<![CDATA[Background: Low utilization of ultrasonography (USG) examinations among pregnant women, at only 16,1% during first antenatal care (ANC) visits and 18,7% during last ANC visits, may hinder the early detection of pregnancy complications and contribute to a high infant mortality rate (IMR) which reached 34 cases in 2024 in Tulang Bawang Regency. This study aimed to analyze the determinants of utilization with USG examinations among pregnant women in Tulang Bawang Regency in 2025. Methods: This quantitative analytic study used a cross-sectional design. From a population of 2,694 pregnant women in Tulang Bawang Regency in 2025, a sample of 267 respondents was selected using stratified random sampling from six primary health centers. Instruments included a questionnaire and secondary data sources. Data were analyzed using univariate, bivariate (Chi-square), and multivariate analyses was conducted using multiple logistic regression. Results: Of the 267 respondents, 141 (52.8%) adhered to ultrasound examinations. Knowledge (p=0.000), attitude (p=0.008), age (p=0.000), service availability (p=0.008), accessibility (p=0.000), and perception (p=0.013) were significantly associated with ultrasound adherence, whereas pregnancy risk status was not (p=0.643). Age was the dominant factor (p=0.001; OR=3.660; 95% CI: 1.751–7.650). Conclusions: Conclusion: Ultrasound utilization among pregnant women is primarily influenced by age, accessibility, and knowledge. To improve ultrasound utilization as an ANC-strengthening innovation, we recommend prioritizing target screening (pregnant women aged <20 and >35 years), providing structured ultrasound education, implementing written scheduling, tiered reminders, and active follow-up of missed appointments. This innovation should be supported by flexible service hours and improved access through scheduled transportation and mobile ultrasound services, subject to resource availability.]]>
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