Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug;16(3):98-113.
doi: 10.1002/j.2205-0140.2013.tb00106.x. Epub 2015 Dec 31.

A pictorial guide for the second trimester ultrasound

Michael Bethune  1 , Ekaterina Alibrahim  2 , Braidy Davies  2 , Eric Yong  2
Affiliations

A pictorial guide for the second trimester ultrasound

Michael Bethune et al. Australas J Ultrasound Med. 2013 Aug.

Abstract

Introduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images. Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements. Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.

Keywords: imaging; prenatal ultrasound; second trimester routine ultrasound.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Biparietal diameter plane.
  1. 1

    Biparietal diameter

  2. 2

    Cavum Septum pellucidum

  3. 3

    Thalami

  4. 4

    Hypoechoic skull sutures

  5. 5

    Third Ventricle

  6. 6

    Choroid

  7. 7

    Posterior Lateral ventricle

  8. 8

    Corpus callosum

Figure 2
Figure 2
Transventricular plane. The lower right images demonstrate that angling the fetal head can improve visualisation of the near field lateral ventricle.
  1. 1

    Near field posterior horn of lateral ventricle

  2. 2

    Choroid

  3. 3

    Far field posterior horn of lateral ventricle

  4. 4

    Cavum Septum Pellucidum (CSP)

  5. 5

    Corpus callosum (CC)

Figure 3
Figure 3
Cavum septum pellucidum. The corpus callosum is visible as a hypoechoic region just anterior to the CSP.
Figure 4
Figure 4
Cerebellar plane.
  1. 1

    Cavum Septum Pellucidum

  2. 2

    Cerebellar lobes

  3. 3

    Cerebellar vermis

  4. 4

    Cisterna Magna

  5. 5

    Nuchal Fold

  6. 6

    Cerebral peduncles

  7. 7

    Falx

  8. 8

    Thalami

Figure 5
Figure 5
Corpus callosum.
  1. 1

    Corpus callosum

  2. 2

    Cavum Septum Pellucidum

  3. 3

    Nasal bone

Figure 6
Figure 6
Coronal cerebellum.
  1. 1

    Cerebellar lobe

  2. 2

    Cerebellar vermis

  3. 3

    Falx

  4. 4

    Posterior horn of lateral ventricle

  5. 5

    Cisterna magna

Figure 7
Figure 7
Coronal Orbits.
  1. 1

    Orbit

  2. 2

    Lens of the eye

  3. 3

    Nasal bridge

Figure 8
Figure 8
Coronal lips and nose
  1. 1

    Two nostrils

  2. 2

    Upper lip

  3. 3

    Lower lip

  4. 4

    Chin

Figure 9
Figure 9
Axial orbit and lenses.
  1. 1

    Orbit

  2. 2

    Lens

  3. 3

    Nasal bridge

Figure 10
Figure 10
Upper lip and palate.
  1. 1

    Upper lip

  2. 2

    Hard palate.

Figure 11
Figure 11
Lower lip and mandible.
  1. 1

    Lower lip

  2. 2

    Mandible

Figure 12
Figure 12
Profile and nasal bone
  1. 1

    Nasal bone

  2. 2

    Nose

  3. 3

    Mandible

  4. 4

    Hard palate.

Figure 13
Figure 13
Cordes Technique. The operator places his left hand in front of the screen with the palm on the spine and the fingers pointing at the sternum – the thumb of his left hand now points to the left side of the fetus.
Figure 14
Figure 14
Diaphragm and lungs.
  1. 1

    Stomach

  2. 2

    Diaphragm

  3. 3

    Heart

  4. 4

    Lungs

Figure 15
Figure 15
Coronal situs.
  1. 1

    Stomach

  2. 2

    Heart

  3. 3

    Scapula

  4. 4

    Diaphragm

  5. 5

    Iliac crest

Figure 16
Figure 16
Abdominal situs.
  1. 1

    Stomach

  2. 2

    Aorta

  3. 3

    IVC

  4. 4

    Spine

Figure 17
Figure 17
Four chamber view of heart.
  1. 1

    Right ventricle (RV)

  2. 2

    Moderator band

  3. 3

    Left ventricle (LV)

  4. 4

    Left atrium (LA)

  5. 5

    Foramen ovale

  6. 6

    Descending aorta

  7. 7

    Ribs

  8. 8

    Pulmonary veins

  9. 9

    Right atrium (RA)

Figure 18
Figure 18
Four‐chamber with blood flow – intraventricular septum. Color flow is seen into both ventricles, all of the way to the apex. Flow is demonstrated across the foramen ovale.
Figure 19
Figure 19
Left ventricular outflow tract.
  1. 1

    Right ventricle

  2. 2

    Left ventricle

  3. 3

    Rib

  4. 4

    Spine

  5. 5

    Descending aorta

  6. 6

    Left atrium (tip of appendage)

  7. 7

    Right atrium

  8. 8

    Ascending aorta (can just see tip of the aortic valve between this and the left atrium)

Figure 20
Figure 20
LVOT Doppler assessment. Forward flow is seen across the aortic valve with no obvious turbulence.
Figure 21
Figure 21
Right ventricular outflow tract.
  1. 1

    Right ventricle

  2. 2

    Pulmonary valve

  3. 3

    Pulmonary trunk

  4. 4

    Ductus arteriosus

  5. 5

    Descending aorta

  6. 6

    Right pulmonary artery

  7. 7

    Superior vena cava

  8. 8

    Ascending aorta

  9. 9

    Right atrium

Figure 22
Figure 22
RVOT Doppler assessment. No turbulence is seen across the pulmonary valve, the direction of flow down the ductus arteriosus is correct.
Figure 23
Figure 23
Three vessels and trachea view (3VI).
  1. 1

    Pulmonary Arch

  2. 2

    Aortic Arch

  3. 3

    SVC

  4. 4

    Trachea

  5. 5

    Spine

  6. 6

    Rib

Figure 24
Figure 24
Three vessels and trachea view (3VT), Doppler assessment. The correct direction of flow (away from the heart) is demonstrated in both the aorta and ductus Arteriosus.
Figure 25
Figure 25
Aortic arch.
  1. 1

    Aortic arch

  2. 2

    Three head and neck vessels arise from the aorta

  3. 3

    Descending aorta

  4. 4

    Spine

  5. 5

    Heart

Figure 26
Figure 26
Aortic arch, Doppler assessment.
Figure 27
Figure 27
Ductal arch.
  1. 1

    Ductal arch arises anteriorly from the heart.

  2. 2

    Pulmonary valve

  3. 3

    Descending aorta

  4. 4

    Heart

Figure 28
Figure 28
Ductal arch, Doppler assessment. Demonstrates flow away from the heart with no obvious turbulence or reverse flow and no tributaries directed towards the neck.
Figure 29
Figure 29
Fetal heart rate.
Figure 30
Figure 30
SVC & IVC.
  1. 1

    Superior vena cava

  2. 2

    Right atrium

  3. 3

    Inferior vena cava

  4. 4

    Diaphragm

  5. 5

    Spine

Figure 31
Figure 31
Abdominal circumference.
  1. 1

    Umbilical vein

  2. 2

    Middle portal vein

  3. 3

    Stomach

  4. 4

    Spine

  5. 5

    Rib

Figure 32
Figure 32
Umbilical cord insertion.
  1. 1

    Umbilical arteries

  2. 2

    Skin line

  3. 3

    Spine

Figure 33
Figure 33
Bladder and umbilical arteries.
  1. 1

    Bladder

  2. 2

    Umbilical arteries

  3. 3

    Thighs

Figure 34
Figure 34
Axial kidneys.
  1. 1

    Spine

  2. 2

    Kidney

  3. 3

    Renal pelvis

Figure 35
Figure 35
Coronal kidneys.
  1. 1

    Kidney

  2. 2

    Renal pelvis

  3. 3

    Aorta

  4. 4

    Iliac arteries

  5. 5

    Iliac crest

Figure 36
Figure 36
Renal arteries. Coronal section with the aorta horizontal facilitates demonstrates of flow from the aorta to each renal artery.
Figure 37
Figure 37
Spine and skin line – longitudinal.
  1. 1

    Skin line

  2. 2

    Bladder

  3. 3

    Abdominal Aorta

  4. 4

    Vertebrae

Figure 38
Figure 38
Coronal spine.
  1. 1

    Iliac crest

  2. 2

    Sacrum

  3. 3

    Vertebrae

  4. 4

    Ribs

Figure 39
Figure 39
Coronal spine – sacrum.
  1. 1

    Iliac crest

  2. 2

    Sacrum

  3. 3

    Vertebrae

Figure 40
Figure 40
Axial spine images. Four images of different levels of the spine clockwise from upper left to lower left: cervical spine, thoracic spine, abdominal spine, lumbar spine.
  1. 1

    Vertebral body

  2. 2

    Ossification centre in vertebral lamina.

  3. 3

    Intact skin line

  4. 4

    Clavicle

  5. 5

    Rib

  6. 6

    Heart

  7. 7

    Kidney

  8. 8

    Iliac crest

  9. 9

    Bladder

Figure 41
Figure 41
Femur.
  1. 1

    Femur

  2. 2

    Posterior acoustic shadow

Figure 42
Figure 42
Leg bones. The tibia and fibula are noted to be the same length.
  1. 1

    Tibia

  2. 2

    Fibula

Figure 43
Figure 43
Heel. There is a right angle between the sloe of the foot and the leg bones.
  1. 1

    Tibia

  2. 2

    Fibula

  3. 3

    Heel

Figure 44
Figure 44
Feet. Five toes are identified on each foot.
Figure 45
Figure 45
Humerus. The humerus is identified on each arm; the posterior acoustic shadow is noted.
Figure 46
Figure 46
Forearm. The ulna is longer than the radius at the elbow.
Figure 47
Figure 47
Hands. The hand is best imaged open palmed, the full length of the fingers is seen, and the thumb is not adducted
Figure 48
Figure 48
Male gender sagittal and axial. The top image and diagram are mid sagittal and demonstrate the genitalia separate to the cord insertion. The bottom axial image and diagram confirms the presence of penis and scrotum between the legs.
  1. 1

    Penis

  2. 2

    Scrotum

  3. 3

    Leg

Figure 49
Figure 49
Female gender sagittal and axial. The top image and diagram are mid sagittal and demonstrate the flat mons pubis below the cord insertion. The bottom axial image and diagram show the three lines of the labia.
  1. 1

    Bladder

  2. 2

    Mons pubis

  3. 3

    Umbilical cord

  4. 4

    Labia

  5. 5

    Thigh

Figure 50
Figure 50
Placenta and cord insertion. The cord inserts centrally into an anterior placenta. Identification of the insertion point is facilitated by the use of color or power Doppler.
Figure 51
Figure 51
Placental site and cervical length.
  1. 1

    Placenta

  2. 2

    Lower placental edge

  3. 3

    Cervical canal

  4. 4

    Fetal limbs

Figure 52
Figure 52
Doppler over the internal os. No vasa praevia is seen overlying the internal os
Figure 53
Figure 53
Transvaginal cervical length. The hypoechoic cervical canal is demonstrated; the vaginal probe is not sitting hard up against the cervix and therefore is not artificially elongating the cervical canal measurement.
  1. 1

    Cervical canal

  2. 2

    Fetal head

  3. 3

    Maternal bladderz

See this image and copyright information in PMC

References

    1. Chitty LS, Hunt GH, Moore J, Lobb MO. Effectiveness of routine ultrasonography in detecting fetal structural abnormalities in a low risk population. BMJ 1991; 303 (6811): 1165–69. - PMC - PubMed
    1. Nisbet DL, Robertson AC, Schluter PJ, McLennan AC, Hyett JA. Auditing ultrasound assessment of fetal nuchal translucency thickness: a review of Australian National Data 2002–2008. Aust N Z J Obstet Gynaecol 2010; 50 (5): 450–55. - PubMed
    1. Vintzileos AM, Ananth CV, Smulian JC, Beazoglou T, Knuppel RA. Routine second‐trimester ultrasonography in the United States: a cost‐benefit analysis. Am J Obstet Gynecol 2000; 182 (3): 655–60. - PubMed
    1. American Institute of Ultrasound in Medicine . AIUM standard for documentation of an ultrasound examination. American Institute of Ultrasound in Medicine. J Ultrasound Med 2002; 21 (10): 1188–89. - PubMed
    1. ASUM D2 . Australasian Society for Ultrasound in Medicine – Guidelines for the mid Trimester Obstetrics Scan Last Revised July 2005. Available at http://www.asum.com.au/newsite/files/documents/policies/PS/D2_policy.pdf. Accessed October 2012

LinkOut - more resources