Posted on April 11th, 2017 by wombwithaviewblog.com

OOPS! Not a Girl! – The Case of Mistaken Fetal Sex

Yep, it happens…the mistaken fetal sex guess. It can happen to anyone and sometimes does! We all have heard the story somewhere. A friend. Family member. Someone’s friend’s cousin’s sister-in-law… The truth is that the right conditions can make anyone susceptible to an incorrect guess. Consequently, the discovery of the opposite sex inevitably leads to a roller coaster of emotions! This is precisely why I have always been careful and cautious when throwing out a guess to any interested parent-to-be.

In the Eye of the Beholder

I have certainly been on the giving end of that conversation. Most of the time, it’s not pretty. The result usually accompanies shock and wonder at how this could have happened, especially with today’s technology. This is the typical feeling. However, still get the feeling that the general public thinks it’s the machine doing the guessing and not the observer. This would be an incorrect assumption. It always has been and always will be the observer who guesses. The machine does nothing without the operator making it happen. Other healthcare professionals are more experienced and better than others at scanning.

Some docs, nurse midwives, or other healthcare professionals are better than their counterparts at scanning. But I believe all of them in the field would agree that none of them have the skill of a seasoned sonographer. Unfortunately (and unbeknownst to you), some holding that probe are not formally trained in ultrasound at all! Some in the 3D business who are taking a crack at your baby’s sex don’t even come from the medical field. Scary, right?

Factors That Interfere With Fetal Sex Guesses

That said, a whole world of other issues can interfere with the guess of someone who is more than qualified to make it. Factors like fetal position and patient size can both make visualization limited. The laws of Ultrasound Physics dictate how well we will or won’t see a particular object. The more tissue the sound waves have to penetrate, the more limited the image will be once they make their long trek back to the monitor. That said, I could see very well in a few of my heavier patients over the years and definitely struggled in some thinner ones. This is also because air and gas are not our friends in ultrasound. If your intestines are full, it can get in the way of what we need to see…even in the thinnest of people! Yep, poop is a problem.

A Case of Mistaken Fetal Sex

Readers from all over the world email me with their images for a second opinion on fetal sex. This can be very difficult when the image isn’t a great one to start. I always like to play it cautious with my patients and readers. Especially when I’m examining one frozen image, the ability to see from all angles is taken out of the equation and a real disadvantage. The image has to be technically great, or it is simply a wild card.You’ll find one reader’s story below who wanted my opinion, but I was clueless. This baby didn’t look like a boy or girl!

You’ll find one reader’s story below who wanted my opinion, but I was a bit hesitant with this one. She wrote initially expressing her confusion. She was 20 Weeks but couldn’t make out typical girl or boy parts. This was the image below. Same for me, confused mama! The image below is not “textbook” for either sex, though I think most any sonographer would guess “girl” based on this one image alone. Hmm…

fetal sex, mistaken fetal sex

I wrote her back saying this:

Hi, this is not a very clear image but does seem to be a good angle. I don’t see anything sticking out, so I would have to guess girl based on that alone. Maybe a future ultrasound may be more clear? I’m sorry I couldn’t help more!

Best,
wwavblogger, RDMS

She wrote me back a couple of weeks later with a correction:

Everyone said it’s a girl again. I was a little disappointed, but now he is here. Blessed with a baby boy. The family is complete now. Wanted to share this happiness with you. Thank you.

I have to say I was a bit shocked that this was a boy, however, I was so happy for her that she got what she wanted. My reply to her:

Oh, congratulations!! This is precisely why I don’t like to try to confirm sex with other sonographer’s images! Sometimes they just aren’t very good and depend on angle and experience. A lack of something in one shot is not a definite girl! Many blessings to you!

Now, obviously, we all look different from one another and abnormally developing parts can cause confusion on sonography. I surely can’t say her baby didn’t have normal genitalia, but it just goes to show that angle and skill are everything!

I certainly and regrettably have had my share of patients get angry with me for not making a guess, but I’d rather play it safe any day. And this case is exactly why!

Have a great day, Moms, and feel free to email me at wombviewerblog@gmail.com!

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Posted on September 30th, 2015 by wombwithaviewblog.com

One of the highlights of parenthood for everyone is the day they hear the words “It’s a Girl!” or “It’s a Boy!” — regardless of whether heard in the delivery room or the ultrasound room. While no one ever invites news that something is not quite normal, parents rarely expected a problem with fetal genitalia development. I recently received just such an email about the subject of ambiguous fetal genitalia. Some of the technical information of the case has been omitted.

concerned mom:  I was just told by a doctor at the perinatal center that my baby’s genitals appear abnormal on my late 3rd trimester ultrasound. My only other scan was at 20 weeks and I was told “probably boy” but it took the tech a while to make that guess. I’m aware that there are a range of genital abnormalities that can occur so I asked my physician if she saw both male and female parts. She told me she thought it was a boy but admitted that it can be hard to distinguish labia from scrotum (because of the appearance of the presumed sac and questionable small penis). I was referred to get some genetic testing done but I sense the chromosomal info will still leave me with questions about the probable condition if there is a mismatch between genotype and phenotype.

I’ve gathered info on some of the more common genital abnormalities to try to come to overcome disappointment and find peace. I find myself wondering about this one doctor’s opinion and likelihood of accuracy. In your years of practice, do you find labia and scrotum difficult to distinguish towards the end of pregnancy? I realize you can not confirm or clarify the details of my particular situation but I’m still interested in your general thoughts.

Thank you for sharing your expertise.

wwavb:  Firstly, I will say that a perinatologist should be the most qualified physician to answer these questions for you. Her specialty being high-risk pregnancies qualifies her as the go-to for your general OB for all things presenting as unusual. Though it is one doctor’s opinion, it is a highly specialized one and she would be able to provide answers for you to a likely far greater degree than your general OB.

I can only speculate here, of course, but it sounds as though the perinatologist has questions, too, and ordered genetic testing to help clarify whether baby is genetically male vs female and to possibly rule out whether a chromosomal abnormality could explain the physical appearance of the genitalia. I imagine any information it yields could only help aid your physician in a diagnosis which can, in turn, aid you in the educational and emotional preparation of baby’s condition. I have to advise here to not consult “Dr. Google”, as we refer to the Internet in our office, because it only adds to your confusion and provides a whole spectrum of variables of potential diagnoses that do not apply to your case. I know it’s hard to wait but, truly, until you get genetic results, all of your time spent looking for answers can compound the problem in your mind and peace is the last thing you’ll find there…it typically only leads to more questions. The only time I find it’s good advice is if your doc has referred you to a specific site.

In my experience, gender typically becomes easier to distinguish as pregnancy progresses, fetal position providing. Your case, though not frequent, is the prime example for why we prudent sonographers do not throw out a random sex guess with a quasi peek. It’s why, also, I never guess prior to 18wks or any time if I cannot see well with respect to all the variables that can hinder that determination. Later on, the labia become more full and, sometimes, the clitoris remains visible. Testicles usually descend about 28wks which are typically easy to visualize, and though penis size does vary, it still is fairly easy to see in most babies.

Below are links for some of my normal-appearing male and female genitalia images at different times in pregnancy:

http://wombwithaviewblog.com/female-gender-on-ultrasound-2/
http://wombwithaviewblog.com/boy-vs-girl/
http://wombwithaviewblog.com/twin-gender-update/
http://wombwithaviewblog.com/third-trimester-male-gender/

I hope my information hasn’t been entirely redundant and that I’ve helped in some small way. I wish you all the very best and, please, if you don’t mind, I would love a follow-up email once you have more answers.

Take care and please do not hesitate to contact me if I can assist you in the future!

Regards,
wwavblogger

***

Ultrasound and other antenatal testing was created, first and foremost, as a vehicle to education, understanding, and preparedness when our pregnancies become challenging with information and events we don’t understand. There has been no better time than the present for medical advances and those with the ability to use and understand them. Our providers hold our hands and help us navigate through the associated roller coaster of emotions. The goal in the end is the most healthy baby and educated parent(s) to care for him. And although what results for medical professionals is education through experience, it’s ONLY the experience of treating such patients that creates the empathy to care for them.

 

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