AMMA Center for Diagnosis & Preventive Medicine Pvt Ltd, Kochi

REDEFINING ANOMALY SCANS

It is time to redefine anomaly scans. The partial or incomplete evaluation of fetus and its environment
in the name of routine anomaly scan is an eyewash. Do these scans satisfy the concerns and hopes of
expectant parents ? Every parent has this question in mind when they come for an anomaly scan- Is my
baby structurally, genetically and functionally normal?

To answer this question, fetal anomaly scans has to incorporate

1. Targeted organ specific structural evaluation of the fetus- IT IS A WHOLE BODY SCAN-We need
to change our concept of fetal anomaly scan with the proper understanding of it being a whole-
body scan. Emphasis has to be given for fetal echo, fetal urosonogram, fetal neurosonography
,fetal face evaluation and musculoskeletal assessment.

2. Use of high resolution equipments and volume imaging techniques- 2D,3D and 4D imaging
techniques like STIC(Spatial temporal image resolution) and Multislice Ultrasound increases the
quality of anomaly scan .High resolution scanning machines are to be made mandatory for
anomaly evaluation. Use of low resolution equipment and improper settings will not allow the
examiner a proper evaluation of fetus. The ability of 3D & 4D in visualizing surface features,
reconstructions and computer assisted analysis of fetal structures adds new planes in fetal
imaging.

3. Evaluation of genetic markers-The importance of nuchal translucency, nuchal fold thickness,

nasal bone ,ductus venosus flow and soft tissue markers has to be incorporated into anomaly
scan. Multiple genetic markers in fetal imaging becomes the beginning point for invasive tests
to detect genetic abnormality.

4. Serial assessment- The tendency of doing a single anomaly scan at 18-20 wks can be disastrous
in cases like achondroplasia, skeletal dysplasias, late onset hydrocephalus, diaphragmatic hernia
etc as these cases presents usually after 24wks. Ideally anomaly scans has to be done at
different intervals, preferably, 11-14wks, 18-23wks and 32wks.

5. Assessment of fetal environment.-The placenta, umbilical cord, amniotic fluid,IUGR and signs of
intrauterine infection and hemolytic anemias has to be evaluated .

6. Evaluation of functional assessment and fetal developmental milestones.-Bladder

emptying,gastric emptying, fetal diaphragmatic movements, body and limb movements, etc has
to be assessed as part of anomaly scan.

7. Counseling has to be made an integral part of anomaly scan.

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AMMA Center for Diagnosis & Preventive Medicine Pvt Ltd, Kochi

It has to be emphasized that fetal medicine is a multidisciplinary entity and requires interdisciplinary
interactions between,Obstetricians, radiologists, neonatologists, pediatric geneticists, pediatric
cardiologists, and pediatric surgeons .Each specialist working as separate islands will not give the true
insights in fetal medicine.

The importance of fetal imaging has to be understood in the context of the findings of new researches in
genetics and fetal antecedents of disease susceptibility,developmental biology etc. Genetics and fetal
antecedents of disease susceptibility includes the interaction of the genotype with socioeconomic,
environmental and psychological factors in the fetal and postnatal environment that contribute to
health or the pathophysiology of diseases.

Basic understanding of the biological and adaptive mechanisms operative during both very early fetal
and intrauterine life and early childhood will lead to new insights into diagnosis, pathophysiology and
treatment of a wide spectrum of human diseases .

Fetal imaging offers a major window to look into the fetal development, behavior, structure, genetic
markers and functions of different organs and systems.

It is time to redefine anomaly scans. Our concepts about anomaly scans has to change from the routine
anomaly scans. Before we change the systems we need to change the assumptions on which present
systems are built. I wish this article will help all those interested in fetal medicine to review their
present concepts on anomaly scans.

DR. RIJO MATHEW, MD, DNB

DIRECTOR, AMMA SCANS, KOCHI

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