Mrs Okafor had spent three weeks dreading her 20-week scan after a colleague's scan had found a problem. The anomaly scan at Mascot Healthcare took 30 minutes and assessed 40 anatomical structures — the report: all normal. Her baby girl was growing perfectly.
Civil servant, Ikeja. Presented at 20 weeks 1 day gestation — second pregnancy (previous term delivery, no complications). Referred by her antenatal clinic for the standard 18–22 week morphology scan. No risk factors. Mild anxiety about the scan due to a colleague's recent experience of a scan finding at this gestation.
Anomaly Scan (18–22 Weeks)Mrs Okafor's anxiety about the anomaly scan had started when her colleague — also 20 weeks pregnant — had returned from her own scan distressed: the scan had detected a kidney finding that required specialist review. Her colleague had spent 2 weeks in limbo before a specialist confirmed it was likely to resolve. Mrs Okafor had quietly dreaded her own appointment ever since.
"What if they find something?" she asked her husband. He tried to reassure her. She appreciated it but was still nervous. On the morning of the scan, she barely ate breakfast.
The sonographer at Mascot Healthcare worked methodically — head to toe, structure by structure, measuring and annotating. Mrs Okafor watched the screen. She could see the baby's profile, the tiny fingers, the four chambers of the heart beating rhythmically. After 28 minutes, the sonographer said: "I've checked everything. Everything looks normal." Mrs Okafor exhaled — and then cried.
The 18–22 week anomaly scan (also called the morphology or structural scan) is the most comprehensive pregnancy ultrasound. It systematically checks the baby's brain, heart, spine, kidneys, limbs, and face — and measures growth. It is the scan that catches most structural abnormalities.
Measures head circumference, checks for open neural tube defects, assesses the cerebellum, ventricles, and nuchal fold.
Assesses the four chambers of the heart, outflow tracts, and rhythm — detecting most major cardiac defects.
Full-length spine evaluation to exclude spina bifida and other spinal abnormalities.
Both kidneys assessed for size, echogenicity, and pelvicalyceal dilatation; bladder filling confirmed.
Placental position (to detect low-lying placenta) and amniotic fluid index (AFI) — both essential safety checks.
Mrs Okafor's fears were specific — shaped by her colleague's experience. She was most worried about a kidney finding, but also about the heart (she had read about congenital heart defects being detected at this scan), and about the neural tube.
The Mascot Healthcare team explained before the scan began: the anomaly scan checks over 40 structures systematically. Most findings — if any — are minor and require only monitoring. A small percentage require specialist referral. And the majority of scans at this stage are completely normal.
Head and brain: head circumference 178 mm (50th centile); biparietal diameter 48 mm (50th centile); cerebellum 21 mm (normal); no ventriculomegaly; cavum septum pellucidum present. Spine: intact from cervical to sacral — no neural tube defect. Face: profile normal; no cleft lip detected.
Heart: four-chamber view normal; both outflow tracts visible and normal; rhythm regular; estimated fetal heart rate 148 bpm. Abdomen: stomach bubble present; cord insertion normal; no anterior wall defects. Kidneys: both identified, normal size and echogenicity; no pelvicalyceal dilatation; bladder filling confirmed.
Biometry: femur length 35 mm; abdominal circumference 161 mm; estimated fetal weight 322 g — all measurements consistent with 20 weeks 1 day. Placenta: posterior, grade 0, well clear of os. AFI: 14.2 cm (normal). Fetal sex: confirmed as female on parental request.
All 40 anatomical structures assessed — within normal limits. Fetal biometry consistent with 20 weeks 1 day. Posterior placenta, grade 0, clear of os. AFI normal. Female sex.
Continue antenatal care as planned. No referral required. Next scan: 32–34 weeks growth scan (routine). Advised on fetal movement monitoring.
Growth scan at 34 weeks: all measurements on centile. Delivered at 39 weeks 4 days — healthy baby girl, birth weight 3.4 kg, Apgar 9/10.
Mrs Okafor delivered a healthy baby girl at 39 weeks. The anomaly scan report that said "all normal" became, she said, the most important piece of paper she received during the pregnancy.
The 20-week anomaly scan is the most information-rich pregnancy scan. It assesses the fetal anatomy comprehensively — and for most women, it is the scan that provides the deepest reassurance. Anxiety before the scan is normal and universal.
Attending every recommended scan is not optional — it is part of responsible antenatal care. The anomaly scan at 18–22 weeks is the standard timing because fetal structures are large enough to assess clearly at this gestation.
The 20-week scan checks over 40 parts of your baby's body in 30 minutes. For most women, the result is "all normal" — and those two words are worth the wait.
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