Congenital heart defects are one of the most common types of birth defects, so the heart gets particular attention during the anatomy scan. The sonographer will look at all four chambers, the valves, and the major vessels exiting the heart. If anything warrants a closer look, they may ask you to come back for a follow-up scan — sometimes it’s simply a matter of baby’s position making it hard to get a clear image.
Is there anything you weren’t able to see clearly?
Babies are notorious for being uncooperative. They might be curled up, facing the wrong way, or just refusing to give the sonographer a good angle. If something couldn’t be fully visualized, a follow-up scan might be scheduled — and that doesn’t mean anything is wrong. It just means you might get another peek at that little face sooner than expected.
If something looks different, what happens next?
While an ultrasound can offer a helpful glimpse into what’s happening with your baby’s growth and development, it’s not a highly accurate tool. In some cases, your fetus may not have been in an ideal position during the scan, which could make the results less reliable.
As Diana Spalding, MS, CNM states in The Motherly Guide to Becoming Mama: “A 2013 study reports that ultrasounds are good, but not perfect, at identifying abnormalities. They detect 70% to 90% of nervous system problems, 40% to 50% of heart problems, 25% to 70% of urinary tract problems, 46% to 100% of abdominal and digestive problems, 20% to 50% of bone problems, and 7% to 55% of cleft lips and palates. Technology advances all the time, but it is important to keep in mind that an ultrasound is a tool, and not a flawless one.”
If your doctor has any concerns, they’ll likely schedule a follow-up scan in two weeks to take another look. Be sure to talk to your doctor or midwife about any of your own worries that may arise.
How accurate is the sex determination?
If your technician declares you’re having a girl but you could’ve sworn you’ve got a boy brewing in there, feel free to ask them to take another look. But know that in most cases, ultrasound sex determinations are highly accurate.
Ultrasounds technicians are specially trained in reading sonograms and usually hit this right on the nose. One small study in 2014 found that for anatomy scans after 14 weeks gestation, ultrasound technicians’ sex predictions were 100% accurate. (Pretty impressive, if you ask me!)
Remember, though, that gender disappointment is a real, valid and completely normal feeling. If you’re going through it, be gentle with yourself, and don’t hesitate to reach out to a mental health professional for counseling.
Can I get a printed photos?
Don’t forget to ask for a selection of printed sonogram photos to take home and hang on your fridge/show off to your relatives/paste in your baby book/stare at for hours (those tiny feet!). It’s a sweet marker of this magical point in time—and will help you cherish the memory.
When and how will I receive results?
If you’re interested in finding out your baby’s assigned sex, your ultrasound technician should be able to let you know during this appointment. (Ultrasound techs usually aren’t able to directly share most of the results they discover during this visit with you, but assigned sex is one they’re able to disclose).
After your ultrasound, the technician will submit a write-up of their findings for the radiology doctor to review, and that physician will in turn submit their report to your obstetric care provider. This may only take a day or two, but it could take longer, so be sure to ask your technician when you can expect to hear about the findings.
What happens next?
While your ultrasound technician may not be able to share the results with you right away, if you have any questions or concerns about your anatomy scan or the results, be sure to follow up with your doctor or midwife after the appointment. At that point, you can also ask what to expect at your 24-week appointment!
One more thing
It’s completely normal to feel a mix of excitement and anxiety going into this appointment. The anatomy scan is designed to give you and your care team information — and in the vast majority of cases, what you’ll leave with is reassurance and a few sonogram pictures. Come prepared, ask your questions, and try to soak up a few minutes of watching your baby on screen. Those tiny feet never get old.
Sources:
Kearin M, Pollard K, Garbett I. Accuracy of sonographic fetal gender determination: predictions made by sonographers during routine obstetric ultrasound scans. Australas J Ultrasound Med. 2014;17(3):125-130. doi:10.1002/j.2205-0140.2014.tb00028.x
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