Warning Signs of a Problematic Ultrasound During Pregnancy

Pregnancy is a time of anticipation, joy, and hope. For many parents, ultrasound scans offer the first glimpse into their baby’s development and bring reassurance that everything is progressing normally. However, not all ultrasound results bring comforting news. Occasionally, scans reveal findings that may suggest potential concerns or complications. Recognizing the warning signs of a problematic ultrasound during pregnancy is crucial for early intervention, informed decision-making, and emotional preparedness.

In this guide, we’ll walk through the key signs that can appear during an ultrasound; particularly using advanced mobile ultrasound technology like the Sono Mobile™️ CT61; and what those signs may mean. We’ll explain how healthcare providers interpret such findings, what follow-up procedures may be recommended, and how to manage the emotional side of unexpected results.

What Is Considered Concerning Ultrasound?

An ultrasound becomes “concerning” when it reveals findings that deviate from the normal expectations for a baby’s age, size, shape, or movement. While not every anomaly is dangerous or life-threatening, abnormal ultrasound results often require additional tests or monitoring.

Some of the most common findings that raise concerns include:

• Absence of fetal heartbeat: In early pregnancy, the lack of a detectable heartbeat by 6–7 weeks can signal a potential miscarriage.
• Irregular shape or size of gestational sac: A gestational sac that is too small, too large, or misshapen can be a red flag.
• Poor fetal growth: If a fetus is measuring smaller than expected for gestational age, it may indicate intrauterine growth restriction (IUGR).
• Abnormal fluid levels: Either too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid can pose a risk.
• Structural anomalies: Visible irregularities in the brain, heart, limbs, spine, or abdomen may be a sign of congenital abnormalities.
• Placental complications: Issues like placenta previa or placental abruption can be detected via ultrasound.
• Empty gestational sac (blighted ovum): If the gestational sac is present but no embryo is seen by 7 weeks, it may indicate a nonviable pregnancy.

Early detection using Sono Mobile™️ CT61 or equivalent diagnostic tools allows physicians to address or monitor issues appropriately. It’s important to note, however, that a single scan rarely tells the full story.

Red Flags in Early Pregnancy Scans

The first trimester (weeks 1–12) is a particularly sensitive time in pregnancy, and ultrasound plays a key role in confirming viability. Early pregnancy patients are often most vulnerable to emotional distress when scans don’t go as expected.

Red flags during early scans include:

1. No fetal heartbeat by week 6–7

While some fetuses develop slightly later, the absence of cardiac activity by the end of the 7th week may be a sign of miscarriage. Repeat ultrasounds are often done to confirm the findings.

2. Irregular or misshapen gestational sac

A sac that appears flattened or has uneven walls might indicate a nonviable pregnancy or may precede a miscarriage.

3. Subchorionic hematoma

This is a collection of blood between the uterine wall and the gestational sac. Although not always dangerous, large hematomas can increase the risk of pregnancy loss.

4. Yolk sac abnormalities

The yolk sac provides nutrition to the embryo in early development. An enlarged or irregular yolk sac can signal chromosomal issues or poor prognosis.

5. Empty gestational sac

If a gestational sac is seen but no embryo is visible by week 7–8, this may indicate a blighted ovum, which often results in early pregnancy loss.

In many cases, doctors will recommend a follow-up ultrasound in 7–10 days, since timing and ovulation differences can affect what is visible in early scans.

Determining the sex of the fetus is done in various ways, and you can read about the best method, Finding Out Baby’s Sex With an Ultrasound, in this article.

Abnormal Findings in the Second Trimester

The second trimester (weeks 13–27) is the window for the detailed anatomy scan, typically performed around week 18–22. This is when most structural abnormalities are first detected.

Some potential scan concerns in this phase include:

1. Fetal growth restriction

If your baby is significantly smaller than expected, your healthcare provider may consider conditions like placental insufficiency or genetic disorders.

2. Neural tube defects

Ultrasound can detect issues like spina bifida, where the spinal column does not close properly. Early detection improves the chances of successful management.

3. Heart defects

Abnormalities such as hypoplastic left heart syndrome, ventricular septal defect, or abnormal rhythm may be visible. Advanced instruments such as the Sono Mobile™️ CT61, one of the best handheld ultrasound devices, offer high-resolution imaging to aid in cardiac evaluations.

4. Limb or organ irregularities

Missing limbs, shortened bones, or abnormal kidney and liver development can be seen. These may be linked to syndromes or chromosomal disorders.

5. Abnormal amniotic fluid volume

A scan may reveal polyhydramnios (excess fluid) or oligohydramnios (insufficient fluid), both of which may indicate issues with fetal swallowing, kidney function, or placental health.

6. Placental position

A low-lying placenta or placenta previa can affect delivery plans and pose risks for preterm birth or bleeding.

When an abnormality is detected, patients are usually referred for a targeted ultrasound or fetal echocardiogram, depending on the nature of the concern.

How Doctors Confirm and Follow Up

A concerning ultrasound doesn’t always mean the worst. Physicians follow a structured protocol to confirm or rule out a serious issue, including:

1. Repeat ultrasounds

A second scan after 7–10 days helps evaluate whether the finding was due to temporary conditions (like baby’s position) or persistent problems.

2. Blood tests

Levels of HCG (human chorionic gonadotropin) and progesterone can indicate whether a pregnancy is progressing normally.

3. Genetic testing

When abnormalities suggest a chromosomal disorder (e.g., Down syndrome or Edwards syndrome), doctors may recommend noninvasive prenatal testing (NIPT) or diagnostic procedures like amniocentesis.

4. Doppler ultrasound

This technique assesses blood flow in the placenta and umbilical cord, offering insight into fetal well-being and placental function.

5. Referral to maternal-fetal medicine (MFM)

Specialists in high-risk pregnancies evaluate complex cases using advanced imaging, including 3D and 4D ultrasound.

6. MRI or other imaging

In rare cases, fetal MRI is used to clarify uncertain findings from ultrasound.

Using tools like Sono Mobile™️ CT61, providers can perform detailed bedside imaging; especially valuable in rural or resource-limited settings, and provide rapid feedback.

Emotional Support and Next Steps

Receiving concerning ultrasound results is one of the most emotionally challenging experiences for expectant parents. It’s natural to feel fear, confusion, sadness, or even guilt; even though most issues are beyond the parents’ control.

Here’s how to manage the emotional and practical next steps:

1. Don’t panic; ask for clarification

Sometimes, what appears concerning may resolve on its own. Ask your provider to explain the findings in simple terms, and whether a second opinion is warranted.

2. Prepare questions

Come to follow-up appointments prepared with questions like:

• Is this definitely a problem, or could it resolve?
• Are there treatments or interventions?
• How often will follow-up scans be needed?
• What are the risks of continuing the pregnancy?
• What support services are available?

3. Lean on your support system

Speak with your partner, family, or trusted friends. Let them help you process information and attend appointments if needed.

4. Seek professional counseling

If anxiety, depression, or emotional overwhelm persist, a perinatal mental health counselor can be invaluable.

5. Connect with others

Many parents find comfort in online or in-person support groups where they can share experiences with those facing similar concerns.

6. Consider spiritual or faith-based guidance

For those with spiritual beliefs, speaking to a religious advisor may bring comfort and perspective.

Remember, even in the face of scan concerns, many pregnancies proceed safely, and some findings turn out to be false alarms or manageable issues.