A Level 2 ultrasound is a comprehensive, detailed evaluation of fetal anatomy and development. It is a much more in-depth evaluation of the fetus than a Standard or Level 1 ultrasound. The ultrasound examination is usually performed at about 20 weeks gestational age. An ultrasound evaluation performed prior to this time may be limited because structures may still be too small to accurately evaluate. This ultrasound examination requires appropriately trained physicians and ultrasonographers as well as state of the art ultrasound equipment. Physicians at the Adventist Maternal Fetal Medicine Center have received additional training in accurately diagnosing birth defects and managing pregnancies to optimize outcome. Ultrasound equipment at the Adventist Maternal Fetal Medicine Center is state of the art and includes 3-D and 4-D imaging. A high risk Level 2 ultrasound can be performed at the Maternal Fetal Medicine Center.
When a Level 2 Ultrasound is Recommended
Common indications for a Level 2 ultrasound include family history of birth defects, maternal medical problems associated with birth defects (poorly controlled diabetes, for example), exposure to medications associated with birth defects, a maternal age of 35 or older, abnormal serum screening results, and birth defects suspected on a Level 1 ultrasound.
The vast majority of patients who have a baby with a birth defect are considered low risk at the beginning of the pregnancy. If a baby does have a birth defect, usually there is nothing the mother did to cause it to happen. Also, there is usually nothing anyone could have done to prevent the birth defect. However, the detection of some birth defects (i.e., heart defects) at the time of the Level 2 can help with prenatal treatment or immediate treatment at delivery to prevent serious complications or an adverse outcome. A comprehensive Level 2 ultrasound is available for any patient, including low-risk patients, at the Adventist Maternal Fetal Medicine Center.
The detection rate for congenital anomalies (birth defects) with a level 2 ultrasound is around 70 to 80 percent, while the detection rate can be as low as 15 to 20 percent with a standard ultrasound. While there is no ultrasound that can detect 100 percent of serious birth defects, most birth defects that are undetected with a Level 2 ultrasound usually are clinically less significant (such as a small hole in the heart which commonly closes on its own after birth or an isolated cleft palate with intact upper lip which can be fixed surgically after birth without any long-term complications).
Treatment and Care Options
If a birth defect is detected, the parents meet with a team of healthcare providers to formulate a plan of care for their baby throughout the remainder of the pregnancy, at time of delivery and into the newborn period. Prior to delivery, parents also have the opportunity to meet with the neonatologists and pediatric subspecialists who will care for the baby after birth. This is done so prospective parents can obtain as much information as possible and be well informed on the care of the baby after it is born. Also, the other members of the healthcare team at Adventist Maternal Fetal Medicine Center (specially trained nurses, genetic counselors) can provide the parents with additional information on educational resources and support groups. Parents will be offered a tour of the Adventist Maternal Fetal Medicine Center special care nursery (level 3 nursery), which is equipped to care for the vast majority of babies who have a birth defect.