Second-Trimester Anatomy Ultrasound Report

Maternal-Fetal Medicine — 18–22 Week Detailed Structural Survey

Report ID: MAA-PUA-4D2E47
Generated: May 14, 2026
Analysis: AI-Powered Image Interpretation

Patient Profile

Maternal age:
29 years
Gestational age:
20 weeks 2 days (LMP-confirmed by first-trimester scan)
Pregnancy:
G1P0 — singleton, spontaneous conception
First-trimester screening:
Combined screen low-risk for T21/18/13 (1:2,800)
History:
No medication exposures, no maternal illness, no family history of congenital anomaly
Examiner credentials:
Maternal-Fetal Medicine sonographer, AIUM-credentialed equipment

Summary Overview

Comprehensive second-trimester anatomy ultrasound following AIUM/ISUOG guidelines. Biometry consistent with dates; estimated fetal weight at the 48th percentile. No major structural anomaly identified. One minor "soft marker" (isolated echogenic intracardiac focus) noted; isolated and not clinically significant in low-risk pregnancy.

48%
EFW Percentile
14.2
AFI (cm)
1
Soft Marker

Biometry (Hadlock C)

BPD:
48 mm (50th percentile)
HC:
178 mm (52nd percentile)
AC:
156 mm (49th percentile)
FL:
33 mm (47th percentile)
EFW:
340 g (48th percentile) — appropriate for gestational age

Structural Survey by System

Central Nervous SystemNormal
Skull contour normal; cavum septum pellucidum present; lateral ventricles symmetric (atrium 6.5 mm, normal); cerebellum normal shape and size; cisterna magna 5.0 mm (normal); choroid plexuses symmetric; midline falx intact.
FaceNormal
Profile normal; both orbits visualized and symmetric; nasal bone present; upper lip continuous (no cleft); palate sufficient (continuous on coronal view).
SpineNormal
Cervical, thoracic, lumbar, and sacral segments visualized in three planes; ossification appropriate; intact overlying skin; no cyst or splaying.
CardiacSoft Marker
Four-chamber view normal; ventricular outflow tracts crossed normally; aortic and ductal arches identified. Single echogenic intracardiac focus (EIF) in left ventricle, isolated. EIF is a benign normal variant in 3–5% of low-risk pregnancies and is not associated with structural cardiac disease [Bromley B, J Ultrasound Med 2002]. In an isolated, low-risk setting, EIF does not warrant further testing [SMFM Consult, AJOG 2018].
Thorax / DiaphragmNormal
Lungs symmetric; diaphragm intact bilaterally; no pleural effusion or mass.
AbdomenNormal
Stomach in left upper quadrant; bowel non-dilated, non-echogenic; cord insertion intact (no gastroschisis or omphalocele); kidneys bilaterally visualized with renal pelves < 4 mm; bladder filled.
ExtremitiesNormal
Four limbs identified, three segments each, with hands and feet visualized. No talipes equinovarus.

Placenta, Cord, Amniotic Fluid

  • Placenta: anterior, fundal, no previa (lower edge well clear of internal cervical os)
  • Cord: 3-vessel cord (2 arteries, 1 vein); central insertion
  • Amniotic Fluid Index (AFI): 14.2 cm — within normal range (5–24 cm)
  • Cervical length (transabdominal): appears > 30 mm; transvaginal screening would refine if indicated

Findings & Interpretation

  • No major structural anomalyReassuring
    All major organ systems imaged at the recommended planes; biometry concordant with dates; placenta and amniotic fluid normal.
  • Isolated echogenic intracardiac focus (EIF)Normal variant
    Isolated EIF in a low-risk pregnancy with normal first-trimester screening does not increase aneuploidy risk meaningfully and does not require further action [SMFM 2018].

Analytical Summary & Recommendations

Clinical pattern

Reassuring detailed anatomy survey at 20+2. Single isolated soft marker that does not require additional management in this clinical context.

Recommended next steps

  • Continue routine prenatal care
  • Third-trimester growth scan only if clinical indication arises (e.g., fundal-height/dates discrepancy)
  • Routine fetal movement awareness from ~26 weeks; report decreased movement immediately
  • Standard postnatal newborn examination — no specific cardiac follow-up indicated for isolated EIF

Key Questions for Your Physician

  • Should the echogenic focus in the heart be re-evaluated later?
  • Is there a need for any additional ultrasound or specialist visit before delivery?
  • What signs would prompt earlier follow-up (e.g., decreased fetal movement, bleeding, contractions)?
  • Any specific delivery considerations based on placental position or biometry?

What This Means for You

Your 20-week anatomy ultrasound is reassuring. All the major structures of your baby were imaged and look as expected, your baby's growth is right in the middle of the expected range, and the placenta, cord, and amniotic fluid are all normal.

There is one finding worth understanding: a small bright spot in the left side of your baby's heart — called an echogenic intracardiac focus (EIF). This is a common normal variant, found in about 3–5% of all healthy pregnancies. On its own, in a low-risk pregnancy like yours (with normal first-trimester screening), it does not indicate a problem and does not require any extra testing or follow-up. It does not affect heart structure or function — your baby's heart looks normal.

No further imaging is needed unless something specific comes up later in pregnancy. Continue routine prenatal care and reach out if you notice decreased fetal movement, bleeding, or contractions before 37 weeks.

Analysis Confidence 93%

Comprehensive views obtained per AIUM/ISUOG protocol; biometry and structural survey complete and confidently interpreted. Sonographic AI analysis benefits from real-time scanning context — final clinical determination always rests with the imaging clinician.

References

  1. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 weeks 0 days and 13 weeks 6 days. J Ultrasound Med 2025 (and the analogous 2nd-trimester parameter).
  2. ISUOG Practice Guidelines: performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2022.
  3. Society for Maternal-Fetal Medicine (SMFM) Consult Series #45: Isolated Soft Markers. AJOG 2018;219(4):B2–B14.
  4. Bromley B, Lieberman E, Shipp TD, Benacerraf BR. The genetic sonogram: a method of risk assessment for Down syndrome. J Ultrasound Med 2002;21(10):1087–96.
  5. Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements. Am J Obstet Gynecol 1985;151(3):333–7.
  6. ACOG Committee Opinion 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol 2017.