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Test done between the 14th and 22nd week of pregnancy, preferably for women 35 years and older, who used drugs, or have diabetes.

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Also Known as Alpha-Fetoprotein Test (AFP)

MSAFP is a screening test that examines the level of alpha-fetoprotein in the mother's blood during pregnancy. This is not a diagnostic test. It is often part of the triple screen test that assesses whether further diagnostic testing may be needed.

What is a screening test?

It is very important to remember what a screening test is before getting one performed. This will help alleviate some of the anxiety that can accompany test results.

Screening tests do not look only at results from the blood test. They compare a number of different factors (including age, ethnicity, results from blood tests, etc...) and then estimate what a person's chances are of having an abnormality.

These tests DO NOT diagnose a problem; they only signal that further testing should be done.

How is the MSAFP performed?

Blood is drawn from veins in the mother's arm and sent off to a laboratory for analysis. Results are usually returned between one and two weeks.

When is MSAFP performed?

MSAFP may be performed between the 14th and 22nd weeks of pregnancy, however it seems to be most accurate during the 16th to 18th week. Your levels of AFP vary during pregnancy so accurate pregnancy dating is imperative for more reliable screening results.
All pregnant women should be offered the MSAFP screening, but it is especially recommended for:
What does the MSAFP test look for?

Alpha- fetoprotein(AFP) is found in both fetal serum and also amniotic fluid.

This protein is produced early in gestation by the fetal yolk sac and then later in the liver and gastrointestinal tract. The true function of AFP is unknown.

We do know that this protein's level increases and decreases during certain weeks of pregnancy which is why accurate pregnancy dating is crucial.

The AFP test is measuring high and low levels of alpha-fetoprotein. The results are combined with the mother's age and ethnicity in order to assess probabilities of potential genetic disorders.

High levels of AFP may suggest the developing baby has a neural tube defect such as spina bifida or anencephaly.

High levels of AFP may also suggest defects with the esophagus or a failure of your baby's abdomen to close.However, the most common reason for elevated AFP levels is inaccurate dating of the pregnancy.

Low levels of AFP and abnormal levels of hCG and estriol may indicate the developing baby has Trisomy 21( Down syndrome), Trisomy 18 (Edwards Syndrome) or another type of chromosome abnormality.
Abnormal levels may also be a result of the following:
What do MSAFP results mean?

It is important to remember that the AFP is a screening test and not a diagnostic test. This test only notes that a mother is at risk of carrying a baby with a potential disorder.

There are approximately 25 to 50 abnormal test AFP results for every 1,000 pregnancies tested.

Of these abnormal results, only 1 in 16 to 1 in 33 will actually have a baby that has been affected with a neural tube defect or other condition.

75% to 90% of babies with neural tube defects are discovered through AFP screening. Click To Tweet

Abnormal test results warrant additional testing for making a diagnosis.

A more conservative approach involves performing a second MSAFP or complete triple screen test followed by a high definition ultrasound.

If the testing still maintains abnormal results, a more invasive procedure such as amniocentesis may be performed.

Invasive procedures should be discussed thoroughly with your healthcare provider. It is also important to talk through further testing with you partner. Additional counseling and discussions with a counselor, social worker or minister may prove helpful.

What are the risks and side effects of MSAFP to the mother or baby?

Except for the discomfort of drawing blood, there are no risks or side effects associated with the MSAFP.

What about further testing?

MSAFP is a routine test that is not an invasive procedure and poses no known risks to the mother or baby. The MSAFP results may warrant additional testing.
The reasons to pursue further testing or not may vary from person to person and couple to couple. Performing further testing allows you to confirm a diagnosis and then provides you with certain opportunities:

Pursue potential medical interventions that may exist

Begin planning for a child with special needs

Start addressing anticipated lifestyle changes

Identify support groups and resources

Make a decision about carrying the child to term

Some individuals or couples may elect not to pursue further testing for various reasons:

They are comfortable with the results no matter what the outcome is

Because of personal, moral, or religious reasons, making a decision about carrying the child to term is not an option

Some parents choose not to allow any testing that poses any risk of harming the developing baby

It is important to discuss the risks and benefits of further testing thoroughly with your healthcare provider. Your healthcare provider will help you evaluate if the benefits from the results could outweigh any risks from the procedure.

Compiled using information from the following sources:

1. William's Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 13.

2. Mayo Clinic Complete Book of Pregnancy & Baby's First Year Johnson, Robert V., et al, Ch. 6.

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MSAFP is a screening test that examines the level of alpha-fetoprotein in the mother's blood during pregnancy. This is not a diagnostic test. It is often part of the triple screen test that assesses whether further diagnostic testing may be needed. It is very important to remember what a screening test is before getting one performed.

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A State's Interest in Prenatal Screenings- AL

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A State's Interest in Prenatal Screenings- AL

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State government has involved itself in the promotion of prenatal screenings in an attempt to monitor the birth defects present in the state.

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Pros and Cons of Prenatal Screening- CH 

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Pros and Cons of Prenatal Screening- CH 

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Prenatal screening is both a positive and negative thing depending on peoples believes.

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Prenatal genetic testing has been a source of controversy for many parents to be. There are certainly pros and cons to the process, many of which come down to personal beliefs and medical preparedness that can be difficult to look at when you're expecting. Overall, the genetic testing is there to offer you certain choices in response to the probability of having a healthy or unhealthy child in your future.

When you decide on genetic testing, you end up with information that you wouldn't normally have. This can mean that you could expect to make decisions that you otherwise wouldn't be making. There are many people who choose to do this because they want the information and others who end up feeling pressured into by family or friends, or even their own doctor.
Choosing the Genetic Tests You Want
There are some great advancements in genetic testing that offer you a wide range of options for determining genetic markers. Some of the tests will only show markers, which means possibilities. This can make it more difficult to make a determination regarding how you're going to respond to test results.

Tests can be tailored to a parent's preference, which has also stirred up controversy. For instance, there has been a movement in some scientific circles to test for gene markers that indicate the tendency for homosexuality, autism, and violence. This has led to a public outcry to stop the research.

There are currently genetic tests that help parents understand the likelihood of having a child with chromosomal disorders. Cystic fibrosis, cancer, and downs syndrome are often on the screening list. Cystic fibrosis is often determined by testing the parents instead of the fetal tissue, but two positive parents often choose to test the fetus. Not all babies born to parents with the genetic tendency will have children with cystic fibrosis.

What Do the Results Mean?

The results of prenatal genetic testing are not clear cut. Even if you have a "positive" result for the test you still don't know whether a child would be born with symptomatic traits or even if the condition would be severe enough to cause any life changing elements. In some cases the likelihood would be high, as in cases with downs syndrome and cystic fibrosis. Yet at the same time there is no way to determine the future course of severity or the future course of medicine. By the time the child is 5 years old there may very well be new alternative treatments for some conditions that are currently unavailable.

At the same time, having positive results can give you time to reflect on the potential options that you may have. There is a big difference between prenatal genetic testing and genetic engineering. Engineering allows you to bypass certain genetic markers in order to eliminate the potential for certain diseases and illnesses.

The test results can be use only as a likelihood. In cases where parents have experienced previous positive results for genetic conditions and have given birth to children that have the condition, the likelihood is higher yet, but still not a guarantee.
Using Tests to Prepare
Most parents can use the information they receive from the testing to prepare for the possibility that their child may have special needs. This may include decisions that are legally based such as making sure medical insurance coverage starts immediately, taking out life insurance policies on their child, and having a donation fund set up well in advance. It can mean the possibility of preparing to keep one parent at home and moving into a home where that can happen.

In some cases parents make the choice to terminate the pregnancy. Tay sachs syndrome is one of the more detrimental diseases that can lead to a very short and very painful life and many parents choose not to bring a child into the world who is going to suffer and die. It's a difficult decision but often parents who make this decision do so with a full range of knowledge regarding the condition and its severity.
Questioning Knowledge
Some experts recommend questioning the value of believing you have knowledge. Even with prenatal testing you can't know if you're going to have a healthy, happy baby. There are plenty of illnesses and conditions that can't be tested for.

Some experts believe that the knowledge is detrimental. It can cause futurizing. If you know your child has a marker for a certain condition how likely are you going to be to relax and allow a healthy child to be healthy? Is it not possible to live in the future and believe that every cough, sniffle, or ear infection could be a sign that they are getting detrimentally ill? Parents have to be prepared to live with the knowledge they seek, and the medical community does not necessarily help parents do that.
Seeking Answers Early
At the same time, when symptoms of the genetically tested illness do appear, you have a direct line to a diagnosis. You can save both time and money when you can offer the child's doctor a genetically tested likelihood. You also have had time to look into treatment or management options and then be prepared for the day that symptoms develop.

Diagnostics are one of the most expensive aspects of medical conditions. Being able to provide the physician with more than a family history can cut out the costs and time associated with having to run the gamete of diagnostics in order to find out what the problem really is.
Potential Cures
Some people believe that gene therapy is going to one day transform the way we treat illness and disease. The remarkable progress we've made on this has been astounding. Many parents believe that by going through with genetic testing their children will have the option of going into gene therapy for any future condition that they may have that can be treated this way.

Is it possible that this will become a possibility in your child's future? Of course. It is guaranteed? Nothing is guaranteed. You can have clean genetic markers and still lose a child to SIDS. You can have a host of genetic markers and end up with a perfectly healthy child that lives beyond the next 100 years. There is no way to determine or control the future. The most we can do is learn how the knowledge is useful and whether it is actually useful for us on a personal level. Beyond that, there still have to be mysteries in the world.

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The Pros and Cons of Prenatal Genetic Testing

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Prenatal genetic testing has been a source of controversy for many parents to be. There are certainly pros and cons to the process, many of which come down to personal beliefs and medical preparedness that can be difficult to look at when you're expecting.

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Prenatal screenings can detect birth defects in the fetus, such as Down's Syndrome. It gives the parents the choice to either abort the baby or keep it no matter the abnormalities it might have. Although, prenatal screenings can not provide a definite answer whether or not the baby will have birth defects.

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Prenatal screening tests are a set of procedures that are performed during pregnancy on expectant mothers to determine whether a baby is likely to have specific birth defects. Most of these tests are noninvasive. They're usually performed during the first and second trimesters, although some are performed during the third.

A screening test can only provide your risk, or probability, that a particular condition exists. When the results of a screening test are positive, diagnostic tests can provide a definitive answer.

Some prenatal screening tests are routine procedures, such as glucose tolerance tests, which check for gestational diabetes. Women who have a higher risk of having a child with certain conditions are usually offered additional screening tests. For example, pregnant women who've lived in regions where tuberculosis is common should have a tuberculin skin test.

First trimester screening tests can begin as early as 10 weeks. These usually involve blood tests and an ultrasound. They test your baby's overall development and check to see if your baby is at risk for genetic conditions, such as Down syndrome. They also check your baby for heart defects, cystic fibrosis, and other developmental problems.

Second trimester screening tests occur between 14 and 18 weeks. They can involve a blood test, which tests whether a mother is at risk for having a child with Down syndrome or neural tube defects, as well as an ultrasound.

Ultrasound

An ultrasound uses sound waves to create an image of the baby in the uterus. The test is used to determine the size and position of your baby, confirm how far along you are in your pregnancy, and find any potential abnormalities in the structure of your baby's growing bones and organs.

A special ultrasound called a nuchal translucency ultrasound is performed between the 11th and 14th weeks of pregnancy. This ultrasound checks the accumulation of fluid at the back of your baby's neck. When there's more fluid than normal, this means there's a higher risk of Down syndrome.

During the second trimester, a more detailed ultrasound, which is often called a fetal anatomy survey, is used to evaluate the baby carefully from head to toe for any birth defects. However, not all birth defects are visible by ultrasound.

Early Blood Tests

During the first trimester, two types of blood tests called a sequential integrated screening test and a serum integrated screening are conducted. They're used to measure the levels of certain substances in your blood, namely, pregnancy-associated plasma protein-A and a hormone called human chorionic gonadotropin. Abnormal levels of either mean there's a higher risk of a chromosome abnormality.

At your first prenatal visit, your blood may also be tested to see if you're immunized against rubella and to screen for syphilis, hepatitis B, and HIV.

A blood test will also be used to determine your blood type and Rh factor, which determines your Rh compatibility with your growing fetus. You can be either Rh-positive or Rh-negative. Most people are Rh-positive, but if a mother is found to be Rh-negative, her body will produce antibodies that will affect any subsequent pregnancies.

When there's an Rh incompatibility, most women will be given a shot of Rh-immune globulin at 28 weeks and again a few days after delivery. Incompatibility occurs if a woman is Rh-negative and her baby is Rh-positive. If the woman is Rh-negative and her baby's positive, she'll need the shot. If her baby is Rh-negative, she won't.

Chorionic Villus Sampling

Chorionic villus sampling is an invasive screening test that involves taking a small piece of tissue from the placenta. It's usually performed between the 10th and 12th weeks and is used to test for genetic abnormalities, like Down syndrome, and birth defects. There are two types. One type tests through the belly, which is called a transabdominal test, and one type tests through the cervix, which is called a transcervical test.

Testing has some side effects, like cramps or spotting. There's also a small risk of miscarriage.

Blood Tests

A quad marker screening test is a blood test conducted during the second trimester. It's done to test your blood for indications of birth defects, such as Down syndrome. It measures four of the fetal proteins.

A quad marker screening is typically offered if you start prenatal care too late to receive either the serum integrated screening or the sequential integrated screening. It has a lower detection rate for Down syndrome and other birth defects than a sequential integrated screening test or serum integrated screening test.

Glucose Screening

A glucose screening test checks for gestational diabetes. This is usually a condition that can develop during pregnancy. It's usually temporary. Gestational diabetes can increase your potential need for a caesarean delivery because babies of mothers with gestational diabetes are usually born larger. Your child may also have low blood sugar in the days following delivery.

The test is usually performed during the second trimester. It involves drinking a sugary solution, having your blood drawn, and then checking your blood sugar levels. If you do test positive for gestational diabetes, you have a higher risk of developing diabetes within the following 10 years, and you should get the test again after the pregnancy.

Amniocentesis

During amniocentesis, amniotic fluid is removed from the uterus for testing. Amniotic fluid surrounds the baby during pregnancy. It contains fetal cells with the same genetic makeup as the baby, as well as various chemicals produced by the baby's body. There are several types of amniocentesis.

A genetic amniocentesis tests for genetic abnormalities, such as Down syndrome and spina bifida. A genetic amniocentesis is usually performed after week 15 of the pregnancy. It may be considered if:

a prenatal screening test showed abnormal results

you had a chromosomal abnormality during a previous pregnancy

you're 35 or older

you have a family history of a specific genetic disorder

you or your partner is a known carrier of a genetic disorder

Amaturity amniocentesis is performed later, during the third trimester, to determine whether or not your baby's lungs are ready for birth. This diagnostic test is only done if a planned early delivery through either induction of labor or a cesarean delivery is being considered for medical reasons. It's usually done between weeks 32 and 39.

Group B Strep Screening

Group B Streptococcus (GBS) is a type of bacteria that can cause serious infections in pregnant women and newborns. GBS is often found in the following areas in healthy women:

GBS in the vagina generally isn't harmful to a woman regardless of whether she's pregnant. However, it can be very harmful to a newborn baby who doesn't yet have a robust immune system. GBS can cause serious infections in babies exposed during birth. You can be screened for GBS with a swab taken from your vagina and rectum at 35-37 weeks.

If you test positive for GBS, you'll receive antibiotics while you're in labor to reduce your baby's risk of contracting a GBS infection.

Diagnostic tests are the next step after a screening test that yields a positive result. They leave virtually no doubt as to the existence or absence of certain birth defects.

Diagnostic tests are more invasive than screening tests. They're usually only done if there's a specific concern, if a screening test indicates a problem, or if your age, family history, or medical history suggests that you may have an increased risk for a problematic pregnancy. Diagnostic tests can carry a very small risk of miscarriage.

Prenatal screening tests can be an important source of information for many people. While many of these tests are routine, some can be a much more personal decision. Talk to your doctor about your concerns if you're not sure if you should be screened or if you're feeling anxious. You can also ask to be referred to a genetic counselor. Your healthcare team can discuss the risks and benefits with you and help you decide whether prenatal screening is right for you.

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Prenatal Screening Tests: Types, Diagnosis, and Takeaways

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Prenatal screening tests are a set of procedures that are performed during pregnancy on expectant mothers to determine whether a baby is likely to have specific birth defects. Most of these tests are noninvasive. They're usually performed during the first and second trimesters, although some are performed during the third.

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Risks of Amniocentesis and CVS screenings - LA

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Risks of Amniocentesis and CVS screenings - LA

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Amnio: 1/200 risk of miscarriage and 1-2% of women have spotting, cramping, or leaking of amniotic fluid after the procedure
CVS: 1/100 risk of miscarriage and a possible risk of getting a uterine infection

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Alloy Photography/ Veer

Blood tests done during preconception testing and first- and second-trimester pregnancy screenings are basically risk-free other than the slight pinch of the needle and some bruising. The risks of most genetic testing are more emotional than physical, says Ellen Simpson, Ph.D., a genetics counselor in the prenatal diagnostic center at the University of California, San Francisco Medical Center. It can be disappointing and incredibly stressful if you find out during preconception testing that your and/or your partner carry carry gene mutations that could be passed along to future children, and waiting for the results of prenatal screenings can be anxiety-inducing.

If your pregnancy is determined to be higher risk you may be offered two other genetic diagnostic tests -- amniocentesis and chorionic villus sampling -- both of which do have possible side effects. In an amnio, a doctor removes a small amount of amniotic fluid (which contains some fetal cells) by inserting a needle through your abdomen into the uterus to diagnose many genetic conditions including Down syndrome and spina bifida, sickle cell anemia, cystic fibrosis, and Tay-Sachs. One to 2 percent of women have spotting, cramping, or leaking of amniotic fluid after the test, and there is about a very small 1 in 200 risk of miscarriage. Chorionic villus sampling (CVS) is done by inserting a needle through the cervix or abdomen to take a sample of the placental tissue. CVS can diagnose Tay-Sachs, sickle cell, CF and other genetic conditions, but not spina bifida or certain others. Risk of miscarriage after CVS is about 1 in 100. There is also a very small risk of uterine infection.
Copyright © 2013 Meredith Corporation. All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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Blood tests done during preconception testing and first- and second-trimester pregnancy screenings are basically risk-free other than the slight pinch of the needle and some bruising. The risks of most genetic testing are more emotional than physical, says Ellen Simpson, Ph.D., a genetics counselor in the prenatal diagnostic center at the University of California, San Francisco Medical Center.

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There are various tests performed to determine the health and status of the  fetus. All tests are voluntary.

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A diagnosis preformed to test a baby for any genetic diseases through an ultra sound and the withdrawal of amniotic fluid.

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Amniocentesis is a diagnostic test that may be recommended by your health care provider following an abnormal triple test result. Inherited or genetic concerns lead some parents to choose amniocentesis to determine if specific genetic disorders may be present in their baby.

How is amniocentesis performed?

An ultrasound is used as a guide to determine a safe location for the needle to enter the amniotic sac, so the fluid may be safely removed. A sample of amniotic fluid is collected through the needle. The procedure takes about 45 minutes, although the collection of fluid takes less than five minutes.

The amniotic fluid, which contains cells shed by the fetus, is sent to the laboratory for analysis. Results can take anywhere from a few days to a couple weeks to be returned.

When is amniocentesis performed?

Amniocentesis is usually performed between 14 and 20 weeks. Some medical facilities may perform amniocentesis as early as 11 weeks.

Amniocentesis can be used later in the third trimester for a few reasons. Your healthcare provider may recommend the procedure if your membranes have ruptured prematurely, in order to assess for uterine infections. Amniocentesis may also help determine the severity of fetal anemia in babies with Rh disease, and assist your physician determine whether the fetus requires lifesaving blood transfusions.

Amniocentesis is sometimes done to assess lung maturity. If so, this is done shortly before delivery.

What does the amniocentesis test look for?

Amniocentesis detects chromosome abnormalities, neural tube defects, and genetic disorders. Down syndrome or Trisomy 21 is the most common chromosome abnormality. Genetic disorders include disorders such as cystic fibrosis. The most common neural tube defect is spina bifida.

Amniocentesis is occasionally used late in pregnancy to assess whether the baby's lungs are mature enough for the baby to breathe on his own.

Amniocentesis also provides access to DNA for paternity testing prior to delivery. DNA is collected from the potential father and is compared to DNA obtained from the baby during amniocentesis. The results are accurate (99%) for determining paternity.

What do amniocentesis results mean?

Amniocentesis is a diagnostic test that detects chromosome abnormalities, neural tube defects and genetic disorders with high levels of accuracy (98-99%). Although the probabilities of identification are high, this test does not measure the severity of these birth defects.

Alpha-fetoprotein levels and advanced level ultrasounds may assist in assessing degree of disability that may be present.

What are the risks and side effects to the mother or baby?

Although amniocentesis is considered to be a safe procedure, it is recognized as an invasive diagnostic test that does pose potential risks. According to the Mayo Clinic, it is performed approximately 200,000 times a year. Miscarriage is the primary risk related to amniocentesis.

The risk of miscarriage ranges from 1 in 400 to 1 in 200. In facilities where amniocentesis is performed regularly, the rates are closer to 1 in 400. Miscarriages can occur because of infection in the uterus, water breaking, or labor being induced prematurely.

Although extremely rare, it is possible for the needle to come in contact with the baby. Great precautions are taken by using a sonogram to guide the needle away from the baby. The mother may experience a sharp pain when the needle enters the skin and again when it enters the uterus.

Following completion of the procedure, the mother may experience other side effects that include:

Leakage of fluid

Minor irritation around the puncture site

Contact your healthcare provider if these complications continue or get worse.

What are the reasons to test or not test?

The reasons to test or not vary from person to person and couple to couple.

Performing the tests and confirming the diagnosis provides you with certain opportunities:

Pursue potential interventions that may exist (i.e. fetal surgery for spina bifida)

Begin planning for a child with special needs

Start addressing anticipated lifestyle changes

Identify support groups and resources

Some individuals or couples may elect not to pursue testing or additional testing for various reasons:

They are comfortable with the results no matter what the outcome is

Because of personal, moral, or religious reasons, making a decision about carrying the child to term is not an option

Some parents choose not to allow any testing that poses any risk of harming the developing baby

It is important to discuss the risks and benefits of testing thoroughly with your healthcare provider. Your healthcare provider will help you evaluate if the benefits from the results could outweigh any risks from the procedure.

Compiled using information from the following sources:

1. Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 13.

2. Mayo Clinic Complete Book of Pregnancy & Baby's First Year. Johnson, Robert V., M.D., et al, Ch. 6.

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Amniocentesis - American Pregnancy Association

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Amniocentesis is a diagnostic test that may be recommended by your health care provider following an abnormal triple test result. Inherited or genetic concerns lead some parents to choose amniocentesis to determine if specific genetic disorders may be present in their baby.

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A test done betweek weeks 10 and 12 to screen the baby for genetic problems through the cervix or abdomen.

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Chorionic villus sampling: MedlinePlus Medical Encyclopedia

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Read our article and learn more on MedlinePlus: Chorionic villus sampling

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An ultrasound is a device that uses high frequency sound waves that travel through soft tissue and fluids to create an image that detects abnormalities of the fetus in the uterus.

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An ultrasound scan uses high-frequency sound waves to create images of the inside of the body. It is suitable for use during pregnancy.

Ultrasound scans, or sonography, are safe because they use sound waves or echoes to make an image, instead of radiation.

Ultrasound scans are used to evaluate fetal development, and they can detect problems in the liver, heart, kidney, or abdomen. They may also assist in performing certain types of biopsy.

The image produced is called a sonogram.

Fast facts on ultrasound scans

Here are some key points about ultrasound scans. More detail is in the main article.

Ultrasound scans are safe and widely used.

They are often used to check the progress of a pregnancy.

They are used for diagnosis or treatment.

No special preparation is normally necessary before an ultrasound scan.

Concept

Ultrasound scans are carried out by a sonographer.

The person who performs an ultrasound scan is called a sonographer, but the images are interpreted by radiologists, cardiologists, or other specialists.

The sonographer usually holds a transducer, a hand-held device, like a wand, which is placed on the patient's skin.

Ultrasound is sound that travels through soft tissue and fluids, but it bounces back, or echoes, off denser surfaces. This is how it creates an image.

The term "ultrasound" refers to sound with a frequency that humans cannot hear.

For diagnostic uses, the ultrasound is usually between 2 and 18 megahertz (MHz).

Higher frequencies provide better quality images but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies.

Lower frequencies penetrate deeper, but the image quality is inferior.

How does it capture an image?

Ultrasound will travel through blood in the heart chamber, for example, but if it hits a heart valve, it will echo, or bounce back.

It will travel straight through the gallbladder if there are no gallstones, but if there are stones, it will bounce back from them.

The denser the object the ultrasound hits, the more of the ultrasound bounces back.

This bouncing back, or echo, gives the ultrasound image its features. Varying shades of gray reflect different densities.

Ultrasound transducers

The transducer, or wand, is normally placed on the surface of the patient's body, but some kinds are placed internally.

These can provide clearer, more informative images.

Examples are:

an endovaginal transducer, for use in the vagina

an endorectal transducer, for use in the rectum

a transesophageal transducer, passed down the patient's throat for use in the esophagus

Some very small transducers can be placed onto the end of a catheter and inserted into blood vessels to examine the walls of blood vessels.

Uses

Ultrasound images are made from reflected sound, and a diagnosis can then be made.

Ultrasound is commonly used for diagnosis, for treatment, and for guidance during procedures such as biopsies.

It can be used to examine internal organs such as the liver and kidneys, the pancreas, the thyroid gland, the testes and the ovaries, and others.

An ultrasound scan can reveal whether a lump is a tumor. This could be cancerous, or a fluid-filled cyst.

It can help diagnose problems with soft tissues, muscles, blood vessels, tendons, and joints. It is used to investigate a frozen shoulder, tennis elbow, carpal tunnel syndrome, and others.

Circulatory problems

Doppler ultrasound can assess the flow of blood in a vessel or blood pressure. It can determine the speed of the blood flow and any obstructions.

An echocardiogram (ECG) is an example of Doppler ultrasound. It can be used to create images of the cardiovascular system and to measure blood flow and cardiac tissue movement at specific points.

A Doppler ultrasound can assess the function and state of cardiac valve areas, any abnormalities in the heart, valvular regurgitation, or blood leaking from valves, and it can show how well the heart pumps out blood.

It can also be used to:

examine the walls of blood vessels

check for DVT or an aneurysm

check fetal heart and heartbeat

evaluate for plaque buildup and clots

assess for blockages or narrowing of arteries

A carotid duplex is a form of carotid ultrasonography that may include a Doppler ultrasound. This would reveal how blood cells move through the carotid arteries.

Ultrasound in anesthesiology

Ultrasound is often used by anesthetists to guide a needle with anesthetic solutions near nerves.

Ultrasound in emergency medicine

Ultrasound is commonly used in emergency medicine to assess various conditions, including:

traumatic injuries

pericardial tamponade

fluid buildup around the heart

hemoperitoneum, or blood leakage in the abdomen

Abdominal sonography

Gastroenterologists use ultrasound to generate images of the spleen, kidneys, bile ducts, gall bladder, liver, aorta, inferior vena cava, pancreas, and other solid organs located in the abdomen.

It can evaluate patients for suspected gallstones or inflammation of the gallbladder, known as cholecystitis.

It can detect if the appendix is swollen or inflamed, which would suggest appendicitis. Blood work would confirm an infection.

Fat and gas in the bowel can sometimes block the ultrasound waves, making diagnosis more difficult.

Newborn infants

The sonographer can perform an ultrasound scan on a newborn by placing the probe on the fontanelle, the soft spot on the top of the skull.

This can check for abnormalities in the brain, hydrocephalus, and periventricular leukomalacia, a form of white-matter brain injury.

As the fontanelle grows smaller in time, the quality of the images becomes poorer.

Obstetric ultrasonography

Ultrasound devices emit a high-frequency sound from their wand and can be used to give an image of the inside of a person's body, for example, during pregnancy.

Ultrasound is part of standard prenatal care. It gathers images of the fetus or embryo in the uterus.

Obstetric ultrasonography can reveal various aspects of both fetal and maternal health. It can also help doctors assess the progress of the pregnancy.

The probe or transducer is typically placed on the mother's abdomen, but sometimes it is placed in the vagina.

A transvaginal scan can provide a clearer picture during early pregnancy, and it may be a better option if the mother has obesity.

Doppler sonography shows the fetal heartbeat. It can help the doctor detect signs of abnormalities in the heart and blood vessels.

Ultrasound and urology

In urology, ultrasound can check:

how much urine remains in the bladder after urinating

the health of the organs in the pelvic region, including the uterus and testicles

In young, adult males, ultrasound can distinguish different types of swelling from testicular cancer.

Pelvic sonographies can be internal or external.

In a male, the internal sonogram may be inserted into the rectum. In a female, it might be inserted into the vagina.

This can provide information about the prostate gland, ovaries, or uterus.

Ultrasound scans of the pelvic floor can help the doctor determine the extent of, for example, a pelvic prolapse, incontinence, or obstructed defecation.

Musculoskeletal sonography

Ultrasound can be used to examine ligaments, bone surfaces, soft tissue masses, nerves, muscles, and tendons.

What to expect

An ultrasound can be done at a doctor's office, at an outpatient clinic, or in the hospital.

Most scans take between 20 and 60 minutes. It is not normally painful, and there is no noise.

In most cases, no special preparation is needed, but patients may wish to wear loose-fitting and comfortable clothing.

If the liver or gallbladder is affected, the patient may have to fast, or eat nothing, for several hours before the procedure.

For a scan during pregnancy, and especially early pregnancy, the patient should drink plenty of water and try to avoid urinating for some time before the test.

When the bladder is full, the scan produces a better image of the uterus.

The scan usually takes place in the radiology department of a hospital. A doctor or a specially-trained sonographer will carry out the test.

External ultrasound

The sonographer puts a lubricating gel onto the patient's skin and places a transducer over the lubricated skin.

The transducer is moved over the part of the body that needs to be examined. Examples include ultrasound examinations of a patient's heart or a fetus in the uterus.

The patient should not feel discomfort or pain. They will just feel the transducer over the skin.

During pregnancy, there may be slight discomfort because of the full bladder.

Internal ultrasound

If the internal reproductive organs or urinary system need to be evaluated, the transducer may be placed in the rectum for a man or in the vagina for a woman.

To evaluate some part of the digestive system, for example, the esophagus, the chest lymph nodes, or the stomach, an endoscope may be used.

A light and an ultrasound device are attached to the end of the endoscope, which inserted into the patient's body, usually through the mouth.

Before the procedure, patients are given medications to reduce any pain.

Internal ultrasound scans are less comfortable than external ones, and there is a slight risk of internal bleeding.

Safety

Most types of ultrasound are noninvasive, and they involve no ionizing radiation exposure. The procedure is believed to be very safe.

However, since the long-term risks are not established, unnecessary "keepsake" scans during pregnancy are not encouraged. Ultrasound during pregnancy is recommended only when medically needed.

Anyone who is allergic to latex should inform their doctor so that they will not use a latex-covered probe.

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Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT

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An ultrasound scan uses high-frequency sound waves to create an image of the inside of the body. It is safe to use during pregnancy and is also a diagnostic tool for conditions that affect the internal organs, such as the bladder, and reproductive organs. Learn how ultrasound is used, operated, and interpreted here.