PEMERIKSAAN USG OBSTETRI DASAR

TRIMESTER 2 & 3 NORMAL

KOLEGIUM OBSTETRI
OBSTETR I GINEKOLOGI INDONESIA
PERKUMPULAN OBSTETRI DAN GINEKOLOGI INDONESIA

2017
 AGENDA
• PENDAHULUAN
• TUJUAN
• PERSIAPAN
• SONOGRAFI NORMAL TRIMESTER 2 & 3
• MARKER SONOGRAFI (GENETIC SONOGRAPHY)
• PESAN DIBAWA PULANG
• KEPUSTAKAAN
 PENDAHULUAN
• USG Dasar Trimester 2 dan 3 struktur normal
usia gestasi, pertumbuhan, anomali janin

• Pelajari kembali anatomi, embriologi, genetika,

fisiologi, dan ilmu terkait tumbuh kembang embrio
dan janin + penyakit ibu

• Kuasai Panduan Pemeriksaan  laporan USG Uji

Kompetensi kompetensi USG tingkat dasar
Bukulog & Portfolio PROFISIEN Tingkat Madya
P2KB USG
 TUJUAN

• UMUM
- Mampu melakukan pemeriksaan USG trimester
2 dan 3 dengan baik dan benar, melalui
pemeriksaan transabdominal dan/atau
transvaginal

• KHUSUS
 TUJUAN KHUSUS
• Mampu mengetahui indikasi pemeriksaan USG Obstetri.
• Mampu menentukan jumlah, letak, dan presentasi janin.
• Mampu menentukan implantasi dan morfologi plasenta.
• Mampu menentukan volume cairan amnion.
• Mampu melakukan pemeriksaan umbilikus.
• Mampu melakukan pemeriksaan biometri dasar janin.
• Mampu menentukan letak jantung dan DJJ normal.
• Mampu menilai morfologi normal janin.
• Mampu menentukan jenis kelamin.
• Mampu menilai aktivitas janin.
• Mampu melakukan evaluasi uterus, adneksa, dan rongga pelvik.
• Mampu membuat dokumentasi dan laporan USG trimester 2
dan 3 (POGI).
 PERSIAPAN

• PASIEN
- Informed consent & choice
• PERALATAN
- USG real-time, Transduser abdomen dan vagina
- Pengaturan : institusi, waktu, pasien, pemeriksa,
TIb < 1, MI < 1, fokus dua buah , power < 100%, Body-
mark, dan Biometri dasar Hadlock 1984
• PEMERIKSA
 – Kompeten
 PEMERIKSAAN TRIMESTER 2-3
• Anamnesis : haid, paritas/fertilitas, keluhan, dsb.
• Pemeriksaan Fisik : status generalis dan obstetri 
• Pemeriksaan penunjang
• Diagnosis Kerja : ibu dan janin
• Sistematika Pemeriksaan : Eksplorasi dulu
rongga pelvik dan abdomen !
 – IKUTI PANDUAN POGI
 – Kenali struktur normal 
 – Periksa secara sistematis dan serius
 EKSPLORASI
• Mulai dari supra simfisis posisi
transduser transversal, tegak lurus
lantai nilai rongga pelvik menuju
prosesus xyphoideus ke lateral
kanan lateral kiri bila perlu
potongan longitudinal

• Perhatikan : presentasi janin, letak 

 punggung, tanda kehidupan, letak 
dan derajat maturasi plasenta, serta
volume cairan amnion
 ISUOG RECOMMENDATION (2014)
• Determination of fetal
 position
•  Assessment of fetal
wellbeing , including fetal
movements
•  Amniotic fluid volume
estimation and conditions
associated with abnormal
amniotic fluid volume
• Placental assessment,
including relation to the
internal cervical os
• Standard fetal biometry
(BPD, HC, AC, FL)
• Fetal growth and typical
causes of abnormal fetal
growth
• Fetal head (intact
cranium, head shape,
midline falx, cerebral
ventricles, cavum septi 
 pellucidi, cerebellum,
cisterna magna) and
typical anomalies
 ISUOG RECOMMENDATION (2014)
• Fetal face (orbits, nose and
mouth in different plane)
and typical anomalies
• Fetal thorax (lung
morphology and
relationship to heart size)
and typical anomalies
• Fetal heart (situs, four
chamber view, outflow
tracts, three-vessel view)
and typical anomalies
• Fetal abdomen (stomach,
liver with umbilical vein,
kidneys and urinary bladder,
diaphragm, bowel,
abdominal wall and cord
insertion) and typical
anomalies
• Fetal spine in longitudinal
and transverse planes and
typical anomalies
• Fetal limbs (arms, hands,
legs, feet) and typical
anomalies
• Umbilical and uterine artery
Doppler 
PLASENTA, UMBILIKUS,
AMNION
 ANATOMI JANIN NORMAL

• Kepala
• Wajah
• Leher
• Thoraks
• Jantung
• Abdomen
• Traktus Urinarius
• Genitalia
• Vertebra
• Ekstremitas
 KEPALA JANIN

• Tiga bidang potong :

- Sagital : dari telinga kanan
telinga kiri 
- Koronal : dari ujung hidung
oksipitalis
- Transversal (aksial) : dari 
 puncak kepala basis kranii 
• ISUOG : intact cranium, cavum
septi pellucidi (CSP). midline falx,
thalami, cerebral ventricle,
cerebelum, cisterna magna
• Biometri dasar : BPD; HC; AC;
FL
 ISUOG Guidelines
 Sonographic examination of the fetal central nervous system:
 guidelines for performing the basic examination and the fetal neurosonogram
 WAJAH JANIN

Tiga bidang potong :

• Sagital :  profil, tulang
hidung, maksilla, mandibula,
dagu
• Koronal : orbita, lensa
mata, hidung, lubang
hidung, bibir 
• Transversal (aksial) :
dahi, orbita, hidung, dagu
WAJAH : Potongan Sagital

Profil wajah janin : dahi, hidung, bibir, dagu

 WAJAH : Potongan Koronal

L ta (b tuk ti inci
WAJAH : Potongan koronal

Lubang hidung (tanda panah)

 WAJAH : Potongan Transversal

Tampak kedua orbita normal

 THORAKS JANIN
• 3 Bidang potong : L, AP, dan T
• Paru :
- Kanan : homogen, terdiri dari 3 lobus
- Kiri : homogen, terdiri dari 2 lobus, terdapat jantung
- Menempati 2/3 rongga thoraks
- Cairan abnormal : tebal > 2 mm (efusi pleura,
hidrothoraks)
• Vertebra dan kostae : efek shadowing
• Jantung : lihat penjelasan selanjutnya
 THORAKS JANIN : Transversal

Kedua lobus paru tampak homogen

 THORAKS JANIN :
Koronal dan sagital
KORONAL SAGITAL
 JANTUNG JANIN
• Kelainan terbanyak diagnosis sulit pemeriksaan
harus sistematis screening 20 – 22 minggu
• Tentukan presentasi, letak, dan posisi kiri kanan janin
cari gaster (pot. aksial) geser ke arah kranial
beberapa mm situs, 4CV, outflow tract , 3VV
• Bila curiga patologi : rujuk 
 Hubungan Apeks dan Gaster

Hubungan letak gaster dan apeks jantung (Di unduh dari :

http://www.centrus.co.br/DiplomaFMF/SeriesFMF/18-23weeks/chapter-04/heart/heartfmf-complete.html 
tanggal 7 Oktober 2006)
Figure
ure 2. Four-chambamber viewiew. The key elem
lements of the norma
rmal mid-tr-trimes
imestter four-
chamber view include heart area no more than one third of chest area, right- and
left-sided structures approximately equal (chamber size and wall thickness), a
patent foramen ovale with its valve in the left atrium, an intact cardiac ‘crux’ with
normal offset
set of the two
two atriov
ioventricu
icular valv
alves and
and intact ventri
tricular septum. The
morphological right ventricle (RV) is iden dentifie
fied by the presence of the moderator
band and tricuspid valve, this his valve inserting more apically in the septum than does
the mitral valve (normal offset). D. Aorta, descending aorta; L, left; LA, left atrium;
LV, lef
left vent
entric
ricle;
le; R, righ
ight; RA,
RA, righ
ight atriu
trium.
m. ISUO
ISUOGG, 2013
2013
Figu
Figure
re 4. Feta
Fetall hear
heartt scan
scanni
ning
ng tech
techni
niqu
que.
e. The
The four-
our-ch
cham
ambe
berr view
view is obt
obtaine
ained
d thr
through
ough
an axial scanning plane across the fetal chest. Cephalad tilting of the transducer
from the four-chamber view towards the fetal head gives the outflow tract views
sequen
uentially: left ventricular outflow tract (LVOT), right ventricular outflow tract
(RVOT), thr
three-
ee-vess
essel (3V)
3V) and
and thr
three vess
essels
els and
and tra
trachea
chea (3VT
(3VT)) vie
views. ISUO
ISUOG,
G, 2013
2013

http://onlinelibrary.wiley
http://onlinelibrary.wiley.com/store/
.com/store/10.1002/uog.12403/asset/i
10.1002/uog.12403/asset/image_n/uog12403-fig-0004.png?v=1&t=hjwzp4
mage_n/uog12403-fig-0004.png?v=1&t=hjwzp45y&s
5y&s=
Figu
Figure
re 5. Left
Left vent
entricula
cularr outfl
utflo
ow tract (LV (LVOT) vie
view. This view
view show
showss a vesse
essell
conn
connececte
tedd to the
the left
left ventr
entriicle
cle (LV)
(LV).. It is impor
mporta
tannt to demon
emonsstrat
trate
e con
continu
tinuit
ity
y
between the interventricular septum and the anterior wall of this vessel,
which in the normal heart corresponds to the aorta. The aortic valve should
not be thickened and should be shown to open freely. The aortic valve is
closed in (a) and open in (b). D. Aorta, descending aorta; L, left; LA, left
atriu
trium;
m; R, righ
right;
t; RA,
RA, rig
right atriu
trium;
m; RV, rig
right ven
ventric
triclle. ISUOG,
UOG, 2013
2013
Figure 6. Right ventricular outflow tract (RVOT) view. This view shows a vessel connected to
the right ventricle (RV). In the normal heart this vessel crosses over the aorta, which helps in
identifying it as the main pulmonary artery (PA). The pulmonary valve should not be
thickened and should open freely. In (a), the bifurcation of the PA into both pulmonary
branches can be seen. The pulmonary valve is closed. In (b), the plane of insonation is slightly
more cephalad. The PA, right pulmonary artery (RPA) and arterial duct are seen. D. Aorta,
descending aorta; L, left; LPA, left pulmonary artery; R, right; SVC, superior vena cava.
Figure 7. Three-vessel (3V) view. This view best demonstrates the
relationship between the pulmonary artery, aorta and superior vena cava
(SVC) in the upper mediastinum. It is important to note the correct position
and alignment of the three vessels as well as their relative size. The
pulmonary artery, to the left, is the largest of the three and the most
anterior, whereas the SVC is the smallest and most posterior. D. Aorta,
descending aorta.
Figure 8. Three vessels and trachea (3VT) view. This view best demonstrates the
transverse aortic arch and its relationship with the trachea. In the normal heart,
both the aortic arch and the ductal arch are located to the left of the trachea, in a
‘V’-shaped configuration. L, left; R, right; SVC, superior vena cava.

http://onlinelibrary.wiley.com/store/10.1002/uog.12403/asset/image_n/uog12403-fig-0008.png?v=1&t=hjx0n8iq&s=
 ABDOMEN

• Penilaian :
- Keutuhan dinding
abdomen
- Insersi tali pusat
- Hepar, gaster, intestin,
kolon-rektum
- Intestin (diameter < 7
mm)
- Kolon (diameter < 12
mm)
 DINDING ABDOMEN

Algoritma pemeriksaan dinding abdomen. (Di unduh dari :

http://www.centrus.co.br/DiplomaFMF/SeriesFMF/18-23-
 ISI RONGGA ABDOMEN

TRANSVERSAL

Tampak vertebra, gaster, dan V. porta

 ISI RONGGA ABDOMEN

Algoritma pemeriksaan traktus digestivus. (Di unduh dari :

http://www.centrus.co.br/DiplomaFMF/SeriesFMF/18-23-
weeks/algorytms/algorytms_file/abdome/abdome.html  Pada ta al 8 Oktobe 2006)
 TRAKTUS URINARIUS
• Ginjal : Ekstra peritoneal 
bilateral  bentuk seperti
kacang  korteks & medulla
berisi cairan : anekhoik 

sistem pelvio-kalises 
ureter  VU  nilai dalam 3
bidang potong
• VU :
- Waktu pengosongan dan
pengisian
- Tidak tampak / kosong :
agenesis
ginjal 
- Dilatasi : obstruksi katup
 posterior, dll 
 TRAKTUS URINARIUS

Algoritma pemeriksaan ginjal. (Di unduh dari :

http://www.centrus.co.br/DiplomaFMF/SeriesFMF/18-23-
weeks/algorytms/algorytms_file/kidneys/kidneys.html . P da t al 8
 GENITALIA
• Tingkat kesalahan : ± 3%
Kesalahan penentuan kelamin perempuan > laki-laki
• Perempuan :
- Labia, uterus (?)
• Laki-laki :
- Penis, testis, dan skrotum
- 30 minggu : testis masuk ke skrotum
- Hidrokel : sering ditemukan
VERTEBRA
The vertebrae are formed from three
ossification centers in fetal life; one for
the vertebral body and one for each
lamina of the neural arch. The spinous
process only begins to ossify after birth.
The ossification centers are seen as three
reflective foci on a transverse (axial)
image, surrounding the echo-free central
neural canal. In the cervical, thoracic and
upper lumber region they have a
triangular shape, but become U-shaped in
the lower lumbar spine due to the normal
lumbar expansion of the neural canal. In
the Sagittal view the anterior and
posterior elements of the vertebral body
are present as a double row of echoes
(representing the vertebral bodies and
laminae).
 EKSTREMITAS
• Superior
- Humerus, Radius, Ulna, dan Telapak Tangan, Jari
- Jumlah : sepasang
• Inferior
- Femur, Tibia, Fibula, dan Telapak kaki, Jari
- Jumlah : sepasang

• Korelasi antar ekstremitas

- Sudut antara punggung kaki dan tungkai bawah > 900
- Talipes (Club-foot )
 BIOMETRI DASAR
• Biometri dasar : BPD, HC, AC, FL, EFW 
• Biometri extended : Cerebellum, dll 
• Usia kehamilan
• Gangguan pertumbuhan : makrosomia dan PJT
perhatikan kecenderungannya
• Skrining anomali
• Pakai satu peneliti untuk biometri dasar : Hadlock ?
 Jeanty ? Peneliti lokal ? Lainnya ?  POGI (2013)
memakai Hadlock 1984
 Parameter Klinis dalam
Penentuan Usia Gestasi
Prioritas untuk Penentuan Usia Gestasi Prakiraan Perbedaan untuk 95% Kasus
1. IVF / Inseminasi < 1 hari
2. Induksi ovulasi 3 – 4 hari
3. Pencatatan suhu basal badan - 5 hari
4. USG : CRL 4 – 5 hari
5. USG : BPD (12 – 20 minggu) ± 1 minggu
6. Pemeriksaan fisik trimester 1 (uterus normal) ± 1 minggu (?)
7. USG : volume kantong gestasi ± 1,5 minggu
8. USG : BPD (20 – 26 minggu) ± 1,6 minggu
9. HPHT siklus tercatat (haid normal) ± 2 – 3 minggu
10. USG : BPD (26 – 30 minggu) ± 2 – 3 minggu
11. USG : BPD ( > 30 minggu ) 3 – 4 minggu
12. Pengukuran Tinggi fundus uteri 4 – 6 minggu
13. Pertama kali DJJ terdengar 4 – 6 minggu
14. Quickening 4 – 6 minggu
Adapted from Hadlock FP. Ultrasound evaluation of fetal growth. In: Callen PW. Ultrasonography in
Biparietal Diameter (BPD)
• Tentukan letak dan
presentasi janin
• Susuri vertebra hIngga ke
daerah kepala  putar 
transduser hingga terletak di
atas telinga  transversal
• Tampak : cranium, falx cerebri,
CSP, Thalamus, Ventrikel 3,
ventrikel lateral
• Tidak boleh tampak 
cerebellum dan orbita
• Ukur : OUTER TO INNER
 Head Circumference (HC)
• Bidang potong sama seperti BPD
• Sering dipergunakan pada trimester 3
• Cara ukur : outer to outer , ellips atau tracing
Abdominal Circumference (AC)

Tentukan letak dan presentasi.

Susuri punggung, hingga tampak
Jantung.
Putar transduser 900.
Cari vertebra, gaster, dan vena
Porta. Tidak boleh tampak ginjal
Buat AC sebundar mungkin.
Cara ukur : OUTER TO OUTER
 Femur Length (FL)
Tentukan letak dan presentasi, susuri vertebra hingg bokong.
Tampak VU dan bonngol femur putar transduser 900.
Cara ukur : diafisis ke diafisis (tulang ke tulang)
 SONOGRAPHIC MARKERS
(GENETIC SONOGRAPHY)

• Soft marker (Soft sign)

a. A minor fetal anomaly that have been found to be
statistically associated with fetal chromosomal anomaly.

b. An ultrasound finding at 18-22 weeks gestation which

increases the risk of the fetus having a chromosomal
anomaly (usually T-21)

» When several soft markers are combined in the one fetus,

the risk for chromosomal anomalies increases markedly.
FREQUENCY OF CHROMOSOME ABNORMALITIES &
NUMBER OF ULTRASOUND-DETECTED DEFECTS

No. of defects No. with chromosome abn./total with defect (%)

any 301/2086 (14)

2 276/958 (29)

3 223/488 (48)

4 153/248 (62)

5 93/133 (70)

6 58/80 (72)

7 33/40 (82)

≥8 22/94 (92)

(Adopted from: Nicolaides KH, et al. Lancet, 340; 1992)

 Sonographic Markers and Fetal
Chromosome Abnormality
Sonographic Marker Isolated Appearance Combined Appearance

Nuchal translucency > 3 mm (11-14 wks) 29% 29%

Echogenic intestine up to 7% up to 46%
Umbilical cord cyst 7% 55%
Early growth restriction (< 20 wks)  5% 40%
Bilateral pylectasia 2 - 3% up to 30%
Choroid plexus cysts (bilateral) 0.6 - 1.5% 4.5 - 45%
Single umbilical artery (SUA) 0 - 2% 20 - 30%
Ventricular enlargement (10-15 mm) 2% 17%
Echogenic intracardiac focus 0 - 1.2% up to 12%

(Barbara Ulm. Sonographic Indications for Fetal Chromosome Abnormalities)

 SOFT MARKERS
(11-14 WEEKS GESTATION)

• Nuchal translucency (NT) → T-21, T-18, T-13,

triploidy, 45X/O

• Absent of nasal bone → T-21

 SOFT MARKERS
(18-22 WEEKS GESTATION)

Sonographic marker T-21 T-18 T-13

∙ Nuchal fold ≥ 6 mm. + + +

∙ Echogenic bowel +
∙ Echogenic foci in the fetal heart +
∙ Short femur (< 3 %-ile) +
∙ Short humerus (< 3 %-ile) +
∙ Dilated renal pelvis (> 5 mm) + + +
∙ Mild ventriculomegaly (10-15 mm) + +
∙ Single umbilical artery + +
 Sonographic Scoring Index

∙ Nuchal fold ≥ 6 mm 2
∙ Structural defect 2
∙ Short femur (< 3%-ile) 1
∙ Short humerus (<3&-ile) 1
∙ Pyelectasis (> 5 mm) 1
∙ Echogenic bowel 1
∙ Choroid plexus cyst 1

* Amniocentesis should be performed when the score ≥ 2

(Nadel AS, et al. J Ultrasound Med. 1995; 14)

 SOFT MARKERS

Other indications to offer amniocentesis

• A single soft marker if present in a woman who at
risk for chromosomal anomaly:

▪ > 35 years of age

▪ Positive for biochemical test.

 SONOGRAPHIC SCORING INDEX FOR DETECTING
DOWN SYNDROME

∙ Nuchal fold ≥ 6 mm 2
∙ Structural defect 2
∙ Short femur (< 3%-ile) 1
∙ Short humerus (<3&-ile) 1
∙ Pyelectasis (> 5 mm) 1
∙ Maternal age 35-39 years 1
∙ Maternal age ≥ 40 years 2

* Score ≥ 2: sensitivity 86,8%; false-positive rate 27,1%

(Bromley B, et al. Ultrasound Obstet Gynecol. 1997; 10)

 SOFT MARKERS FOR DETECTING
DOWN SYNDROME

Isolated marker Sensitivity False (+) rates

∙ Nuchal translucency (> 3 mm) 75% 1.0%

∙ Nuchal thickening (> 6 mm) 39,4% 0.6%

∙ Absent of the nasal bone 81% 11%

∙ Echogenic bowel 20.6% 0.6%

∙ Shortened femur (humerus) 31.6% (21.9%) 5.2% (1.4%)

∙ Echogenic intracardiac focus 27.7% 4.4%

∙ Renal pyelectasis 13.5% 2.6%

(Adopted from: PubMed Central. J Perinat Educ. 2006 Winter; 15)

 SONOGRAPHIC MARKERS

• Hard/strong marker (Hard sign)

A major fetal structural abnormality that have an

established and strong association with
chromosomal anomaly.

» Amniocentesis should be performed.

 HARD MARKERS

1. Head abnormalities
∙ hydrocephalus (21, 18, triploidy)
∙ microcephaly (13, 45X/O)
∙ holoprosencephaly (13)
∙ Dandy-Walker malformation (21, 18, 13)
∙ agenesis of the corpus callosum (18)
2. Face & neck abnormalities
∙ cleft lip & palate (18, 13)
∙ micrognathia (18)
∙ nuchal edema (21, 18, 13)
∙ cystic hygroma (45X/O)
Anomali kongenital daerah kepala
 HARD MARKERS
3. Thoracic cavity abnormalities
∙ diaphragmatic hernia (18, 13)
∙ congenital heart diseases (21, 18, 13, triploidy, 45X/O)

4. Abdominal wall & GI tract abnormalities

∙ esophageal atresia (21, 18)
∙ duodenal atresia (21)
∙ omphalocele (21, 18, 13)
 HARD MARKERS
5. Genitourinary abnormalities
∙ cystic kidney dysplasia (21, 18, 13, triploidy)
∙ hydronephrosis (21, 18, 13)

6. Skeleton abnormalities
∙ shortened femur/humerus (21)
∙ clenched fist (18, triploidy)
∙ club foot (18, 13)
 HARD MARKERS

7. Others
∙ non-immune hydrops (21, 45X/O)
∙ fetal growth restriction (21, 18, 13, triploidy, 45X/O)
∙ polyhydramnios (21, 18, 13)
∙ oligohydramnios (18, 13)
Asites dan hidrothoraks Atresia duodenum & hidramnion
 DOKUMENTASI
• Rekaman permanen :
- cetakan
- foto
- video (tape, flash-disk,
CD, hard-disk, memory
card, dll)
- dsb.

• Laporan pemeriksaan.
 PEMERIKSAAN TRIMESTER 3

• 28 minggu : mulai pemantauan gerak kartu

gerak janin
• 30 minggu : kematangan fungsi SSP  KTG
• 30  –  32 minggu : skrining   anomali yg baru
tampak
• 32  –  34 minggu : hemodilusi maksimal
• 34  –  36 minggu : pelvimetri klinis, PJT 
• 36 minggu : plasenta praevia, KTG
• Aterm : inpartu   USG intra-partum
• Postpartum : HPP, akut abdomen (kista)  
USG postpartum
 PESAN DIBAWA PULANG
• Skrining pada “window period” ada
anomali yang baru tampak pada
trimester 3
• Do not jump to conclusion  OMIM (online
 Mendelian of Inheritance of the Man)
• Penilaian 3 bidang potong (L, AP, dan T)
 volume
• Siapkan diri untuk pelatihan USG intra dan
post partum (Tingkat Madya)
• Bila ragu  rujuk 
 KEPUSTAKAAN
1. POGI. Buku Acuan USG Obstetri dan Ginekologi Dasar. Kolegium
OBGIN, 2013 (Draft).
2. POGI. Penuntun Belajar USG Obstetri dan Ginekologi. Kolegium
OBGIN, 2013.
3. Endjun JJ. USG Obstetri dan Ginekologi Dasar. Edisi 1, Cetakan
Kedua, Balai Penerbit FKUI, Jakarta, 2009.
4. Endjun JJ. USG Obstetri dan Ginekologi Dasar untuk Dokter.
RSPAD-PT. Sagung Seto, Jakarta, 2016.
5. Norton ME, Scoutt LM, Feldstein VA. Callen’s ultrasonography in
obstetrics and gynecology, 6 th Ed, Elsevier, 2017.
6. Salomon LJ, Alfirevic Z, Berghella V et al. ISUOG: Panduan praktik 
untuk melakukan scan rutin ultrasonografi janin mid-trimester,
UOG 2010. Alih bahasa Indonesia, A. Budi Marjono, Azen Salim,
2016.