3D and 4D Ultrasounds: Are They Safe, and Should You Get One?

Grainy black and white two-dimensional (2D) ultrasounds have long been a routine part of prenatal care. 3D and 4D ultrasounds are newer technologies that offer a more detailed and lifelike view of your little one.

Read on to learn more about how these ultrasounds work, why your doctor might perform one, and whether they’re safe for you or your baby.

Advanced ultrasound technology, including 3D and 4D scans, can give your doctor a better picture of your developing baby.

With a 3D ultrasound, your doctor takes several 2D scans from different angles and combines them with special software. This process creates a detailed image of your baby that looks more like a photograph. You’ll be able to see her facial features, limbs, and other body parts, like her fingers and toes, much more clearly than with a traditional 2D ultrasound. 1

A 4D ultrasound takes 3D imaging a step further by generating a live video feed of your baby in the womb. This lets you watch her move in your womb in real time. You might even catch her yawning. 2 3 4

3D and 4D ultrasound sessions usually last between 30 and 60 minutes, including the time it takes to prepare any pictures or videos of your baby to take home. 5 6

You’ll probably have one or two ultrasounds throughout your pregnancy. If everything is progressing normally, you won’t need more. However, depending on how risky your pregnancy is (e.g., if you have a preexisting health condition like diabetes), your doctor may book you in for extra ultrasounds. 7 8

Are 3D and 4D ultrasounds safe?

As long as qualified medical professionals perform them, all ultrasounds, including 3D and 4D ones, are safe. That’s because they use sound waves to get a comprehensive view of your baby instead of radiation (like X-rays). 9

Why doctors still use 2D ultrasounds

Generally, 3D and 4D ultrasounds give you a more comprehensive and dynamic look at your baby inside the womb. In comparison, a 2D ultrasound produces a flat, two-dimensional black-and-white image.

While they may not sound as exciting as 3D or 4D scans, 2D ultrasounds are still sufficient to assess your baby’s overall development and detect abnormalities. 7

Your doctor may decide to perform a 3D or 4D ultrasound if they think your pregnancy is at risk of preterm delivery, fetal growth restriction, or developmental issues. They may want to get a closer look at your baby and uterus to check for: 5 10

• Facial abnormalities: Advanced ultrasounds provide a clearer picture of conditions like cleft lip and palate, which means your doctor can assess your baby’s condition more easily and plan treatment.
• Neural tube defects: Doctors can use 3D ultrasounds to examine the brain and spinal cord, which helps them diagnose neural tube defects like spina bifida. 11
• Congenital heart disease (CHD): A 3D or 4D ultrasound can provide detailed images of your baby’s heart, allowing your doctor to see how it’s working with the blood vessels and surrounding structures. Your doctor can then spot potential problems early so they can plan the best care for your baby right from the start. 12 13
• Uterine problems: Your doctor can use these methods to get a clearer picture of uterine abnormalities like lesions or fibroids. 1

Other kinds of ultrasounds your doctor may perform

2D, 3D, and 4D ultrasounds aren’t the only tests your doctor uses to check how your baby is getting on. They may also use:

• Doppler ultrasounds: With this test, your doctor will use a hand-held fetal Doppler to listen to your baby’s heart. If you’re lucky, you may even be able to hear your baby’s heartbeat yourself. While there are at-home Dopplers on the market, most experts advise against using them, as they could give you misleading results and stop you from getting the right prenatal care. 14
• Fetal echocardiogram: This is a type of 2D ultrasound (performed by a specialist). It isn’t always done, but your doctor may recommend it if they’re concerned your baby might have a cardiac (heart-related) birth defect.
• Nuchal translucency (NT) scans: This optional ultrasound measures the amount of fluid behind your baby’s neck during the first trimester of pregnancy. Your doctor examines the levels of fluid to determine your baby’s risk of congenital conditions like Down syndrome. 15
• Nonstress tests (NST): Your doctor may perform an NST during your third trimester if you’ve passed your due date or there’s a complication with your pregnancy (e.g., you have gestational diabetes). During the test, your doctor places two bands around your belly that have sensors that monitor your contractions and your baby’s cardiac activity. 16

Many private commercial centers offer ultrasounds as a way to get a photo or recording of your baby. This is known as a keepsake, elective, or entertainment ultrasound.

A lot of private studios advise against booking a 3D or 4D ultrasound if you’re less than 26 weeks pregnant. 17 This is because your baby might not have enough fat beneath her skin before then, so her bones will show up on the ultrasound, spoiling the cute image you were hoping for. 18

Concerns around nonmedical ultrasounds

Despite how prolific they are, many medical organizations advise against getting non-medical ultrasounds, including the:

• Food and Drug Administration (FDA) 4
• American College of Obstetricians and Gynecologists (ACOG) 19
• American Institute of Ultrasound Medicine (AIUM) 20

The AIUM even explicitly states that keepsake ultrasounds aren’t “responsible medical practice.” 20

Keepsake ultrasounds aren’t done for medical purposes, so the technicians won’t be able to tell you if something’s wrong and might not be trained to pinpoint any issues that need to be treated, unlike your doctor. 21

Moreover, medical institutions routinely conduct quality-control tests to ensure that their ultrasound equipment is functioning properly, which may not be the case at nonmedical facilities or private ultrasound boutiques.

Ultrasound energy could be dangerous

Too much ultrasound energy can cause a slight increase in tissue temperature. This might create small pockets of gas in bodily fluids or tissues (cavitation). While research hasn’t definitively concluded the long-term effects of cavitation, it might be best to avoid overexposure. 4 21

Doctors are trained to follow the ALARA principle, which stands for “As Low As Reasonably Achievable.” This means that during your ultrasound, they’ll use the lowest amount of sound energy possible, though it’ll still be enough to give them the information they need. This ensures that you and your baby stay safe. 22

If you’re already scheduled for a 3D or 4D ultrasound with your doctor, then it’s OK to get some pictures or videos. However, if you don’t need to expose your baby to unnecessary ultrasound energy, you probably shouldn’t.

Keepsake ultrasounds aren’t legal in certain states

Due to these safety concerns, some states have banned keepsake ultrasounds. In 2009, Connecticut was the first state to ban them. Oregon followed five years later in 2014 with similar regulations. 23

If you’re still planning to get one, check the legal requirements where you live. You should also run your plan by your doctor. Don’t be shocked if they advise against it.

3D and 4D ultrasounds performed at the hospital typically cost $1,000–$2,000 out of pocket. Keepsake ultrasounds can set you back anywhere from $100–$400. 24

Insurance usually covers medical ultrasounds, but those that aren’t medically necessary might not be covered.

It’s also worth noting that sometimes, insurers don’t cover 3D and 4D scans (even medical ones) since they might be classified as experimental or investigational rather than a required procedure. 25 26

Before you get a 3D or 4D ultrasound—medical or nonmedical—check with your insurance provider.

Before booking a 3D or 4D ultrasound, run it by your doctor first. It’s understandable if you’re excited to see your baby, but you should always follow their advice when it comes to what tests and scans you get.

Note that the FDA recommends that facilities offering ultrasound services employ staff trained and accredited in safety protocols, such as those in the programs from the AIUM and the American Registry of Diagnostic Medical Sonographers (ARDMS). 4 [CITATION] Don’t be afraid to ask about their qualifications.

If your doctor doesn’t recommend a 3D or 4D ultrasound, take it as a sign that everything’s going well with your pregnancy.