What is an Anomaly Scan?
Everything Expecting Parents Should Know
A clear, warm, and complete guide to the most detailed pregnancy scan of your second trimester — what it checks, what to expect, and why it matters so much.
What Exactly is an Anomaly Scan?
The anomaly scan is a detailed ultrasound examination performed during the second trimester of pregnancy. It is known by several names — Level 2 ultrasound, morphology scan, mid-pregnancy scan, and in India most commonly, TIFFA scan (Targeted Imaging for Fetal Anomalies). All these terms refer to the same examination.
Unlike early pregnancy scans which primarily confirm the pregnancy, check the heartbeat, and date the pregnancy, the anomaly scan is a systematic, organ-by-organ survey of the baby's physical development. A trained sonographer methodically examines each major structure of the baby — the brain, face, heart, spine, abdominal organs, limbs, and more — looking for signs that everything is developing as expected.
The examination also evaluates the environment around the baby: the position and health of the placenta, the volume of amniotic fluid, and the structure of the umbilical cord. Together, these assessments give doctors a comprehensive picture of how the pregnancy is progressing at its midpoint.
The anomaly scan uses standard ultrasound technology — high-frequency sound waves that create real-time images of structures inside the body. There is no radiation involved, and the procedure is completely painless for both mother and baby.
When Is the Anomaly Scan Done?
The anomaly scan is performed between 18 and 22 weeks of pregnancy, with 20 weeks being the most common timing. This specific window is chosen carefully — it is not arbitrary.
The 18–22 week window works because by this stage, the baby's organs and structures are sufficiently developed to be examined in detail — the heart has four clearly visible chambers, the brain's major structures are formed, and the spine can be assessed completely. The baby is also large enough to image clearly while still having enough room in the uterus to be positioned for a thorough examination. Beyond 22 weeks, the baby becomes larger and harder to examine in full, and some structures may be less accessible.
Timing the scan too early — before 18 weeks — risks missing structures that are not yet developed enough to be evaluated. This is why your doctor will schedule the anomaly scan carefully within this specific window rather than whenever feels convenient.
What Does the Anomaly Scan Check?
The anomaly scan is one of the most thorough single examinations performed during pregnancy. The sonographer works through a systematic checklist of structures, examining each one and recording measurements where relevant. Here is what is assessed:
Brain & Head
Shape of skull, brain ventricles, cerebellum, corpus callosum, and fluid spaces. Neural tube closure is confirmed.
Face
Profile view, both eye sockets, nasal bone, lips and palate to screen for cleft lip.
Heart
Four-chamber view, outflow tracts, rhythm. Checks for major structural cardiac defects.
Spine
Full spine survey in longitudinal and axial views. Screens for spina bifida and neural tube defects.
Chest & Diaphragm
Lungs, diaphragm integrity. Rules out diaphragmatic hernia and abnormal fluid around lungs.
Abdominal Wall
Confirms normal closure. Rules out gastroschisis or omphalocele where organs protrude outside.
Stomach & Bowel
Stomach bubble confirms swallowing. Bowel appearance assessed for obstruction markers.
Kidneys & Bladder
Both kidneys identified, bladder visualised. Checks for hydronephrosis, absent or abnormal kidney.
Limbs
All four limbs measured. Long bones assessed for length and structure. Hands and feet examined.
Umbilical Cord
Cord insertion at abdomen confirmed. Number of vessels in cord (normally 3) assessed.
Placenta
Location documented. Checks for placenta praevia (low-lying placenta covering the cervix).
Amniotic Fluid
Volume measured. Oligohydramnios (too little) or polyhydramnios (too much) can signal problems.
In addition to all structural assessments, the sonographer takes standard fetal measurements — the head circumference, abdominal circumference, femur length, and biparietal diameter — to calculate an estimated fetal weight and confirm that growth is appropriate for the gestational age.
What Can — and Cannot — the Anomaly Scan Detect?
Understanding the capabilities and limitations of the anomaly scan is important for approaching the results with appropriate context. The scan is a powerful screening tool, but it is not infallible — and every expectant parent should understand both sides of this reality.
What the Anomaly Scan Can Detect
Conditions the Anomaly Scan Can Identify
- Neural tube defects — spina bifida (open or closed), anencephaly (absent skull)
- Major cardiac defects — missing chambers, transposition of great vessels, hypoplastic left heart
- Abdominal wall defects — gastroschisis, omphalocele (bowel or organs outside the body)
- Cleft lip — visible lip clefts (palate clefts are harder to see on ultrasound)
- Kidney abnormalities — absent kidney, duplex kidney, hydronephrosis, multicystic kidney
- Skeletal dysplasias — short limb conditions affecting bone growth
- Diaphragmatic hernia — abdominal organs entering the chest cavity
- Placenta praevia — low-lying placenta that may cause complications in labour
- Brain abnormalities — ventriculomegaly (enlarged brain ventricles), holoprosencephaly
- Markers for chromosomal conditions — soft signs that may prompt further investigation
What the Anomaly Scan Cannot Guarantee
Important Limitations to Understand
- Not every abnormality is visible — Some conditions only become apparent later in pregnancy or after birth, even with a perfect scan technique.
- Baby position matters — If the baby is in an unhelpful position (facing away, legs crossed over the face), some structures may not be fully visible. You may be asked to walk around or return for a repeat scan.
- Chromosomal conditions — The anomaly scan cannot diagnose Down syndrome, Edwards syndrome, or Patau syndrome directly. It may detect structural features associated with these conditions, but chromosomal screening requires separate blood tests or invasive testing (amniocentesis, CVS).
- Small or subtle defects — Conditions affecting fine structures — small ventricular septal defects (holes in the heart), minor limb abnormalities, minor facial features — may not always be visible at this stage.
- Maternal body habitus — In some cases, imaging through the abdominal wall is more challenging, which can affect image quality and the completeness of the assessment.
- A normal scan is not a guarantee — A completely normal anomaly scan result is highly reassuring, but it is not a guarantee that the baby is free of every possible condition. No single scan can provide 100% certainty.
NT Scan vs Anomaly Scan — What Is the Difference?
Many expecting parents ask about the relationship between the NT scan they had earlier in pregnancy and the anomaly scan they are now approaching. They are related but serve very different purposes.
| Feature | NT Scan (Nuchal Translucency) | Anomaly Scan (Level 2 / TIFFA) |
|---|---|---|
| Trimester | First Trimester | Second Trimester |
| Timing | 11–14 weeks | 18–22 weeks |
| Primary purpose | Screen for chromosomal markers (Down syndrome, etc.) | Detailed structural anatomy survey of the baby |
| What it measures | Fluid at back of baby's neck (nuchal fold); confirms heartbeat, dates pregnancy | Brain, heart, spine, organs, limbs, placenta, fluid, cord |
| Diagnoses chromosomal conditions? | Screens — not diagnostic | May identify soft markers only |
| Duration | 15–25 minutes | 30–45 minutes |
| Can they replace each other? | No — both are recommended as part of routine antenatal care | |
Both scans are recommended as part of a complete antenatal care programme. Having a normal NT scan does not mean the anomaly scan can be skipped — they screen for fundamentally different things.
What to Expect on the Day
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Preparation Before the Scan
For most anomaly scans performed through the abdomen (transabdominal), a comfortably full bladder helps improve image quality. You are typically advised to drink 2 to 3 glasses of water about 30 to 45 minutes before the scan and avoid urinating beforehand. No fasting is required — you can eat normally. Wear loose, two-piece clothing for easy access to the abdomen. Bring your previous scan reports, your antenatal care booklet, and any doctor's referral letter if you have one.
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At the Imaging Centre
On arrival at Usmanpura Imaging Centre, our team will confirm your details and gestational age. You will be taken to a private, comfortable scan room. The sonographer will ask you to lie on the examination table and will apply a warm gel to your abdomen. This gel is necessary to ensure good contact between the ultrasound probe and your skin, eliminating air gaps that would block the sound waves.
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During the Scan
The sonographer gently moves the probe across your abdomen in a systematic pattern, pausing to examine and measure each structure in sequence. You will see your baby on the screen in real time — and for many parents, this is an emotional and joyful experience. The sonographer will work quietly through the checklist, taking measurements and capturing images. If they are examining something carefully, this does not automatically mean something is wrong — they are simply being thorough. If the baby is in an awkward position, you may be asked to take a short walk and return for the scan to continue.
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After the Scan
Once the examination is complete, the gel is wiped off and you can use the toilet and dress immediately. In most cases, the sonographer will share initial observations with you before you leave. At Usmanpura Imaging Centre, the detailed written report is prepared by a qualified radiologist and is available the same day. The report and images can be shared directly with your obstetrician. If the scan raises any concern that needs urgent attention, the radiologist will communicate this promptly.
If Something Is Found — What Happens Next?
The idea that the anomaly scan might find something concerning is the source of most anxiety that parents feel before the appointment. It is worth addressing this directly and honestly.
The vast majority of anomaly scans — well over 95% — come back completely normal. Most parents leave the appointment reassured and with a set of ultrasound images they will keep for years. However, a small number of scans do identify a finding that requires further evaluation, and it is worth understanding what that process looks like.
Minor or Uncertain Findings
Some findings are described as "soft markers" — features that are slightly outside the expected range but that, on their own, are usually not significant. A slightly enlarged kidney pelvis (pyelectasis), a small echogenic focus in the heart, or mild ventriculomegaly may be noted and monitored with a repeat scan in a few weeks rather than requiring immediate action. In many cases, these findings resolve entirely by the third trimester or after birth.
Findings That Need Further Investigation
If the scan identifies a structural finding that needs further assessment, your referring doctor may recommend one or more of the following:
- Repeat anomaly scan — in 3 to 4 weeks, to see if the finding has changed or resolved, or to assess structures that were not clearly visible due to baby's position
- Fetal echocardiogram — a dedicated detailed cardiac scan if any concern about the heart is identified
- Referral to a fetal medicine specialist — for expert opinion on complex or significant findings
- Amniocentesis or chromosomal testing — if structural findings suggest the possibility of a chromosomal condition
- MRI of the fetal brain — for detailed assessment of brain abnormalities that ultrasound cannot fully characterise
A Note of Reassurance for Expecting Parents
- Finding a concern on the anomaly scan is never the end of the story — it is the beginning of informed care.
- Many findings that appear on scans turn out to be minor, self-resolving, or manageable with early intervention.
- Early detection of a serious condition allows parents and the medical team to plan the safest possible birth, the right hospital setting, and any specialist care the baby may need from the first moments of life.
- The anomaly scan is designed to find problems early — because finding them early is always better than not finding them at all.
- You will not receive a diagnosis in the scan room. A radiologist's report, followed by a discussion with your obstetrician, is always the next step before any conclusions are drawn.
Obstetric Sonography at Usmanpura Imaging Centre, Ahmedabad
For over 40 years, Usmanpura Imaging Centre has been a trusted partner in the healthcare journeys of Ahmedabad families — including the journey of pregnancy. Our obstetric sonography services bring skilled, experienced sonographers and advanced imaging technology together across a network of 9+ branches across Ahmedabad and Gujarat.
We understand that a pregnancy scan is not just a medical examination — it is an experience that many parents will remember for the rest of their lives. Every scan at Usmanpura Imaging Centre is performed in a private, comfortable environment, by a trained professional who takes the time to explain what is being seen and answer questions as they arise.
Obstetric & Pregnancy Scan Services Available at UIC
- Anomaly Scan (Level 2 / TIFFA) — Detailed fetal anatomy survey at 18–22 weeks
- NT Scan (Nuchal Translucency) — First trimester chromosomal marker screening at 11–14 weeks
- Dating Scan / Viability Scan — Early pregnancy confirmation and gestational age dating
- Growth Scan (Third Trimester) — Fetal growth monitoring, amniotic fluid, and position assessment
- Colour Doppler (Obstetric) — Umbilical artery, uterine artery, and fetal blood flow assessment
- Fetal Echo (Basic) — Four-chamber cardiac view and outflow tract assessment
- 3D / 4D Sonography — Three-dimensional fetal imaging for parents and clinical detail
- Cervical Length Scan — For assessment of preterm birth risk
- Placental and Biophysical Profile — Comprehensive fetal wellbeing assessment in late pregnancy
Pregnancy Scans Available Across Ahmedabad & Gujarat
Frequently Asked Questions
The most commonly asked questions from expecting parents about the anomaly scan:
An anomaly scan — also called a Level 2 ultrasound, morphology scan, or TIFFA scan — is a detailed ultrasound examination performed between 18 and 22 weeks of pregnancy. It uses high-frequency sound waves to systematically examine the baby's anatomy, checking that all major organs and body structures are developing normally. It also assesses the placenta, amniotic fluid volume, and umbilical cord. It is one of the most important scans of pregnancy and is performed routinely as part of antenatal care.
The anomaly scan is ideally performed between 18 and 22 weeks of pregnancy, with 20 weeks being the most common timing. At this stage, the baby's organs are sufficiently developed for detailed examination, the baby is large enough for a complete structural survey, and there is still enough time to plan further investigations or management if any concerns are identified.
The anomaly scan checks the baby's brain, face, spine, heart (4-chamber view and outflow tracts), lungs, diaphragm, stomach, abdominal wall, kidneys, bladder, limbs, hands and feet, and umbilical cord. It also checks the placenta location (to detect placenta praevia) and amniotic fluid levels. The sonographer takes fetal measurements to assess growth appropriateness for gestational age.
Yes. TIFFA stands for Targeted Imaging for Fetal Anomalies. It is the most commonly used term in India for the detailed Level 2 anomaly scan performed between 18 and 22 weeks. The terms anomaly scan, Level 2 ultrasound, morphology scan, and TIFFA scan all refer to the same comprehensive fetal structural examination.
Yes, the anomaly scan is completely safe. It uses ultrasound — high-frequency sound waves — with no ionizing radiation whatsoever. Ultrasound has been used in obstetric practice for over 60 years with an excellent safety record. There is no known risk to the mother or baby from a routine diagnostic ultrasound scan performed by a trained professional.
No — the anomaly scan is a highly valuable screening tool but it cannot detect every possible condition. Some structural abnormalities only become apparent later in pregnancy or after birth. The scan cannot directly diagnose chromosomal conditions like Down syndrome, which require separate blood tests or invasive testing. A normal anomaly scan is very reassuring but does not guarantee a 100% problem-free outcome. The scan is one important part of a complete antenatal care programme.
For a transabdominal anomaly scan, a comfortably full bladder is helpful — drink 2 to 3 glasses of water about 30 to 45 minutes before the scan and avoid urinating beforehand. No fasting is required. Wear loose, comfortable clothing that allows easy access to the abdomen. Bring your previous scan reports, antenatal booklet, and any referral letter from your doctor.
The anomaly scan typically takes 30 to 45 minutes, though it can take longer if the baby is in a position that makes certain structures difficult to see. If the baby is not cooperating, you may be asked to walk around briefly and return for the scan to continue. The sonographer needs to assess a comprehensive checklist of structures — thoroughness takes priority over speed.
If a finding is identified, the sonographer or radiologist will discuss it with you calmly and clearly. Depending on what is found, next steps may include a repeat scan in a few weeks, referral to a fetal medicine specialist, a dedicated fetal echocardiogram, chromosomal testing, or an MRI. Many findings turn out to be minor or resolve on their own. Finding a concern early always allows the medical team to plan the best possible care for you and your baby.
The NT scan is performed at 11–14 weeks and measures the fluid at the back of the baby's neck as a marker for chromosomal conditions. It is a first-trimester chromosomal screening test. The anomaly scan is performed at 18–22 weeks and is a detailed structural survey of the baby's major organs and anatomy. Both scans serve different purposes and are recommended as part of routine antenatal care — one does not replace the other.
Usmanpura Imaging Centre offers anomaly scans and comprehensive obstetric sonography across 9+ branches in Ahmedabad — Usmanpura, Maninagar, Bapunagar, Naroda, Nikol, Satellite, Sabarmati, Vadaj, and Juhapura — as well as Gandhinagar, Bareja, Rajkot, Morbi, Anand, Nadiad, and Patan. All centres are open 24 hours, 7 days a week. Call +91 79 6969 0900 or WhatsApp +91 97255 04245 to book your appointment.
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Medical Disclaimer
The content published on this website is intended for general informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified doctor or radiologist before making any health-related decisions. Usmanpura Imaging Centre does not provide medical advice through this blog. If you have a medical emergency, please contact your doctor or call emergency services immediately.
