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At a level 2 US around 18 to 20 weeks they can look for more indicators of downs. Things like long bone length, echogenic foci in the heart bowels etc. If there are no other indicators then you won't worry so much. One of my twins came back with and increased risk for downs at the level 2 u/s. And Riley cam back with something wrong during the NT scan. All 4 of my kids have no issues (other than Nathan being very high functioning autism - goes to typical school and nobody really knows he is on the spectrum)