Interpretation of Laboratory and Ultrasound Findings at 20 Weeks 6 Days Gestation

Overall Assessment

These results demonstrate a reassuringly normal pregnancy at 20 weeks 6 days gestation with appropriate fetal development, no evidence of infection or gestational trophoblastic disease, and no soft ultrasound markers for aneuploidy requiring further evaluation. The breech presentation and anterior myometrial wall contraction are normal findings at this gestational age that require no immediate intervention 1.

Hematologic Parameters

Hemoglobin and Hematocrit

Hemoglobin of 11.6 g/dL (116 g/L) and hematocrit of 35% fall within the normal range for pregnancy at 20 weeks gestation 1.
These values do not meet criteria for anemia in pregnancy, which is typically defined as hemoglobin <11 g/dL in the second trimester 1.
No iron supplementation beyond routine prenatal vitamins is required at this level 1.

Blood Type

AB+ blood type indicates the patient is Rh-positive, eliminating the need for Rh immunoglobulin prophylaxis 1.
No risk of Rh alloimmunization exists with this blood type 1.

Urinalysis Findings

Overall Interpretation

The urinalysis shows essentially normal findings with only trace leukocytes and few bacteria, which do not meet criteria for asymptomatic bacteriuria or urinary tract infection 1.

Specific Parameters

Yellow, hazy appearance with pH 7.5 and specific gravity 1.010 are within normal limits for pregnancy 1.
Negative albumin and glucose appropriately exclude proteinuria and glycosuria 1.
WBCs 0-1/hpf and RBCs 2-3/hpf are normal findings; the trace leukocytes and few bacteria without pyuria do not warrant antibiotic treatment 1.
Few epithelial cells represent normal vaginal contamination 1.

Metabolic Parameters

Random Blood Glucose

Random blood glucose of 114 mg/dL is within normal limits and does not suggest gestational diabetes 1.
This value is below the threshold that would trigger concern for hyperglycemia in pregnancy 1.
Standard glucose challenge testing at 24-28 weeks remains indicated per routine prenatal care 1.

Infectious Disease Screening

Comprehensive Negative Screen

All infectious disease markers (HBsAg, VDRL, HIV) are non-reactive, indicating no evidence of hepatitis B, syphilis, or HIV infection 1.
These negative results are reassuring and require no further action beyond routine prenatal care 1.
The negative HBsAg result eliminates the need for neonatal hepatitis B immunoglobulin at delivery 1.

Cervical Cytology

Pap Smear Results

Negative for intraepithelial lesion or malignancy represents a normal result requiring no intervention during pregnancy 1.
Routine cervical cancer screening guidelines apply; no additional follow-up is needed 1.

Ultrasound Findings

Gestational Age and Fetal Biometry

Pregnancy dated at 20 weeks 6 days by fetal biometry is consistent with second-trimester anatomy scan timing 2.
This dating should be used for all clinical decision-making if it differs from last menstrual period dating by ≥10 days 2.
Fetal biometry at this gestational age is accurate to within ±10 days 2.

Fetal Presentation

Breech presentation at 20 weeks 6 days is a normal finding that requires no intervention, as most fetuses will spontaneously convert to cephalic presentation by term 1.
Approximately 25% of fetuses are breech at mid-pregnancy, with only 3-4% remaining breech at term 1.
No follow-up ultrasound is needed solely for fetal presentation until 36-37 weeks gestation 1.

Placental Assessment

Posterior-fundal placenta location is normal and carries no increased risk 1.
Grade 2 placental maturation at 20 weeks is within normal limits; placental grading has limited clinical utility in modern obstetrics 1.
"No previa" confirms the placenta is not covering the internal cervical os, eliminating placenta previa as a concern 1, 3.

Amniotic Fluid Volume

Adequate amniotic fluid volume is a reassuring finding indicating normal fetal renal function and membrane integrity 1.
This finding requires no additional evaluation or follow-up 1.

Myometrial Findings

Anterior myometrial wall contraction represents a normal, transient phenomenon during ultrasound examination and should not be confused with placental abnormalities 1.
These contractions are benign, resolve spontaneously, and have no clinical significance 1.
If there is any uncertainty about placental location due to myometrial contraction, a repeat ultrasound after the contraction resolves or at a later gestational age can clarify anatomy 1.

Absence of Soft Ultrasound Markers

Aneuploidy Risk Assessment

The ultrasound report does not mention any soft markers for aneuploidy (echogenic intracardiac focus, echogenic bowel, choroid plexus cysts, shortened long bones, thickened nuchal fold, or urinary tract dilation) 1.
The absence of these findings is reassuring and suggests low risk for chromosomal abnormalities 1.
If the patient had negative first-trimester or second-trimester aneuploidy screening, no further evaluation is recommended 1.

Structural Anomaly Screening

The second-trimester anatomy scan at 18-22 weeks is the optimal time for detecting fetal structural abnormalities 1, 4.
No mention of structural anomalies in this report is reassuring, though a complete anatomic survey should document all required views per standard guidelines 1, 4.

Clinical Management Recommendations

Immediate Actions Required

No immediate interventions are needed based on these results 1.
Continue routine prenatal care with standard visit intervals 1.

Follow-Up Testing

Glucose challenge test at 24-28 weeks for gestational diabetes screening 1.
Third-trimester ultrasound is not routinely indicated based on these findings unless specific indications develop 1.
Fetal presentation should be reassessed at 36-37 weeks; if breech persists, discuss external cephalic version or planned cesarean delivery 1.

Patient Counseling Points

Reassure the patient that all laboratory and ultrasound findings are normal for this stage of pregnancy 1.
Explain that breech presentation at 20 weeks is common and usually resolves spontaneously 1.
Discuss the purpose and timing of upcoming glucose screening and any additional prenatal testing 1.

Important Clinical Caveats

Dating Considerations

If this ultrasound-based gestational age differs from last menstrual period dating by ≥10 days, the ultrasound date should be adopted for all clinical decisions 2.
Accurate dating is crucial for appropriate timing of glucose screening, third-trimester surveillance, and delivery planning 2.

Limitations of Second-Trimester Ultrasound

Second-trimester ultrasound has variable sensitivity (40-90%) for detecting fetal anomalies, depending on operator skill, equipment quality, and maternal body habitus 5.
Some anomalies may not be apparent until later in pregnancy or may be missed entirely 6, 5.
Soft markers have low positive predictive value for aneuploidy in the general population, and their absence does not guarantee a chromosomally normal fetus 1, 7.

Myometrial Contraction Pitfall

Anterior myometrial contractions can mimic placental abnormalities or obscure true placental location; if there is any diagnostic uncertainty, repeat imaging after the contraction resolves 1.

Help us tailor your experience