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It is the nail-biting undercurrent of every pregnancy: Is the baby normal? For some parents-to-be, the more screening and testing for potential problems, the better. Now, a Toronto hospital is formally offering additional early fetal ultrasounds aimed at detecting many anomalies.

By the time most pregnant women have reached the 20-week mark in their pregnancy, they have undergone two ultrasounds: one as early as 10 weeks to assess the risk of chromosomal abnormalities such as Down syndrome; and one between 18 and 20 weeks to look for other physical abnormalities.

For the past year, the Toronto Centre for Early Fetal Ultrasound at Sunnybrook Hospital has been offering an additional ultrasound to a small number of high-risk women at about 12 to 15 weeks. The centre, the first of its kind in Canada, is now ready to see more women considered at a higher risk of fetal anomalies, including women with a family history of chromosomal and physical abnormalities and women considered obese.

Ori Nevo, the maternal fetal medicine specialist who leads the program, says 90 per cent of the anomalies found at 18 to 20 weeks can be caught with the earlier ultrasound. The testing is done vaginally instead of across the belly, using equipment already standard in medical imaging.

The early scan can detect complications in the formation of the skull, brain, abdominal wall and bladder, among other areas.

Unfortunately, little can be done to treat most of the physical anomalies that may be detected early, such as skull malformations. Alain Gagnon, a maternal fetal specialist at BC Women's Hospital, says one of the only treatments that could result from the testing would be the early repair of a blocked bladder.

The major benefit, then, comes when no problems are found."We can rule out most of the issues," Dr. Nevo says. "Most of the patients I see are pretty stressed before the ultrasound."

When the ultrasound delivers bad news, women who may decide to terminate a troubled pregnancy can make that decision earlier.

"It's safer to do it early on. There are less complications," he says.

Other doctors working in this field say that this type of ultrasound is already being performed across the country, but on an ad hoc basis. Philip Wyatt, a genetic medical expert who helped create guidelines for health professionals relating to ultrasounds for the Society of Obstetricians and Gynaecologists of Canada, says additional ultrasounds are already "strongly encouraged ... for the pregnancies that need it."

Dr. Wyatt, head of genomic medicine in the department of obstetric gynecology at York Central Hospital in the Toronto area, adds that most women can get the information they need from the standard two ultrasounds. And the first and earliest ultrasound can be very detailed. "Everyone encourages the first survey to be as complete and anatomical as can be carried out," he says.