I follow a structured checklist based on ISUOG guidance. It takes in the brain, spine, heart, chest, abdomen, kidneys, bladder and limbs, as well as the placenta, the cord, the amniotic fluid and - when relevant - the cervix. About 2–3 in every 100 babies have a major structural condition, and the scan aims to pick up many of them, though not every one. I perform the scan and write the report myself.
TIFFA Scan Full Form and Other Names for This Scan
TIFFA stands for "targeted imaging for fetal anomalies". Level II scan, level 2 anomaly scan, anatomy scan, mid-trimester scan and 20-week scan are other names you may see on a prescription. They all describe the same examination at 18–22 weeks.
The word "level" simply describes depth. A level I (basic) obstetric scan confirms that the baby is growing and looks at the heartbeat, the position, the placenta and the fluid. A level II scan keeps all of that and adds a structured look at each organ system in turn. Of all the routine scans in pregnancy, this one examines the baby's anatomy in the most depth. That is why it takes longer, and why I do not hurry it.
If a referral slip from your own doctor uses any of these names, the same appointment is meant; there is no need to book two scans.
Level 2 Scan in Pregnancy: What It Sets Out to Find
At this scan I check how each part of the baby's body has formed. The main purpose is to find conditions such as spina bifida, cleft lip, serious heart defects, kidney problems and defects of the abdominal wall. Finding them now gives us time for counselling and for planning the birth.
Alongside the anatomy, I check the baby's growth against your dates, where the placenta lies and the amount of fluid. I also look at the number of vessels in the cord and, when relevant, the cervix. For most families, the scan shows that the anatomy looks as expected.
My Level 2 Anomaly Scan Checklist, Organ by Organ
- Head and brain: the shape of the skull, the ventricles, the cerebellum, the cisterna magna and the structures along the midline.
- Face: the upper lip and the profile (looking especially for cleft lip), and the eye sockets.
- Spine: its alignment and skin covering from neck to tail, in long and cross-sectional views.
- Heart: its position, the four chambers, both outflow tracts, and the three-vessel and trachea views.
- Chest and abdomen: the chest and diaphragm, the position of the stomach, the abdominal wall where the cord inserts, and the bowel.
- Kidneys and bladder: both kidneys, the renal pelvis and the bladder.
- Limbs: arms, legs, hands and feet, the long bones, and the position of the feet.
- Measurements (biometry): head circumference, abdominal circumference and femur length
- Placenta, cord and fluid: where the placenta sits, the cord vessels and where the cord inserts, and the amniotic fluid.
- When indicated: cervical length and uterine artery Doppler
Published Detection Rates for the Level II Scan
These are typical ranges reported for a scan at 18–22 weeks. They show why a normal report is reassuring but cannot rule everything out.
| Condition | Usual detection at 18–22 weeks | What I would add |
|---|---|---|
| Anencephaly | Over 95% | Usually already seen at the NT scan |
| Open spina bifida | About 90% | Signs in the head (the "lemon" and "banana" signs) help |
| Abdominal wall defects (gastroschisis, exomphalos) | About 90–98% | - |
| Major heart defects | About 50–80% | Higher when the outflow tract views are included; a fetal echo adds more |
| Cleft lip | About 70–80% | A cleft palate on its own is rarely seen |
| Kidney conditions | About 80–90% | Some dilatation shows up later on |
| Limb reduction defects | About 50–70% | Fingers and toes are hard to count reliably |
TIFFA Scan in Which Month? It Is Done at 18–22 Weeks
The TIFFA scan falls in the fifth month of pregnancy - between 18 and 22 weeks, and ideally at 19–20 weeks. Before 18 weeks, the heart and parts of the brain are small and harder to assess. After 22 weeks, the bones are denser and throw shadows, and there is less time for any follow-up.
Time also matters legally. Under the MTP (Amendment) Act 2021, ending a pregnancy beyond 24 weeks for a substantial fetal abnormality needs approval from a state medical board. A scan at 18–22 weeks leaves room for further tests, counselling and decisions.
If the baby's position hides a view, I may ask you to walk around, change position, or come back later the same day or in 1–2 weeks. This happens often, particularly when BMI is higher, and it does not mean there is a problem.
Soft Markers on the Anomaly Scan and What They Usually Mean
Soft markers are small findings such as a bright spot in the heart (echogenic focus), a choroid plexus cyst, mildly dilated kidneys or a single umbilical artery. Seen on their own, after earlier screening that was low chance, most of them change the overall risk very little.
Choroid plexus cysts, for example, are seen in about 1–2% of babies. They usually disappear by 28 weeks and do not affect the brain or development.
A few markers carry more weight - a thickened nuchal fold, an absent or small nasal bone, or mildly enlarged ventricles in the brain. These may lead to counselling, NIPT or a diagnostic test. I will always tell you plainly whether a finding matters. When a single soft marker is found after a low-chance NT or NIPT result, invasive testing is rarely needed.
If I See a Structural Difference on Your Scan
I will explain what I have found, how certain the diagnosis is, and what it may mean for your baby before and after birth.
- Some findings, such as mild kidney dilatation, are simply watched and often settle on their own.
- Cleft lip can be repaired with surgery after birth, and in the meantime babies can usually feed with some support.
- With a serious finding, you will have time, written information and, if you wish, a second opinion - within the time limits set by Indian law.
Depending on the finding, the next steps may include a fetal echo, amniocentesis with microarray, or an MRI for selected brain conditions. They may also include repeat scans, a meeting with a neonatologist or paediatric surgeon, and planning the delivery at a centre suited to the baby's needs.
Limits of the Level II Anomaly Scan
- It does not find every condition.
- Some heart defects, bowel blockages, brain changes and skeletal conditions develop, or become visible, later in pregnancy.
- Many genetic conditions - including autism and most learning difficulties - cannot be seen on ultrasound at all.
- What can be seen depends on the conditions on the day.
- A normal report means no major structural problem was seen. It does not mean every condition has been excluded.
After a Level II Scan: Follow-Up and Your Next Pregnancy
After a normal result, most women do not need another anatomy scan. I advise a repeat scan in these situations:
- A view could not be completed.
- The placenta is low-lying (I recheck it at about 32 weeks).
- A marker such as mild kidney dilatation needs following up at 28–32 weeks.
- A high-risk pregnancy needs growth scans in the third trimester.
If a baby has had a structural condition, the chance of it happening again depends on the cause. It is around 2–5% for isolated conditions such as a single heart defect or cleft lip. For genetic conditions, it can be 25% or more. After a neural tube defect, I advise folic acid 5 mg before the next pregnancy. A pre-pregnancy visit also lets us plan an early scan at 12–16 weeks next time.
Anomaly Scan Report: How to Read What I Write
Your anomaly scan report has a fixed layout, and knowing it makes the page much less confusing.
- Biometry - the head circumference, biparietal diameter, abdominal circumference and femur length, each with the week it corresponds to and an estimated weight. Small differences of a few days from your dates are normal.
- Anatomy list - each organ system with a note such as "seen, appears normal". "Not well seen" or "suboptimal view" usually means the baby's position hid that part, and I will say whether a repeat look is needed.
- Placenta - its position (for example anterior, posterior or fundal) and whether it is low-lying.
- Fluid and cord - the deepest pool of amniotic fluid and the number of vessels in the cord.
- Extras when measured - cervical length and uterine artery Doppler.
- Impression and plan - a short summary in plain words, followed by any further scan or test I advise.
Keep the report with your pregnancy file: it is referred to at later visits and again in labour.
Anomaly Scan Price in Ahmedabad: What Affects the Charge
I do not put a figure on this page, because the charge depends on what the scan has to include. The hospital gives current charges on request when you book.
The main factors are:
- One baby or more - in twins every organ system is checked for each baby, so the scan takes considerably longer.
- Extra measurements when indicated - cervical length or uterine artery Doppler.
- 3D views - used only for a specific question, such as the face or the spine.
- A dedicated fetal echo - a separate, longer heart scan, arranged only when the risk is higher or the routine heart views are not clear.
- Further testing - amniocentesis, microarray or an MRI are separate items and are needed only for particular findings.
When you call, mention the week of pregnancy, whether it is a twin pregnancy, and any reason your doctor has given for the scan. The information you receive will then fit your situation.
Anomaly Scan and the PCPNDT Act
India's PCPNDT Act prohibits identifying a baby's sex before birth, and breaking it is a criminal offence. During the anomaly scan I look at the baby's organs for health reasons only; the sex is not determined and is never told to the parents or relatives.
Your Anomaly Scan Appointment in Five Steps
- BookingI time your appointment for 18–22 weeks from the dating scan. Please bring earlier reports, your NT and NIPT results, and your prescriptions.
- HistoryI go through your medicines and earlier results so that I can focus on any particular concern.
- The scanI examine each organ system in a fixed order; this usually takes 30–60 minutes.
- Explanationwe look at the images together, and I explain the findings in plain language in Gujarati, Hindi or English.
- Report and planyou receive a written report, and any further scan, echo or test is arranged before you leave.
Reasons to Book a Level II Scan
The anomaly scan is routinely advised in every pregnancy at 18–22 weeks. It is particularly important in these cases:
- Your NT, double marker or NIPT result was higher chance.
- You have diabetes, or took anti-epileptic medicines in early pregnancy.
- A previous baby had a structural condition.
- An earlier scan suggested a finding that needs a closer look.
- You and your husband are blood relatives.
Warning Signs in the Second Trimester: Come in the Same Day
- Any vaginal bleeding in the second trimester, however small.
- A gush, or a steady trickle, of fluid from the vagina.
- Regular tightenings or period-like cramps before 37 weeks.
- Sudden puffiness of the face or hands, a bad headache or blurred vision.
- Fever above 38 °C with abdominal pain.
These need a same-day check at Divine Women's Hospital, whose staff work round the clock (24×7); telephone on the way if you can.
Anomaly Scan Myths I Hear Often
Belief: A 3D/4D scan is more thorough than the anomaly scan.
The organs are assessed in 2D. 3D is an extra I use for specific questions, such as the face or spine; it does not replace the anomaly scan.
Belief: The anomaly scan can confirm that my baby has no genetic problem.
Many chromosomal and genetic conditions look normal on ultrasound. That question is answered by screening and diagnostic genetic tests.
Belief: Being asked to come back means something is wrong.
Usually the baby was simply in an awkward position, which is very common.
Belief: Too many scans can harm the baby.
Scans that are medically indicated and done within standard safety settings have no proven harmful effect on the baby's development.
Questions Patients Often Ask Me About the Anomaly Scan
How does a level II scan differ from a level I scan?
A level I scan covers the basics: heartbeat, growth, how the baby is lying, the placenta and the fluid. A level II scan adds a structural assessment of every organ system and is advised at 18–22 weeks.
Which week should I book the anomaly scan for?
Anywhere from 18 to 22 weeks. I find that 19–20 weeks usually gives clear views and still leaves time for any follow-up.
Is a TIFFA scan the same as the anomaly scan?
Yes. TIFFA is another name for the detailed anomaly scan done in mid-pregnancy.
Can the anomaly scan rule out Down syndrome?
Not reliably. About half of babies with Down syndrome look normal on the scan. The dependable routes are NT screening or NIPT, followed by CVS or amniocentesis when needed.
What does an echogenic focus in the heart mean?
It is a small bright spot inside one of the heart chambers. It is seen in about 3–5% of healthy babies and is usually a normal variant.
My anomaly scan says the placenta is low-lying. What does that mean?
At 20 weeks the placenta often lies near the cervix, and it usually moves upwards as the uterus grows. A repeat scan at about 32 weeks checks its position.
Should my bladder be full for the anomaly scan?
No. A full bladder is not needed for this scan, and you can eat normally before your visit.
Can my husband or family come in with me?
One support person is welcome in the scan room. Young children are better left at home.
Is it possible to have the anomaly scan at 24 weeks?
Yes, but the views are harder to obtain. I advise booking within 18–22 weeks because of the time limits for decisions under the MTP Act.
Will I need another scan after this one?
Not always. I advise further scans to check growth, the placenta or the fluid, to follow up a finding, or when the pregnancy is high risk.