Obstetric ultrasound (pregnancy scan): the complete guide

01What is an obstetric ultrasound?

An obstetric ultrasound is a scan that uses high-frequency sound waves to create real-time images of the womb, placenta, amniotic fluid and baby during pregnancy. It is the main tool for monitoring a pregnancy because it is safe, painless and does not use radiation.

During the scan, a small probe (transducer) is placed on your tummy or, in early pregnancy, inside the vagina. The probe sends out sound waves that bounce back from the tissues, and the machine turns those echoes into a picture on screen. The doctor can see not only your baby’s shape but also movements, the heartbeat and, with Doppler, blood flow.

Terms you will hear often:

• Gestational age: how many weeks pregnant you are, counted from the first day of your last menstrual period.
• CRL (crown-rump length): the measurement of the embryo in the first trimester, the most accurate way to date a pregnancy.
• Nuchal translucency (NT): a thin layer of fluid at the back of the baby’s neck, measured at 11–14 weeks.
• Anomaly (morphology) scan: the detailed check of your baby’s anatomy in the second trimester.
• Doppler: an ultrasound technique that measures blood flow in the umbilical cord, the placenta and the baby’s vessels.

An obstetric ultrasound is not a single test but a series of planned scans. Each one has its own purpose and is timed for the weeks when what it looks for can be seen best.

02Why do you need ultrasound scans in pregnancy, and when?

Scans confirm that the pregnancy is developing normally, give you an accurate due date and check your baby’s growth and anatomy. The World Health Organization (WHO) recommends at least one ultrasound before 24 weeks for every pregnant woman.

According to the WHO, an early scan helps to:

• estimate gestational age and the due date accurately;
• detect twins or other multiple pregnancies;
• detect possible fetal anomalies early;
• avoid unnecessary induction of labour because of a wrong date;
• improve the mother’s experience of pregnancy.

On top of the routine scans, your doctor may recommend an extra scan if:

• you have vaginal bleeding or abdominal pain;
• you have had a previous miscarriage or ectopic pregnancy;
• you have diabetes, high blood pressure or another long-term condition;
• you are expecting twins;
• your bump seems larger or smaller than expected for your dates;
• you notice fewer baby movements than usual;
• the pregnancy followed fertility treatment or IVF.

When to contact a doctor or emergency services straight away: heavy bleeding, severe pain in the abdomen or shoulder tip, fluid leaking from the vagina, a high temperature, a severe headache with blurred vision, or a clear drop in your baby’s movements in the third trimester. These situations should not wait for your next scheduled scan.

03How many scans do you have in pregnancy, and at which weeks?

In an uncomplicated pregnancy you will usually have 3–4 main scans: an early scan, the 11–14 week scan, the anomaly scan at 18–22 weeks and, if needed, a growth scan in the third trimester. The exact number depends on your pregnancy and the guidelines your doctor follows.

1. Early pregnancy scan (around 6–10 weeks): confirms the pregnancy is in the womb, shows the embryo’s heartbeat (usually visible from about 6 weeks on an internal scan), counts the embryos and gives a first dating.
2. First-trimester scan (11+0 to 13+6 weeks): according to ISUOG and the Fetal Medicine Foundation, this is done when the baby’s crown-rump length (CRL) is 45–84 mm. It sets the due date, measures nuchal translucency and checks the baby’s basic anatomy.
3. Anomaly scan (18–22 weeks): ISUOG places the routine second-trimester scan at around 18–24 weeks, and in practice it is most often done at 18–22 weeks. The brain, face, heart, spine, abdominal organs, kidneys, limbs, placenta and amniotic fluid are checked one by one.
4. Third-trimester scan (usually around 28–34 weeks): assesses the baby’s growth, the amount of amniotic fluid, the baby’s position and where the placenta lies. In Italy and France it is part of the routine schedule (around 32 weeks); the WHO recommends scans after 24 weeks only when there is a medical reason.

For comparison: the UK NHS offers at least two scans, at 11–14 weeks and at 18+0 to 20+6 weeks; in Italy and France the standard schedule has three scans, one per trimester. Higher-risk pregnancies are scanned more often, based on the doctor’s assessment.

04Abdominal or transvaginal: how is a pregnancy scan done?

In the first weeks of pregnancy a transvaginal (internal) scan gives the clearest picture, while from about 11–12 weeks scans are usually done over the tummy (abdominal). Both methods are safe for you and your baby.

Abdominal ultrasound:

• The probe is moved over your tummy with a little ultrasound gel.
• It is used for most scans from late first trimester to the end of pregnancy.
• You do not need to undress fully; you just uncover your abdomen.

Transvaginal ultrasound:

• A slim probe, covered with a single-use hygienic sheath and gel, is gently inserted a short way into the vagina.
• Because the probe is closer to the womb, the image is far more detailed in early pregnancy, when the embryo is only a few millimetres long.
• It is also useful later to measure the length of the cervix or check where the placenta is.
• It does not cause miscarriage or harm the pregnancy; most women feel only light pressure.

At Klinika Gjata scans are done on a GE Voluson system, an ultrasound platform designed for obstetrics and gynaecology. The doctor chooses the method based on how many weeks pregnant you are, your body type and the clinical question, and explains it to you before starting.

05What happens at a pregnancy scan appointment, step by step?

A scan at Klinika Gjata is a full consultation: the doctor asks, examines and explains the result in the same appointment. This is how it usually goes.

1. Arrival and details: you are asked for the first day of your last period, previous scans and test results, and any conditions or medicines.
2. Talk with the doctor: Dr. Gjata asks how you feel, whether you have symptoms and what questions you have about this scan.
3. Getting ready: you lie on the examination couch and uncover your tummy; if an internal scan is needed, you are given privacy and a cover.
4. The scan: the doctor moves the probe and systematically checks the baby, placenta, amniotic fluid and, when needed, the cervix and blood flow with Doppler.
5. Measurements: the machine records your baby’s measurements (for example CRL, head circumference, abdominal circumference and femur length) and compares them with the expected values for your dates.
6. Your moment: when the baby’s position allows, the doctor shows you the face, hands or heartbeat on screen.
7. Explaining the result: the doctor tells you what she saw, whether everything is within the normal range and whether any further check is needed.
8. Next steps: the date of your next scan is set or, if needed, extra tests or a referral are recommended.

Duration varies: an early scan may take 15–20 minutes, while an anomaly scan may take 30–45 minutes or more. If the baby is lying in a position that hides some views, you may be asked to walk around, change position or come back another day.

06How should you prepare for a pregnancy ultrasound?

Most pregnancy scans need no special preparation: you can eat, drink and take your medicines as usual. Sometimes, mainly for an abdominal scan in the first trimester, you may be asked to have a partly full bladder.

Practical tips:

• Wear comfortable two-piece clothing so you can uncover your tummy easily.
• Bring previous scans, test results and reports, especially if you have been followed at another centre or abroad.
• Note the first day of your last menstrual period.
• Avoid creams or oils on your tummy on the day of the scan, as they can reduce image quality.
• For an internal scan your bladder should be empty; you will be told before the examination.
• Write down your questions so you do not forget them during the visit.

When you book by phone (+355 4 234 0059), say how many weeks pregnant you are and which scan you need, so the team can tell you about any specific preparation.

07Is ultrasound harmful to the baby?

No. Diagnostic ultrasound does not use ionising radiation (like X-rays) and, according to the NHS and international ultrasound societies, there are no known risks to mother or baby when it is done for medical reasons by a trained professional.

Why it is considered safe:

• Ultrasound is sound, not radiation; there is no cumulative effect as with X-rays.
• Modern machines have energy limits and display thermal and mechanical indices on screen.
• Doctors follow the ALARA principle (as low as reasonably achievable): the lowest energy and the shortest time that allow an accurate diagnosis.

What the authorities recommend:

• ISUOG and ultrasound societies support planned scans during pregnancy as part of standard care.
• The US Food and Drug Administration (FDA) advises against keepsake scans (images or videos with no medical reason) and against using home fetal heartbeat devices without supervision.
• A transvaginal scan in early pregnancy is safe and does not increase the risk of miscarriage.

In short: the scans your doctor recommends are useful and safe. What should be avoided is unnecessary use, not medical ultrasound.

08What can a pregnancy ultrasound detect, and what can’t it?

Ultrasound can show a lot, including the exact stage of pregnancy, twins, your baby’s growth and many structural anomalies, but it cannot guarantee that a baby is completely healthy. Some conditions have no visible signs on a scan or only appear later.

What can be seen:

• where the pregnancy is (in the womb or ectopic);
• the heartbeat and viability of the embryo;
• the number of babies and, for twins, whether they share a placenta;
• gestational age and the due date;
• nuchal translucency and other markers that raise or lower the risk of chromosomal conditions;
• structural anomalies of the brain, heart, spine, abdominal wall, kidneys and limbs;
• the position of the placenta, the amount of amniotic fluid and the baby’s growth;
• blood flow in the baby and placenta with Doppler.

What ultrasound cannot do:

• It cannot diagnose Down syndrome or other chromosomal conditions with certainty; it only gives a risk assessment. A diagnosis requires genetic testing.
• It does not see every small defect; some heart, facial or finger anomalies can be missed.
• It does not detect metabolic or genetic diseases, or problems that appear after birth.
• Image quality depends on the baby’s position, the stage of pregnancy and the thickness of the abdominal wall.

The NHS points out that the 20-week scan looks for 11 specific conditions but cannot find everything. A normal scan is very reassuring, but it is not an absolute guarantee.

093D/4D ultrasound and your baby’s sex: when can you see them?

Your baby’s sex can usually be seen reliably at the anomaly scan, around 18–22 weeks, when the genitals are clearly formed and the baby is in a suitable position. 3D/4D ultrasound produces three-dimensional images of the face and movements, but medical diagnosis is done mainly with standard 2D ultrasound.

About the baby’s sex:

• At 11–14 weeks there may be a first impression, but errors are more common at this stage.
• At around 18–22 weeks accuracy is much higher, though it depends on the baby’s position.
• Cell-free fetal DNA tests in the mother’s blood (NIPT, such as NIFTY) can reveal the sex from 10 weeks, if you ask.
• Finding out the sex is not the main purpose of a scan; if you do not want to know, tell the doctor at the start.

About 3D/4D ultrasound:

• 3D gives a still three-dimensional image; 4D shows that image moving.
• The best facial images are usually obtained around 26–32 weeks, when there is enough fluid in front of the face.
• It can help assess certain structures, such as the upper lip, but it does not replace the anomaly scan.

If you would like 3D/4D images or want to know the sex, ask when you book whether this is available for your scan.

10What happens after the scan: results, NIPT and referral

At Klinika Gjata the result is explained during the same visit, because the doctor performs and interprets the scan herself. If everything is normal, your next check is scheduled; if something needs attention, your options and next steps are explained.

When the result is normal:

• You are told what was checked and which measurements were taken.
• Your next scan is planned according to your dates.
• You receive advice on nutrition, activity and the signs to watch for.

When there is a finding to follow up:

1. The doctor explains clearly what she saw and what it may mean, without exaggerating or minimising it.
2. A follow-up scan in a few weeks may be recommended, because some findings change or resolve.
3. To assess chromosomal risk, a combined test or NIPT (such as NIFTY), a blood test that analyses the baby’s DNA in the mother’s blood, may be advised. These are screening tests, not a diagnosis.
4. If the risk is high, a definite diagnosis requires an invasive procedure such as chorionic villus sampling (CVS) or amniocentesis, at a specialised centre.
5. When needed, you are referred to a fetal cardiologist, a geneticist or a fetal medicine centre, in line with ISUOG advice to refer promptly when an anomaly is suspected in the first trimester.

Klinika Gjata does not deliver babies. Pregnancy follow-up and scans take place at the clinic, and for the birth we guide you towards the maternity unit or hospital of your choice.

11Why have your pregnancy scan at Klinika Gjata in Tirana?

At Klinika Gjata every scan is performed and interpreted personally by Assoc. Prof. Dr. Elinda Gjata, an obstetrician-gynaecologist with more than 25 years of experience and specialist training in obstetric ultrasound. The same doctor who scans you explains your result and follows your pregnancy.

What sets us apart:

• Assoc. Prof. Dr. Elinda Gjata, MD, Dr. Sc., Associate Professor at the University of Medicine, Tirana.
• Training at the Ian Donald School of ultrasound (Tirana, 2006 and 2008), one of the best-known international teaching programmes in obstetric ultrasound.
• Dedicated training in fetal cardiac ultrasound and Doppler (2006).
• Member of ESHRE (European Society of Human Reproduction and Embryology), especially relevant for pregnancies after fertility treatment.
• A GE Voluson ultrasound system, designed for obstetrics and gynaecology.
• A small clinic, running since 2009, where you are known by name and your questions get time.

The clinic is on Rruga Hasan Sufa, Tirana. If you live abroad and are visiting Albania, your scan can be planned in advance; call +355 4 234 0059.

12How much does a pregnancy ultrasound cost?

The cost of a pregnancy scan depends on the type of scan and how detailed it is. At Klinika Gjata you receive a personalised quote when you book, so you know the cost before your visit.

Factors that affect the cost:

• The type of scan: early pregnancy, nuchal translucency, anomaly or growth scan.
• Whether the scan is part of a full obstetric consultation.
• Whether Doppler or a detailed assessment of the baby’s heart is needed.
• A twin pregnancy, which takes more time and measurements.
• Whether you would like 3D/4D images, when available.

For an exact price, call +355 4 234 0059 and tell us how many weeks pregnant you are and which scan you need.