Ioannis Raptis has clinical experience from his position as Senior Consultant (Oberarzt) at the German perinatal center AKH Hagen. There, he received comprehensive training in Special Obstetrics and Perinatal Medicine (Spezielle Geburtshilfe und Perinatal Medizin) and specialized in high-risk pregnancies and complicated deliveries.
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The B-Level Ultrasound Examination, also known as the detailed fetal anatomy scan or Level II ultrasound scan, is one of the most important ultrasound examinations during pregnancy. It is usually performed between the 20th and 24th weeks of gestation. Its main purpose is to thoroughly assess the fetus’s anatomy and development, allowing for the early detection of potential structural abnormalities.
During the B-Level Ultrasound Examination, the fetus’s individual organs and anatomical systems are systematically assessed. In addition, fetal growth, the position and structure of the placenta, the amount of amniotic fluid, and the umbilical cord are evaluated. When indicated, ultrasound markers associated with an increased likelihood of certain chromosomal abnormalities may also be assessed.
The B-Level Ultrasound Examination involves a systematic and detailed assessment of fetal anatomy. Using specific ultrasound views, the individual organs and anatomical systems are evaluated, including:
At the same time, fetal biometric measurements are taken to assess fetal growth. The position and structure of the placenta, the amount of amniotic fluid, and the umbilical cord are also examined.
During the examination, certain ultrasound markers (soft markers) may also be assessed, as they can be associated with an increased likelihood of specific chromosomal abnormalities.
The B-Level Ultrasound Examination is not primarily a chromosomal screening test. The risk assessment for common chromosomal abnormalities is usually performed earlier in pregnancy through nuchal translucency screening and, depending on the individual case, other prenatal screening methods, such as Non-Invasive Prenatal Testing (NIPT).
The B-Level Ultrasound Examination does not require any special preparation. Pregnant women can eat and drink normally before the examination and do not need to follow a special diet in the days leading up to it.
In some cases, a moderately full bladder may be recommended, as this can help improve the visualization of certain anatomical structures.
It is also helpful to bring the results of previous pregnancy examinations, such as the nuchal translucency scan, NIPT, or any other prenatal screening tests, so that they can be taken into consideration during the examination.
The B-Level Ultrasound Examination is performed by a physician specializing in prenatal ultrasound screening and usually takes approximately 20–40 minutes. It is painless and safe for both the mother and the fetus.
The examination may take longer if the fetus’s position does not allow all anatomical structures to be visualized immediately, if technical difficulties arise, or if specific findings require a more detailed assessment. In some cases, a short break or a follow-up examination at a later time may be necessary to ensure an accurate and complete evaluation.
The ultrasound scan is primarily performed transabdominally, with the pregnant woman lying on her back or slightly on her side.
During the examination, specific standardized ultrasound views are obtained in accordance with international guidelines and established prenatal ultrasound screening protocols, such as those of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and, where applicable, the Fetal Medicine Foundation (FMF).
After the B-Level Ultrasound Examination is completed and all the necessary anatomical structures have been assessed, the physician informs the parents about the ultrasound findings.
In most cases, the examination does not reveal any significant structural abnormalities. However, if a finding requires further evaluation, the physician explains its significance and recommends the appropriate next steps.
Depending on the type of finding, further investigations may be necessary, such as a specialized follow-up ultrasound scan, fetal echocardiography, or invasive prenatal diagnostic testing, such as amniocentesis. In some cases, additional ultrasound examinations may also be recommended to monitor the pregnancy.
The B-Level Ultrasound Examination is one of the most important prenatal screening methods for detecting structural abnormalities in the fetus. When performed by a properly trained and experienced physician using modern ultrasound equipment, it can detect a large proportion of serious congenital structural abnormalities. However, no ultrasound examination can rule out all possible fetal conditions or developmental disorders.
The detection rate depends significantly on the type of abnormality. Some conditions have characteristic ultrasound features and can be identified with high accuracy, while others, particularly certain congenital heart defects or minor structural abnormalities, may be more difficult to diagnose during the second-trimester ultrasound scan.
The quality of ultrasound imaging may also be affected by factors such as:
Furthermore, some conditions may not yet be visible during the second trimester or may develop later in pregnancy. For this reason, a normal B-Level Ultrasound Examination significantly reduces the likelihood of a serious structural abnormality but cannot guarantee the absence of all congenital, genetic, or developmental conditions.
The B-Level Ultrasound Examination is an essential second-trimester prenatal examination, as it allows for a detailed assessment of fetal anatomy and development and contributes to the early detection of many congenital structural abnormalities.
Although no prenatal ultrasound examination can rule out all possible conditions, the findings provide valuable information about the progress of the pregnancy and, when necessary, help determine the need for further investigation or specialized monitoring.
To achieve the highest possible diagnostic accuracy, it is particularly important that the examination is performed by a physician specializing in prenatal ultrasound screening, using modern, high-resolution ultrasound equipment.
For specialized guidance and support at every stage of pregnancy, Obstetrician–Gynecologist Dr. Ioannis Raptis and his team are at your disposal. Contact us for more information or to schedule an appointment.
