Abnormal Prenatal Ultrasound

I was told that I had an abnormal prenatal ultrasound. Should I worry?

Prenatal Ultrasound

During your pregnancy, you had a lot of ultrasounds. The doctors saw something abnormal and wanted to check your baby frequently. Now your baby is out. What happens next?

If there was enough concern about what the doctors saw on your ultrasounds, then two things may have happened. First, before your baby was born, you may have referred to a perinatologist (an OBGYN specializing in patients with high risk pregnancies). Second, once your baby was born, she may have gone directly to the Newborn Intensive Care Unit (NBICU) to be taken care of by specialists.

If your baby is in the hospital room with you, then she is stable and is being treated like a normal newborn.


The "Problem" of Modern Ultrasound Technology

Modern ultrasound technology is amazing and gets better every year. The level of clarity now possible allows perinatologists to see the insides of developing babies before they are even born. Because this level of detail is so new, we are still learning how to interpret what we see. Doctors and researchers need more experience to understand ultrasound results, and to decide whether or not these images are something to worry about.

Often, a prenatal ultrasound will reveal something called a "soft sign." These signs, such as "a spot on the heart," "a white area in the intestines," or even "a cyst in the brain," may not mean much by themselves. By the time the baby is born, many "soft signs" will have disappeared on their own, and no medical intervention is needed.


What tests need to be done?

There are three situations when further testing will occur after birth, even if your baby is assigned to normal newborn care.

These conditions warrant further testing once your baby is born. Tests after birth are more accurate because the layers of mom's abdomen and uterus are no longer there to look through, and the tests can be done directly on the baby's body.

Heart Abnormality Seen on Prenatal Ultrasound

If you were told your baby has a heart defect that didn't go away before he was born, then he will have a cardiac echo within a day or two of birth. The cardiac echo technician uses a machine that is very similar to the prenatal ultrasound equipment that was used to see your baby during your pregnancy. The web page about heart murmurs explains this in more detail.

Brain Abnormality Seen on Prenatal Ultrasound

Head Ultrasound

If you were told your baby has a "cyst on the brain" that didn't go away before he was born, then he will have an ultrasound of his brain within a day or two of birth. Because of the soft spot on the top of his head, the technician can use the ultrasound probe to see inside his brain. If the radiologist (x-ray doctor) still sees an abnormality, she may suggest further studies. Also, a pediatric neurologist may be consulted. Alternatively, your baby's doctor may recommend repeating the ultrasound in a month or two.

Kidney Abnormality Seen on Prenatal Ultrasound

Kidney Ultrasound

If you were told your baby has "fluid on the kidneys" that didn't go away before he was born, then he will have two tests. One is an ultrasound of his kidneys to check the size and position of the kidneys.

Bladder Catheter

The other is a voiding-cysto-urethogram (VCUG). The VCUG requires a tiny catheter be passed into your baby's bladder. A dye is put into the bladder that shows up on x-ray. When the bladder contracts the dye should only flow one way -- out. If the dye flows backwards, up toward the kidneys, the risk of kidney damage increases, and your baby needs to be managed by a pediatric kidney specialist.


Thanks to Janelle Aby MD, Stanford School Of Medicine, Newborn Nursery, and Lucille Packard Children's Hospital for the use of occasional photographs.