Level 2 Ultrasound: Why and How is it Done?

A level 2 ultrasound is considered to be one of the primary scans during pregnancy. The other two pregnancy scans are level 1 ultrasound and level 3 ultrasound. These three ultrasounds look at the development of the child in the womb in all three trimesters.

Also known as the second-trimester scan, this ultrasound is used to assess foetal anatomy and detect any possible foetal abnormalities.

This ultrasound is performed typically at 20 weeks, but your doctor may recommend this scan anytime between 18 weeks and 22 weeks.

In case you are carrying multiple babies, your doctor may recommend more than one detailed ultrasound. 

Level 2 ultrasound is also known as second-trimester anatomy scan, TIFFA (targeted imaging for foetal anomalies), and foetal anomaly scan.

Why is a level 2 ultrasound done?

A second-trimester ultrasound is important to see the development of your child and look for any abnormalities.

Typically, you are required to visit a doctor’s clinic and your doctor will do the required procedure. Before the ultrasound, your doctor will do a brief physical examination. Also, the nurse will check your weight and blood pressure.

This level 2 ultrasound is done to look at the following:

Fetal face in level 2 ultrasound

Fetal heart and chest

• Cardiac situs (position)
• Foetal heart rate and rhythm
• Aortic and ductal arches
• Four-chamber view
• Diaphragm and lungs
• Right ventricular outflow tract
• Left ventricular outflow tract

Fetal musculoskeletal system in level 2 ultrasound

• Lower limb: Both feet, femora including femoral length (FL) as part of the biometric assessment, both tibia/fibula
• Spine: Transverse, longitudinal +/- coronal views and skin line
• Upper limb: Fingers and thumbs – including hand opening, humeral – including humeral length (HL) and both sides of radius/ulna

Fetal head

• Foetal skull: Shape and integrity
• Foetal brain: Nuchal fold thickness, cavum septum pellucidum, ventricles and choroid plexus, posterior fossa including measurements of cisterna magna and transcerebellar diameter.

Fetal abdomen

• Kidneys and renal arteries
• Umbilical cord insertion
• Fetal gender 
• Stomach (including situs)
• Presacral space
• Abdominal wall
• Urinary bladder and umbilical arteries
• Liver

Ancillary findings

• Umbilical cord – including the number of cord vessels and evaluation of knots
• Fetal position
• Liquor volume
• Cervical length
• Placenta: Distance to cervix and site

This is what your doctor will see through an ultrasound.

Prerequisites

Your doctor will give you all the information and instructions essential for the level 2 ultrasound. 

Commonly, you are asked to drink plenty of water before the ultrasound and have a full bladder. This helps it easier to take ultrasound images.

Also, one of the reasons to drink water is to wake your baby from his/her sleep. Ultrasound looks at the movements of the baby and the device cannot make images if the baby is sleeping. Making a sound or drinking water can wake your baby and get proper foetal ultrasound images.

Before undergoing the level 2 ultrasound, if you have any questions and doubts related to the scan or pregnancy or baby, you can always ask your doctor. Your doctor is the best person to guide you and answer your questions.

Understanding the results

A level 2 ultrasound is a non-invasive procedure that looks at the baby inside the womb. 

You are able to see your baby’s heart beating, baby’s spine, arms, legs, and face. The images captured in this sonography are blurry.

Your doctor guides you through each portion of your womb and baby. Your doctor will explain the movements of your baby and share other essential details about your baby.

In case any abnormality is suspected, your doctor will recommend further tests to detect or confirm any possible abnormality. Your doctor will give you complete guidance about the same. Also, your doctor may share the possible reasons for abnormal results.

When should it be repeated?

Your doctor may suggest repeating level 2 ultrasound if you are carrying more than one child. This helps your doctor to know their health and development. 

However, your doctor may suggest repeating second-trimester ultrasound for multiple reasons. Ask your doctor the reason for repeating this level 2 ultrasound to get a better idea.

Procedure

You will be asked to drink water before the scan so you will have a full bladder. This makes it easier for the doctor to get clear images. 

You will then be asked to lie down on an exam table, exposing your tummy. The sonographer will apply a gel and move a transducer (wand) all over your abdomen area. The transducer will emit sound waves that will collect images of internal organs and fluids. You will be able to see the images on the computer screen placed beside you. The screen will provide 2-dimensional images or cross-sectional view of the foetus. 

Also, there is the availability of 3D or even 4D ultrasound technologies that helps you to see your baby clearly. 

The sonographer will look at important body parts and view them from different angles. When the sonographer gets a perfect shot, he/she takes the picture, also called a sonogram.

During the ultrasound, you may be able to see the parts of babies like hands, fingers, feet, brain, face, beating heart, and spine. Rarely, you may see your baby smiling or sucking a thumb.

This ultrasound takes 45 minutes to 1 hour. Your doctor will discuss the result or aspects that he/she finds interesting.

In the end, you can go home with the sonogram pictures of your baby.