Maternal Health

20-Week Anatomy Scan Unexpected Findings

Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN

Content reviewed against published ACOG, NIH, March of Dimes guidelines

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Your health matters just as much as your baby's. If you are dealing with 20-week anatomy scan unexpected findings, here is what you need to know.

The short answer

The 20-week anatomy scan checks your baby's major organs, structures, and growth. Most scans are completely normal. When unexpected findings are identified, they range from minor variants that resolve on their own to conditions that need further evaluation. Many findings require nothing more than a follow-up ultrasound to confirm the baby is developing well.

Key takeaways

  • The 20-week anatomy scan checks your baby's major organs, structures, and growth. Most scans are completely normal. When unexpected findings are identified, they range from minor variants that resolve on their own to conditions that need further evaluation. Many findings require nothing more than a follow-up ultrasound to confirm the baby is developing well.
  • Usually normal when: All structures appearing normal on the anatomy scan
  • Call your doctor if: You are overwhelmed and need immediate emotional support after receiving unexpected news
“About 1 in 8 women experience symptoms of postpartum depression. If you have symptoms of depression that last longer than 2 weeks, tell your health care provider.”
— Depression During and After Pregnancy, Centers for Disease Control and Prevention (CDC)

This is one of the most common questions parents ask. Searching for answers means you care.

What Parents Should Know

According to ACOG, NIH, March of Dimes guidelines, the 20-week anatomy scan checks your baby's major organs, structures, and growth. Most scans are completely normal. When unexpected findings are identified, they range from minor variants that resolve on their own to conditions that need further evaluation. Many findings require nothing more than a follow-up ultrasound to confirm the baby is developing well. At Second trimester, the anatomy scan (18-22 weeks) examines the brain, heart, spine, kidneys, limbs, and other structures. If something unexpected is found, your provider may recommend a detailed follow-up ultrasound with a maternal-fetal medicine specialist, genetic counseling, or additional testing. Many findings (like a slightly dilated kidney or choroid plexus cyst) are common and resolve on their own. It is generally considered normal when all structures appearing normal on the anatomy scan. However, you should contact your pediatrician promptly if you are overwhelmed and need immediate emotional support after receiving unexpected news.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
All structures appearing normal on the anatomy scan
You are overwhelmed and need immediate emotional support after receiving unexpected news
Minor findings noted as "variants of normal" that require only follow-up
You want to discuss diagnostic testing options urgently
Feeling anxious about the scan - this is completely understandable
You want to better understand findings from your anatomy scan

By Age

What to expect by age

Second trimester

The anatomy scan (18-22 weeks) examines the brain, heart, spine, kidneys, limbs, and other structures. If something unexpected is found, your provider may recommend a detailed follow-up ultrasound with a maternal-fetal medicine specialist, genetic counseling, or additional testing. Many findings (like a slightly dilated kidney or choroid plexus cyst) are common and resolve on their own.

Third trimester

Follow-up ultrasounds may be scheduled to recheck any findings. Many conditions that were uncertain at 20 weeks become clearer later in pregnancy. Your care team will guide you through any additional monitoring or planning needed based on confirmed findings.

What to Tell Your Pediatrician

  • Describe when you first noticed 20-week anatomy scan unexpected findings and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if you want to better understand findings from your anatomy scan.
  • Mention if you would like a second opinion or detailed follow-up.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • All structures appearing normal on the anatomy scan
  • Minor findings noted as "variants of normal" that require only follow-up
  • Feeling anxious about the scan - this is completely understandable
Mention at your next visit when...
  • You want to better understand findings from your anatomy scan
  • You would like a second opinion or detailed follow-up
  • You are struggling emotionally with unexpected findings
Act now when...
  • You are overwhelmed and need immediate emotional support after receiving unexpected news
  • You want to discuss diagnostic testing options urgently

What You Can Do at Home

  • Keep track of when you notice 20-week anatomy scan unexpected findings — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that all structures appearing normal on the anatomy scan — this is generally within the range of normal.
  • At Second trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
  • While monitoring at home, seek immediate care if you are overwhelmed and need immediate emotional support after receiving unexpected news.

Soft Markers on Ultrasound

Soft markers are minor ultrasound findings that are usually variants of normal but may slightly increase the statistical risk of chromosomal conditions. Common soft markers include echogenic intracardiac focus (bright spot on heart), choroid plexus cysts (small cysts in the brain), and mild pyelectasis (slightly dilated kidneys). An isolated soft marker (one finding with no other concerns) is usually not significant.

Dealing with Abnormal Prenatal Screening Results

An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.

Anxiety About Prenatal Tests

Anxiety about prenatal tests is extremely common. Many parents feel nervous about what tests might reveal. Remember that most screening tests have a high rate of reassuring results, and even abnormal screenings often turn out to be false positives. You have the right to choose which tests you want and to decline any test. Understanding what each test tells you can help reduce anxiety.

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When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is 20-week anatomy scan unexpected findings normal?
The 20-week anatomy scan checks your baby's major organs, structures, and growth. Most scans are completely normal. When unexpected findings are identified, they range from minor variants that resolve on their own to conditions that need further evaluation. Many findings require nothing more than a follow-up ultrasound to confirm the baby is developing well.
When should I call the doctor about 20-week anatomy scan unexpected findings?
You are overwhelmed and need immediate emotional support after receiving unexpected news You want to discuss diagnostic testing options urgently
When is 20-week anatomy scan unexpected findings normal?
All structures appearing normal on the anatomy scan Minor findings noted as "variants of normal" that require only follow-up Feeling anxious about the scan - this is completely understandable
What causes 20-week anatomy scan unexpected findings?
The 20-week anatomy scan checks your baby's major organs, structures, and growth. Most scans are completely normal. When unexpected findings are identified, they range from minor variants that resolve on their own to conditions that need further evaluation. Many findings require nothing more than a follow-up ultrasound to confirm the baby is developing well. Common explanations include: All structures appearing normal on the anatomy scan. Minor findings noted as "variants of normal" that require only follow-up.
What should I mention to my pediatrician about 20-week anatomy scan unexpected findings?
You should mention 20-week anatomy scan unexpected findings at your next visit if: You want to better understand findings from your anatomy scan. You would like a second opinion or detailed follow-up. You are struggling emotionally with unexpected findings.
Is 20-week anatomy scan unexpected findings normal at Second trimester?
The anatomy scan (18-22 weeks) examines the brain, heart, spine, kidneys, limbs, and other structures. If something unexpected is found, your provider may recommend a detailed follow-up ultrasound with a maternal-fetal medicine specialist, genetic counseling, or additional testing. Many findings (like a slightly dilated kidney or choroid plexus cyst) are common and resolve on their own.
Is 20-week anatomy scan unexpected findings normal at Third trimester?
Follow-up ultrasounds may be scheduled to recheck any findings. Many conditions that were uncertain at 20 weeks become clearer later in pregnancy. Your care team will guide you through any additional monitoring or planning needed based on confirmed findings.
Should I go to the ER for 20-week anatomy scan unexpected findings?
Seek emergency care if you are overwhelmed and need immediate emotional support after receiving unexpected news, or if you want to discuss diagnostic testing options urgently. When in doubt, call your pediatrician's after-hours line for guidance.
Does 20-week anatomy scan unexpected findings go away on its own?
In many cases, 20-week anatomy scan unexpected findings resolves on its own, especially when all structures appearing normal on the anatomy scan.
ACOGNIHMARCH OF DIMES

References

  1. [1]American College of Obstetricians and Gynecologists. Ultrasound During Pregnancy. ACOG FAQ, 2022. ACOG
  2. [2]National Library of Medicine. Fetal Ultrasound. MedlinePlus, 2023. NIH
  3. [3]March of Dimes. Ultrasound During Pregnancy. March of Dimes, 2023. March of Dimes

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss 20-Week Anatomy Scan Unexpected Findings.

Things to mention

  • Describe when you first noticed 20-week anatomy scan unexpected findings and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if you want to better understand findings from your anatomy scan.
  • Mention if you would like a second opinion or detailed follow-up.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • You want to better understand findings from your anatomy scan
  • You would like a second opinion or detailed follow-up
  • You are struggling emotionally with unexpected findings

Urgent signs to report immediately

  • You are overwhelmed and need immediate emotional support after receiving unexpected news
  • You want to discuss diagnostic testing options urgently

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

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Bottom line

Most cases of 20-week anatomy scan unexpected findings are normal. Talk to your pediatrician if you are overwhelmed and need immediate emotional support after receiving unexpected news.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Soft Markers on Ultrasound

Soft markers are minor ultrasound findings that are usually variants of normal but may slightly increase the statistical risk of chromosomal conditions. Common soft markers include echogenic intracardiac focus (bright spot on heart), choroid plexus cysts (small cysts in the brain), and mild pyelectasis (slightly dilated kidneys). An isolated soft marker (one finding with no other concerns) is usually not significant.

Dealing with Abnormal Prenatal Screening Results

An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.

Anxiety About Prenatal Tests

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