GAMBARAN USG

TRIMESTER 2
Trimester 2
- Done routinely in gestational age of 18 - 22 weeks
- Component:
- Fetal Number
- Viability
- Presentation
- Fetal Biometry
- Amniotic fluid
- Placenta
- Cervix
Biometry
The minimum measurements to report are:
● biparietal diameter (BPD),
● head circumference (HC),
● abdominal circumference (AC), and
● femur length (FL).

Other biometry which could be reported include:

● humerus length (HL),
● nasal bone length (NB),
● nuchal fold (NF),
● cerebellar diameter (TCD),
● cisterna magna and cervical length.

A combination of BPD and HC measurements can be used to calculate an

estimated date of delivery (EDD).
Fetal Head
Biparietal Diameter Plane
Transventricular Plane
Cavum Septum Pellucidum
Cellebelar Plane
Corpus Callosum
Coronal Cerebellum
Abnormalitas
Dolicocephaly (long skull) Brachycephaly (short skull)

Clover Leaf Skull

→ premature
closure of sagittal,
coronal &
lambdoid sutures
Hydranencephaly

Brain hemisphere absent

Cranial cavity filled with CSF

ACRANIA (Absent Cranium) ANENCEPHALY (Frog eye sign)
Major brain tissue may present brain tissue replaced by amorphous
mass (exencephaly)
Cephalocele
Herniasi jaringan intracranial

Encephalocele: herniasi brain

Tissue

Meningocele: herniasi meninges

Meningoencephalocele: herniasi
meninges & brain tissue
Cephalocele
Bila massa terlihat cystic, maka
komponen herniasi yang dominan
adalah meningocele.

Massa solid mengindikasikan

Encephalocele.

Encephalocele yang besar dapat

diikuti dengan gambaran microcephaly
VENTRIKULOMEGALY
Pengukuran:

1. Lebar atria (diameter ventrikel lateral) >10 mm → fetal ventriculomegaly

- Borderline = 10 - 12 mm
- Moderate = 12,1 - 15 mm
- Severe = >15 mm

1. Separasi koroid
- Separasi pleksus koroid >3 mm (dari dinding medial ke dinding medial
ventrikel lateral lainnya) → fetal ventriculomegaly.
Ventriculomegaly
Dangling choroid sign
Fetal hydrocephalus

Ventrikel membesar
karena kenaikkan cairan
serebrospinal

- obstruktif/
nonobstruktif
Choroid plexus cyst
Bilateral/unilateral

Benign/transient

Dapat terlihat pada usia 16 - 21 minggu,

kemudian mulai mengecil
HOLOPROENCEPHALY
Separasi inkomplit dari kedua hemisphere

Tiga tipe yaitu:

- Alobar
- Semilobar
- Lobar
ALOBAR
● monoventrikel
● Fusi dari thalamus
● Tidak ada corpus callosum
● Tidak ada fisura interhemisfer
● Tidak ada cavum septum pellucidum
● Tidak ada 3rd ventricle
● MCA & ACA diganti dengan cabang2 arteri
internal carotid & pembuluh basiler yang
kusut/tangled
● Malformasi wajah berat
SEMILOBAR
● Tidak ada septum pellucidum
● Monoventrikel dengan terbentuk
occipital horn & temporal horn secara
parsial
● falx cerebri: bagian anterior tdk ada
● Pembentukan fisura hemisfer inkomplit
● Fusi parsial atau penuh dari thalami
● Tidak ada traktus olfaktorius
● agenesis/hypoplasia dari corpus
callosum
● Formasi hippocampus inkomplit
LOBAR
- Divisi hemisfer penuh
- Ada falx cerebri
- Thalami terpisah
- Fusi dari frontal horn ventrikel
lateral
- Lobus serebri sepenuhnya
terbentuk
- Tidak ada septum pellucidum
DANDY-WALKER MALFORMATION
Tidak terbentuknya bagian yang
menghubungkan kedua vermis
cerebellum

- Dilatasi cystic 4th ventricle dan

berhubungan dengan posterior fossa
- Perbesaran posterior fossa
- Elevasi tentorium
- hypoplastic/absent vermis
Fetal Face
Coronal Orbits
Coronal Lips and Nose
Axial Orbit and Lenses
Upper Lip and Palate
Lower Lip and Mandible
Profile and Nasal Bone
Abnormalitas
Retrognathia

Letak rahang bawah jauh di belakang rahang atas

Frontal Bossing

Prominent forehead (dahi menonjol ke depan)

Slopped forehead
Agnathia
Absence of jaw

(One or both jaws)

ORBIT

Hypotelorism Hypetelorism

Jarak kedua mata mengecil Jarak kedua mata memanjang

Proboscis cyclopia

Pembentukan hidung abnormal, mata menyatu di tengah

Microphtlamia & Anophtalmia
Absent nasal bone
CLEFT LIP
Macroglossia (large tongue)
Fetal Chest and Heart
Cordes Technique
Diaphragm and Lungs
Coronal Situs
Abdominal Situs
Four Chamber View of Heart
Four-Chamber
with Blood Flow -
Intraventricular
Septum
Left Ventricular Outflow Tract
LVOT Doppler
Assessment
Right Ventricular Outflow Tract
RVOT Doppler
Assessment
3 Vessels and Tracheal View
3VT Doppler
Assessment
Aortic Arch
Aortic Arch
Doppler
Assessment
Ductal Arch
Ductal Arch
Doppler
Assessment
Fetal Heart Rate
SVC and IVC
Abnormalitas
PARU-PARU
Congenital Cystic Adenomatoid Malformation (CCAM)

1:1500 - 1:4000, male predominant

→ kegagalan pembentukan bronkoalveolar dengan proliferasi hamartoma
membentuk gland-like pattern (adenomatoid)
 Pulmonary hypoplasia
Pembentukan paru inkomplit/defisit

- Fetal lung:head ratio decreased

(<1 poor prognosis)
- Thoracic circumference decreased

(Rasio tsb mungkin normal pada

penyebab intrathoracic)

- thoracic : abdominal circumference

ratio <0.6
- femur length : abdominal
circumference ratio <0.16
CDH (Congenital diaphragmatic hernia)

Disebabkan oleh kegagalan fusi pleuroperitonial canal pada minggu ke 8 gestasi

HEART

ASD VSD
Tetralogy of Fallot
Four features:

- VSD
- Right ventricular outflow tract
obstruction (RVOTO)
- Overriding aorta
- Right ventricular hypertrophy
(after birth)
Transposition of the Great Arteries (TGA)
Truncus Arteriosus (TA)
Penyakit Jantung kongenital sianotik di
mana hanya 1 pembuluh darah yang
mensuplai sistem pulmonal dan seluruh
tubuh
Double outlet RV
Aorta (AO) & pulmonary artery (PA)
berasal dari right ventricle (RV)
Rhabdomyoma
Echogenic mass at the
interventricular septum
Fetal Abdomen
Abdominal Circumference
Umbilical Cord Insertion
Bladder and Umbilical Arteries
Axial Kidneys
Coronal Kidneys
Renal Arteries
Abnormalitas
Tanda-tanda abnormalitas pada abdomen
- Tidak terlihat gastric bubble
- Lesi cystic
- Dilatasi usus halus (>7 mm → obstruksi)
- Dilatasi kolon (>20 mm → obstruksi)
- “Usus ekogenik”
- Perbesaran liver/spleen
- Defek dinding abdomen
Gastric bubble tidak tervisualisasi
Esophageal Atresia
Tidak adanya kontinuitas dari
esofagus karena kesalahan divisi
dari foregut menjadi trakea dan
esofagus

TRIAD diagnosis (8-10% kasus):

- Polyhydramnios
- Lambung tidak ada/kecil
- “Pouch” sign: dilatasi proximal
pada pouch esofageal
Esophageal atresia (cont’d)
“POUCH” Sign

Dilatasi dari jalur esofagus karena

menelan cairan amnion

Sagital Coronal
Duodenal Atresia
- Double-bubble sign
- Dapat terlihat terhubung dengan gaster
Usus Ekogenik
Etiologi:

- Intraamniotic
bleeding
- Aneuploidy
- Cystic fibrosis
- Fetal growth
restriction
- Infection
Normal bowel: lebih hypoechoic Echogenic bowel:: usus sangat
- GI obstruction dibanding tulang fetus ekodens seperti tulang pada
bagian tengah abdomen
Hepatomegaly

Koronal parasagittal

Pasien dengan infeksi (Hepatitis A) menunjukkan hepatomegali, dengan

makrokalsifikasi kapsuler dan asites moderat
Hepatomegaly CMV infection

Enlarged, hyperechoic, inhomogenous liver

 Gastroschisis Omphalocele

Para-umbilical abdominal wall defect midline abdominal wall defect

UROGENITAL SYSTEM
Distended bladder (obstructive uropathy)
Potongan transversal level ginjal
(spina anterior)
Dilatasi ureteropelvic junction (UPJ)
pada ginjal kiri tanpa hidronefrosis
Potongan longitudinal
Ginjal hidronefrosis. Terlihat banyak
calyx yang terdilatasi terhubung ke
renal pelvis, membedakan dengan
multicystic kidney
 Cystic Kidney

enlarged, uniformly cystic kidney. Pyelectasis

No apparent renal cortical tissue
Fetal Musculoskeletal System
Spine and Skin Line - Longitudinal
Coronal Spine
Coronal Spine - Sacrum
Axial Spine Images
Femur
Leg Bones
Heel
Feet
Humerus
Forearm
Hands
Abnormalitas
Spina Bifida

Neural tube defect → defect Spina bifida with

in processus spinosus meningo/meningomyocele
Caudal regression syndrome

Caudal regression syndrome → defek struktural di caudal. Bervariasi dari agenesis sebagian keci
koksigis, hingga lumbosakral.

Akibat dari cedera pada awal kehamilan (<4 minggu). Hiperglikemia, infeksi, cedera karena toksin
dan iskemik juga meningkatkan risiko tersebut.
LIMBS
- Confirm 3 long bones:
- Arm: humerus, radius, ulnar
- Leg: femur, tibia, fibula
- Complete absent → amelia
- Phocomelia (deficiency/foreshortening), rhizomelia (prox), mesomelia (mid),
acromelia (dist), micromelia (entire limb)
- Look for bowing, angulation, club foot, and fingers
Amelia Phocomelia
Club foot
Congenital Talipes equinovarus
- Present as adduction of the forefoot, inversion of the
heel and plantar flexion of the forefoot and ankle
- Male : female = 2 : 1
- Deformitas ankle & subtalar joint
Deformity

A: bowed femur ec. campomelic dysplasia, B : X ray for A

C: femur fracture ec. osteogenesis imperfecta type IV, D: X ray for C

Thanatophoric dysplasia
Result from FGFR3 gene mutation

- A - C: micromelia femur

- D: thorax much smaller

compared to abdomen

- E & F: 3D USG and CT of

upper & lower limb
micromelic shortening, no
fracture, normal ossification,
and puppet posture
Fetal Gender
Male Gender
Sagittal and Axial
Female Gender
Sagittal and Axial
Other Structures
Placenta and Cord Insertion
Placental Site and Cervical Length
Placenta location
Marginal placenta previa Complete placenta previa
Retroplacental hematoma
Pseudo-placenta previa
Doppler over
Internal Os
Transvaginal
Cervical Length
Amniotic fluid measurement
Amniotic fluid Index (AFI)

- Uterus divided into four quadrant by

linea nigra & mediolateral line
- Measure in cm from deepest pocket
devoid of fetal part & cord in each 4
quadrant, and then sum.
- Normal range varies with gestational
age
Maximum vertical pocket
Maximum depth of a single pocket (devoid
of fetal parts & cord)

- <2 cm = oligohydramnios
- 2-8 cm = normal (subjective volume)
- >8 cm = polyhydramnios
Terima Kasih