What Happens After the Anatomy Scan: The Referral Gap Nobody Talks About

For a long time, the most meaningful part of my career wasn't delivering babies or performing procedures.

It was teaching.

Teaching sonographers how to think about what they were seeing. Teaching residents and fellows to slow down when something felt off. Teaching everyone that the questions asked after an image was acquired were just as important as the image itself.

And over years of those conversations, I noticed a pattern.

The moments that actually changed practice were never about rare diagnoses. They were about the small, uncomfortable questions nobody wanted to sit with.

Why couldn't we get that view?

Should we really bring this patient back in four weeks?

Is this truly "suboptimal," or is the fact that we can't get the image telling us something?

That last question became one I kept returning to. Because sometimes, the reason a structure can't be visualized isn't a technical limitation. Sometimes it's because the structure itself is abnormal. The inability to obtain the expected view can be a finding in itself.

Most of the time, it isn't. But the cases where it was — those were the ones where timing mattered most.

When a potential fetal anomaly is identified, the next steps seem clear. Refer for specialized imaging. Consult a Maternal-Fetal Medicine specialist. Confirm the diagnosis. Build a plan.

In practice, it rarely moves that cleanly.

Referral timelines vary. Access to MFM specialists is uneven — concentrated in metropolitan areas, often hours away for families in rural or underserved communities. Insurance approvals create friction. Scheduling delays stretch days into weeks.

In pregnancy, weeks matter in a way they don't in almost any other medical context.

A diagnosis made at 19 weeks offers a family very different options than the same diagnosis made at 23 weeks. Fetal surgery for spina bifida, for instance, is only available within a narrow gestational window. Miss it, and the option is gone. A critical congenital heart defect identified before delivery means a team can be ready. Identified after, and the same anatomy leads to a very different outcome.

The diagnosis doesn't change. The timing does.

This is the part of prenatal care that doesn't get discussed enough: not the scan itself, but everything that comes after.

Over the past year, I've been working quietly alongside my team on something we believe can help close that gap.

Not because technology replaces clinical judgment. It doesn't, and it shouldn't.

But because earlier recognition, more consistent detection, and better communication between community OB/GYNs and specialists can shorten the distance between a suspected finding and expert care. And in fetal medicine, that distance is where opportunities are lost.

We built Fetal Review because the clinical knowledge already exists. We know earlier diagnosis improves outcomes. We know structured referral pathways improve access. What's often missing is consistency — the reliable infrastructure that makes those things happen every time, not just when the right people happen to be in the right room.

The anatomy scan is not the finish line. It's the beginning.

I'd love to hear from others who've navigated referral workflows, ultrasound access, and the downstream effects of delayed prenatal diagnosis. These conversations are what push the field forward.

Learn how Fetal Review supports earlier detection → fetalreview.com

Dr. Aswathi Jayaram is a Maternal-Fetal Medicine specialist at Riley Maternal-Fetal Medicine / IU Health and Co-Founder, Co-CEO at Fetal Review — an AI-assisted fetal ultrasound review platform supporting OB/GYNs in identifying structural anomalies earlier, in community and academic settings alike.