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Ultrasonography in pregnancy is part of the NHS Fetal Anomaly Screening Programme (FASP) (PHE 2018b). Two key ultrasound scans are offered as a minimum standard. The first scan is the early dating scan. It is therefore important to note the gestational age of the newborn from the dating ultrasound scan result prior to conducting the examination.

The second is the 18+0 to 20+6 week fetal anomaly scan (PHE 2018b). Additional serial scans will be performed if an abnormality or abnormal fetal growth is detected, either with the fetus or with the intrauterine environment, e.g. liquor volume or placental positioning. Fetal growth estimation is the primary parameter assessed. The Royal College of Obstetricians and Gynaecologists (RCOG) provides a green‐top guideline (RCOG 2013) and the Perinatal Institute offers guidance on fetal growth and the use of growth tools during pregnancy to monitor fetal growth that can be found at http://www.perinatal.org.uk/FetalGrowth/fetalgrowth.aspx.

TABLE 1.3 Using the maternal obstetric records, newborn records and NHS Antenatal Screening Programme results to create a history profile.

Creating a history profile
Maternal medical history	Antenatal screening results	Pregnancy and labour history	Family history	Psychosocial factors	Newborn
General health status	Serology reports		History of diabetes	Smoking	Resuscitation at birth and time to response
Cardiac disease	Rhesus status	Incidence of infection and bacteria isolate	Intergenerational conditions	Substance use	Method and frequency of feeding
Renal disease	Prenatal screening positive test results	Pathologies, e.g. pre‐eclampsia, placental insufficiency	Inborn errors of metabolism	Alcohol dependency	Passage of urine and meconium
Hypothyroidism	Prenatal diagnostic investigations	Mode of delivery and presentation	First‐degree relative with CHD	Depression or mental illness	General health and behaviour since birth
Gestational or type 1 diabetes	Prenatal diagnosis of a cardiac abnormality	Pre‐labour length of membranes rupture	First‐degree relative with DDH	High‐conflict relationship	Presence of meconium at birth or risk or early onset sepsis
Nutritional status and BMI	Prenatal diagnosis of a trisomy		First‐degree relative with a childhood eye condition	Safeguarding issues with siblings	Parental concerns
Depression or history of mental illness	Ultrasound growth scan profile			Social services involvement with family	Symptomatic of illness

Evidence of intrauterine growth restriction is not an uncommon finding There may be evidence in the maternal history that may indicate why the newborn is small for gestation age. There may be a pre‐existing maternal medical condition that has adversely contributed to placental function resulting in a poor fetal growth profile. Fetal growth restriction may be a feature of an underlying chromosomal abnormality or other pathology, e.g. transplacental viral transmission or the effect of a toxic substance, such as alcohol excess in pregnancy. Further information on the NHS FASP can be obtained from the website: https://www.gov.uk/government/publications/fetal‐anomaly‐screening‐programme‐handbook.

The NHS FASP (PHE 2018b) outlines the conditions screened for at the anomaly scan. Whilst it is useful in many cases, it is prudent to accept that this scan does have its limitations; therefore, the focus lies with a standard for 11 structural conditions where the specificity for detection is greater than 50% (PHE 2018b). Conditions screened for are as follows:

 Anencephaly

 Open spina bifida

 Cleft lip

 Diaphragmatic hernia

 Gastroschisis

 Exomphalos

 Serious cardiac anomalies

 Bilateral renal agenesis

 Lethal skeletal dysplasia

 Edward's syndrome (trisomy 18)

 Patau's syndrome (trisomy 13). (Adapted from PHE 2018b.)

The presence of other findings is significant and, as such, is reportable by the ultrasonographer as listed:

 Nuchal fold (greater than 6 mm)

 Ventriculomegaly (atrium greater than 10 mm)

 Echogenic bowel (with density equivalent to bone)

 Renal pelvic dilatation (AP measurement greater than 7 mm) (PHE 2018b).

Fetal renal pelvic dilatation will require serial scan monitoring throughout the pregnancy. However, it is particularly important to note this during history taking and to arrange follow‐up ultrasound scans and urology clinic referral for the newborn.

The presence of oligohydramnios must alert the NIPE practitioner to the possibility of the following:

 Prolonged rupture of membranes earlier in the pregnancy

 Urinary tract anomaly or uropathy

 Fetal growth restriction (Baxter et al. 2010)

 Intrauterine infection.

Conversely, polyhydramnios will alert the examiner to consider the following:

 Duodenal atresia or stenosis (Rajiah 2009)

 Oesophageal atresia.

Exposure to the effects of intrauterine teratogens has been investigated and publicised over recent decades, but arguably the most common causes of such exposure is smoking and excessive alcohol consumption during pregnancy.