Antenatal Screening

18-20 week antenatal scan (being told something may be wrong)

For some people the 18-20 week scan or anomaly scan is the point at which they discover something may be wrong with their baby. Like anybody else, many parents who discovered something was wrong had never expected this to happen and did not feel they had enough information about the purpose of the scan. They were looking forward to seeing their baby and expecting reassurance.

All pregnant women should now be given by their midwife or GP the booklet ‘Screening tests for you and your baby’ by Public Health England, which gives detailed information about the types of scan offered and what they are looking for (see 'Resources' section).

Very occasionally, parents were anxious beforehand, including one woman who was worried something was not right, but she was still unprepared for the shock. With hindsight, many people stressed that, although they did not want to frighten other parents unnecessarily, they would recommend having someone with you for support.

One woman had gone alone with her toddler, and was stunned to be told her baby had a serious heart condition. This was a routine repeat scan because at the previous scan the baby was in an awkward position.

For this group of parents, how staff behaved and spoke to them was very important. Small details such as introducing themselves by name and making sure they got the woman's name right could make a big difference.

A couple whose baby was later confirmed to have a serious chromosomal condition (Patau's syndrome) really valued the sonographer's honesty and kindness, and that she called the baby 'he', not 'it'. (Of course some parents might not wish to know the baby's gender, and staff should check this first).

Parents often picked up that staff had spotted something unusual before anyone told them. Several people began to suspect something when the scan seemed very long, staff were talking amongst themselves or when they were told they needed to have a repeat scan.

People understood how difficult it must be for staff communicating bad news, and why they are sometimes silent while they concentrate, but silence still makes people anxious.

There is no easy solution which will suit everyone; some parents become anxious when staff suddenly go quiet after being chatty, but even when staff explain they will be silent parents cannot help worrying, especially if they have already had a bad experience. Sonographers undoubtedly face a difficult dilemma, given different people's preferences and needs for information.

Most people said they would prefer to be kept informed during the scan. One woman described her anxiety in the waiting room between scans, and would rather have been told immediately that they suspected hydrocephalus.

It was distressing to be asked to wait for a repeat scan, often in the main waiting area with other pregnant women, although later being shown into 'the bad news room', as one woman described it, was not much better.

One woman was reassured early on that there was a heartbeat, before the sonographer explained she would then be silent with the screen turned away. She was therefore not anxious initially. She felt the bad news was then communicated to her honestly and sensitively, and was based on a really thorough examination, but it took her quite a long time to grasp how serious the situation was.

This was true for many people, including one woman who said the first person to scan her seemed bored and off-hand. He did mention the problems he was picking up during the scan, but perhaps not very sensitively. She saw another sonographer who was more sympathetic. Gradually it became clear the baby had major problems, but it was still hard to take in. (See also 'Deciding whether to have further diagnostic tests').

Parents who later decide to end the pregnancy have few mementoes of their baby, and several would have valued a scan photograph to keep, but this may not be offered and in their shock parents may not think to ask or may feel too embarrassed.

Some people were reassured by their 18-20 week scan, but later discovered something was wrong - see 'When screening does not detect the baby has a condition'. Many experiences discussed here are common to other types of scan - see also 'Early dating scans' and 'Combined screening for Down's syndrome and other abnormalities'.

The Royal College of Obstetricians and Gynaecologists (RCOG) have produced a report on ‘Termination of Pregnancy for Fetal Abnormality in England, Scotland and Wales’ (May 2010). Within it are a number of recommendations for the communication of findings from ultrasounds. The following is a quote from their report:

“If the scan reveals either a suspected or confirmed abnormality, the woman should be informed by the sonographer at the time of the scan. It is essential that all practitioners performing fetal anomaly ultrasound screening should be trained to communicate abnormal findings to women, as such information is likely to have significant emotional impact.

Usually, sonographers will ask a senior sonographer colleague to confirm findings and this should be done immediately. If an abnormality is confirmed or suspected, referral is usually required, although some obvious major fetal abnormalities, such as anencephaly, may not require a second opinion (this should be decided by local guidelines).

For women who have been given distressing news about their baby during the scan, there should be a health professional available to provide immediate support. In the case of a suspected abnormality, women should be seen for a second opinion by an expert in fetal ultrasound, such as a fetal medicine specialist. An appointment should be arranged as soon as possible and ideally within three working days. Any delay in receiving more information about the abnormality and its implications will be distressing for women and this should be acknowledged.” 

Last reviewed July 2017.
Last updated July 2017.

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