Context: Myelomeningocele (MMC) is one of the most devastating, nonlethal congenital anomalies worldwide. Ultrasonography is the modality of choice for imaging of an in-utero fetus. In spite of technological advances, differential professional experiences amongst imaging experts from various back grounds has however led to a heterogeneity in results generated from screening gestational sonography in different clinical set-up. Aim: To evaluate the discrepancy between results obtained from sonography done in semi-urban or urban centres for antenatal diagnosis of fetal neural tube defects (NTD) in terms of performance of various diagnostic surrogates for the same. Study Setting & Design: Retrospective observational study conducted over a cross-section of referrals, at a university based teaching institute over a period of two years. Patients and Methods: 38 cases with antenatal of NTD were included. Correlation of factors like presence of cystic swelling, spinal anomaly and ventriculomegaly to each other were done to bring out the differential pattern of observations between sonograms performed at various centers. ROC curves were plotted to evaluate the accuracy, sensitivity and specificity of various parameters. Statistical Analysis: Pearson’s Chi-squared test was applied to assess dependence of antenatal detection of NTD on qualitative variables. Independent sample t-test was employed to compare mean size of the MMC and number of ultrasounds in cases with and without antenatal MMC detection. ROC curve was drawn to assess size of MMC. Results: Difference in size of MMC was not significant for antenatal diagnosis of NTD. Hydrocephalus as a surrogate for NTD performed significantly better than the above direct sign. Cases which had more number of scans had more chances of a correct antenatal diagnosis while a lesion higher up in the vertebral column was less likely to be missed. Conclusion: Sonography in rural centres may miss out significant number of NTD, however ventriculomegaly performs better than detection of MMC in such centers.