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Targeted imaging for fetal anomalies (TIFFA) is a comprehensive ultrasonographic examination of the fetus, typically performed at 18–22 weeks of gestation, aimed at detecting structural congenital anomalies, evaluating fetal growth, and assessing placental and amniotic fluid characteristics.

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It is also called the anomaly scan or level-II ultrasound.

Indications

• Routine part of second-trimester antenatal screening.
• High-risk pregnancies:
  • Advanced maternal age
  • Family history of congenital anomalies
  • Teratogenic drug exposure
  • Diabetes, infections (TORCH), consanguinity
• Abnormal first-trimester screening results (NT, double/triple marker tests).

Timing

18–22 weeks is optimal:

• Organogenesis complete.
• Adequate amniotic fluid and fetal size for visualization.
• Early enough for intervention or medical termination if major anomaly detected.

Components of TIFFA Scan

Maternal evaluation

• Cervix, uterine wall, adnexa, placenta (site, maturity, previa, accreta suspicion).
• Amniotic fluid volume.

Fetal biometry

• Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL).