Posted on June 23rd, 2017 by wombwithaviewblog.com

Ultrasound Gender Determination – Pink or Blue?

Ultrasound gender determination can be tricky! Especially too early in pregnancy. Or any time they just won’t cooperate!

gender determination

Female Gender 16 Weeks

male gender, 16 Weeks pregnant

Male Gender 16 Weeks

 

How many times have all you moms out there, young and old, heard the story that goes, “They told her it was a ‘this,’ and they decorated an entire nursery, and it came out a ‘that’! Those ultrasounds are wrong sometimes, ya know!”

A dollar for every one of those comments would buy me my dream cottage on the Amalfi coast! However, I understand why this happens, and sonographers everywhere need to apply more discretion. First of all, you may already know that it’s not the machine that’s wrong. The sonographer or observer scanning you evaluates what she (or he) sees and determines Baby’s sex. The whole process is entirely subjective! And inexperience sometimes causes sonographers to excitedly guess or, otherwise, cave to the pressure from anxious parents. Unfortunately, sometimes guess incorrectly.

Advice Regarding Gender Determination for the New Sonographer

First rule of thumb for any newbie sonographer out there…don’t guess! Don’t put a percentage on your guess, and don’t say “I think.” Also, don’t say “It kinda looks like ‘this,’ but let’s wait until next time.” Parents may want you to guess, but they also want you to be right! Just a word of caution here – some patients may become upset with you if you don’t guess. But if you’ve exhausted your bag of tricks and you still are not sure of what you are seeing, you owe it to the patient to explain this. It’s something you have no control to change, and you would rather they not become attached to the wrong sex. Hopefully, they will understand!

Psychologically and emotionally speaking, most parents start to really become attached to one sex or the other. They begin to envision the first dance recital or baseball game by the time the next ultrasound exam rolls around. On more than a few occasions in my career, someone else guessed incorrectly (usually, too early!), and I had to be the bearer of bad news. After witnessing the affects of “mistaken identity” (shock, anger, tears, sadness, guilt), I adopted a personal policy long ago to only offer a guess when parts were obvious. In other words, Baby had to be in a great position to easily see a penis and scrotum or labia/clitoris. Even though my policy upset a number of my patients in the past, I truly believe refraining from tossing out any old guess is in their best interest and can save them some heartache later.

True Story!

One grandmother, so excited by the doctor’s early guess, flew right out and bought thirty-two dresses! Yep, 32. She did so despite the doc’s warning about his level of confidence and told her to wait for the sonogram with me. Fortunately, he got lucky with his baby girl guess, and grandma was a very happy woman (and a little less rich)! However, you can imagine the disappointment in returning all those frilly frocks if doc was wrong. I always hated giving such news!

Please, all you excited moms-to-be, remember your sonographer doesn’t withhold information about fetal sex just because! We’d actually really rather all our babies cooperate quickly and easily! It’s such a bummer for us both when they won’t. You can’t plan all the fun things you imagined you could. Shopping, party planning… And believe me, I always preferred when my patients left my room hugging me instead of cursing my existence. A magic trick to make Baby flip on command? It’s too bad we aren’t bestowed with super powers upon certification!

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Posted on October 20th, 2015 by wombwithaviewblog.com

I think most of you reading probably would believe that most of the emails I receive have to do with parents wanting me to confirm fetal sex..sometimes desperately so. And sometimes determining fetal sex is an impossible task.

I try to explain in my replies that my guess is only as good as the images they send me. I don’t believe it is quite understood what I mean when I say that ultrasound is entirely subjective but the person scanning has total control over the images obtained. The sonographer creates these images utilizing a number of controls to optimize the image and uses her own discretion to determine a good angle with the probe she is holding. Yes, there is a standard here but I have to brutally honest. Just as people excel in some areas of life and/or profession, some are also bad. There are good docs and bad, good nurses and bad, good cashiers and bad. That being said, there are sonographers who just do not do it well. This is a painfully obvious fact when I open these image attachments.

In addition, I sometimes use many angles, holding the probe in different places to obtain a different angle of the same area in order to determine sex. At times, just one angle is not enough to see well but only one angle can be depicted in one image at one time. I wasn’t there during your scan so I don’t know anything about the variables that could have made imaging difficult. You’ll find one of my last posts on this subject below:

http://wombwithaviewblog.com/fetal-sex/

I just know a technically bad image when I see one. Sometimes, I can tell measures to improve the image weren’t utilized. In those cases, I can only that someone did not know how to use them correctly or even at all. If the person scanning you is new to ultrasound or is a physician who isn’t trained on how to use the equipment fully (this is not unusual-docs are trained to deliver babies, not scan them!), the image may not appear optimal to someone who is experienced in sonography.

Great Images for Determining Fetal Sex!

Below are some great images of fetal sex that I’ve taken myself.

female fetal sex, 18 Weeks

The above depicts an underside view of typical-appearing female parts from about 16 – 22 Weeks pregnant. The side arrows point to labia, the middle to the clitoris.

 

female fetal sex, 3rd trimester

Female labia in the 3rd trimester

 

male fetal sex, 28 Weeks

Male genitalia, late 2nd trimester

 

male fetal sex, 3rd Trimester

The above demonstrates a side view of typical appearing male parts from about 27 Weeks on.

 

So, all that being said, if the image you send is not an optimal one, I may not be able to take a guess on fetal sex. Even if your sonographer felt sure of her guess, I may not feel I can agree based on limitations of the image. That doesn’t mean your sonographer got it wrong, just that I cannot concur with the former guess because the image quality is not there. If I didn’t observe the scan myself, I am unable to see your baby’s parts from many different angles!

Below are the links I typically email on my posts regarding fetal sex:

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

I hope this gives you some understanding and a little more insight! Ta-Ta for now!

 Until next time, feel free to reply, comment or email with your questions at wombviewerblog@gmail.com!

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Posted on October 5th, 2015 by wombwithaviewblog.com

Fetal gender determination is not always a walk in the park for us sonographers. Ultrasound, like many technologies, have their limitations. There exist many factors which can make fetal gender determination mission impossible! Your OB docs understand there are a number of variables that prevent good visualization in every ultrasound we perform. Unfortunately, many patients do not.

So, if you’ve been losing sleep in anticipation of this long-awaited news, read this first! My goal is to inform expectant moms so that you go into your ultrasound exams with realistic expectations. I sincerely hope that through understanding these limitations, you’re able to leave your experience feeling happy. If all you can see is Baby’s heartbeat, it’s an opportunity to bond with your new addition that doesn’t come everyday.

Is Fetal Gender Determination a Requirement?

Definitely not. Fetal gender determination is not a routine part of a diagnostic examination. It may be information you desire, but it’s not typically information your physician needs. The anatomy screen at about 18 – 20 Weeks or so is ordered to rule out structural fetal malformations. Most U.S. practices do not mind providing a fetal gender determination as a courtesy IF the sonographer feels she can see well. And we LOVE to give you this information, if we can!

What Factors Impair Fetal Gender Determination?

Some of these factors that can get in our way of how well we see are listed below. They are very common! Actually, some of them confront us on a daily basis.

  • a breech fetus
  • a fetus with the rear against the uterine wall
  • a foot or feet in the genital region or crossed feet
  • closed legs
  • the umbilical cord between the legs or against the fetal body
  • body habitus or too much weight around a patient’s middle
  • uterine fibroids or contraction
  • a decrease in amniotic fluid
  • genital malformations
  • early gestational age

Even one of the above factors can prevent even the most experienced sonographer from determining fetal sex. A good sonographer knows when the views are good enough to provide you with a guess. A good sonographer also knows when not to guess! What you don’t want is someone who is inexperienced but willing to guess anyway. Many times, it’s not just one but several of the above variables that limit what we see. Unfortunately, we can’t change any of them.

Another little fact I’ll add here is that a non-arguable truth of the modality is Ultrasound’s laws of physics. The farther sound has to travel, the weaker the returned signal. The more tissue the sound waves have to penetrate, the worse the image. In other words, the more tissue there is around a patient’s middle, the more fuzzy the picture. The more fuzzy our picture is, the less we can see Baby’s parts. Any not just fetal gender, any parts. All it takes is one of the above factors to ruin the party. More often than not, a combo of factors will cause a little unwanted rain on your parade.

What Can We Do to Help?

We can try a couple of variables in an attempt to see better. Jiggling your belly or turning you to each side sometimes helps. We do this in the hopes that your change in position will also change Baby’s. Alas, it doesn’t always work.

What We Can’t Do

Unfortunately, we can’t scan you indefinitely! In an effort for fairness, we always try to get our next patients in as close to their appointment times as possible. Sticking to this schedule can be tough when patients arrive late or when we find abnormalities. Most patients are allotted a 30-minute appointment for their ultrasound exam. However, not all of this time is scanning time.

Before we scan you, we need to examine your chart for your history, an order from your doc, and an indication for the exam. After the exam, we need time to type up your report and send it to the physician. Most of us are nice enough to take more time with a patient if our schedule allows. I always did. Unfortunately, some of my patients (not understanding ultrasound) didn’t think I did!

What You Shouldn’t Do!

An unreasonable action disgruntled patients take these days includes airing their rants on social media. Consider, first, that venting your frustrations reflects poorly on your physician and practice. And you could be fired. Yes, a patient can be fired! In other words, I would advise against this method of revenge. If you are unhappy, you have the right to discuss it with Administration. But just know a practice does not have to tolerate any behavior deemed irrational or unreasonable. Just like one can fire an attorney, a plumber, or doctor, a patient can find herself in the same situation.

A Modern-Day Problem

Unfortunately, our society has become one of immediate gratification, even demanding it in the face unreasonable circumstances. I’m reminded of a few former patients and a like-minded character from one of my favorite childhood movies. Anyone remember Veruca Salt of Willy Wonka fame? These patients actually got angry, yelled, cried, and ranted in a place of medical business, much like the toddlers they would have themselves in another couple of years – all because I couldn’t tell them the sex of her baby. This. Is. Unreasonable.

I realize some sonographers don’t try very hard. In most circumstances, however, most of us make a sincere attempt to obtain this information for our patients who want it. We cannot, however, change the laws of physics.

Moreover, some patients mistakenly assume that because we couldn’t make a fetal gender determination, we must not be able to skillfully perform their diagnostic examination otherwise. Please keep in mind that medical professionals never judge such as gross incompetence. Rather, ranting such on social media is reflective of the patient’s ignorance, a lack of understanding of how the technology works. So, please! Don’t do this:)

We hate when our patients leave foaming at the mouth. Remember, this scan is about Baby’s health first! Just ask any mom who didn’t have a healthy baby.

Please feel free to leave comments below or email me at
wombviewerblog@gmail.com with your questions!

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Posted on June 6th, 2015 by wombwithaviewblog.com

Patients, in general, tend to believe that determining male gender should be very easy any time and the only way to determine Team Pink is the lack of male parts.  Wrong!  Can we see the uterus and ovaries of a female fetus?  Read an email below from a mom with this very question:

mama-to-be:  Is it possible to see baby’s ovaries and uterus with ultrasound? I’ve read these organs are formed around 20/22 weeks. I was thinking it was possible to see them at 22 weeks or later?

wwavb:  A fetus is fully formed at 12wks. And, no, a uterus and ovaries cannot be seen normally anytime in pregnancy as they are simply too small and gender can only be determined by examining external genitalia.

***

On occasion, an ovarian cyst can be diagnosed on fetal ultrasound but is only a guess as these organs are just too tiny to know for sure.

See below for good female gender images!

This image is of a baby girl at about 16wks.  Here, a bottom is seen but not really the legs..imagine Baby is pulling her feet up to her nose. If you are looking up from underneath, only cheeks and girly parts will be seen, right? Note the three arrows which point to three white lines representing the labia on the outside and clitoris in the center.  Sometimes the lines look more like white dots depending on the angle.  As Baby gets a little bigger, she will start to develop some fat in her skin and the labia will plump up a bit, resembling the “hamburger” to which most patients refer!

This image is around the 16wk age, also.  You can see here how the top labia looks more like a dot and the middle and bottom white echoes look more like lines.

This baby is about 32wks!  Notice how the white lines have morphed into the labia you would expect to see on Baby Girl.  Most patients can typically “see” her parts for themselves pretty easily at this stage.

Next time, I’ll discuss all the things that make determining gender impossible!

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Posted on January 24th, 2015 by wombwithaviewblog.com

I’ve written it a hundred times..or seems like it! Someone sends me an image and wants to know if I can confirm gender. Sometimes I can tell, sometimes it’s clear as mud. I usually have to write back and give my spiel about unclear gender on ultrasound and how, because I wasn’t the one who scanned, I can’t see the whole uterus. Some images are just bad!

In ultrasound, we have either images that are beautiful which belong in a textbook and anyone with an eye for the modality can tell you what is pictured. Then there are terrible images where we just shrug our shoulders and wonder what someone was thinking when she snapped the image.

I’ll share this email from a reader and her image and attempt to give you an example here of clear vs not.

unsure mama:  Hello! I’m on my 4th pregnancy and my first 3 were clear as day regarding genders, all done after 20 weeks. But this one, however, my sonographer seemed like she was struggling to get a potty shot. I’m not sure of real fetal age due to bleeding the entire time until 14 weeks. My sonographer said the baby was breech and sunny side up? Baby was also measuring at 17weeks 4days. She hesitated but then said girl. I didn’t ask questions but I didn’t see lines or a turtle. Here’s the pic she gave me. What would you say? Any information will be greatly appreciated. I have one girl who is oldest and two sons.

image

wwavblogger:  Thanks for reading and I hope you’ll subscribe! So, like I typically say, if it’s not a perfect picture, I just can’t sign off on gender. That being said, it could very well be a girl and this just isn’t a great image. It looks like the view is one of baby crawling away from you, if you can put your imagination to work. Right above the arrow is where you would see the 3 dots, however, the dots can blur together if the image is not entirely clear.

I’ll include a link below where I show a baby girl in a similar position, just a little more to the side. Idea is the same. This one is clear and you can clearly see 3 dots here. You can also compare it to the twin brother shot in the same post, too!

http://wombwithaviewblog.com/twin-gender-update/

I don’t see obvious boy stuff hanging down like I would expect to see here!

Good Luck!
wwavblogger

***

So, girl? Maybe! Boy? Sure can’t say it’s not!

My image in the link above that I sent her of girly parts you’ll find below. Which can you see better?

female gender

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Posted on September 16th, 2014 by wombwithaviewblog.com

Below is an email I received from a reader today hoping for some “pink” confirmation:

reader:  Hi!  Please, can you confirm that this is a little girl? Why do the girl bits look so big on this 23 week 3 day scan? Thank you!

 

female genitalia 23wks

female genitalia
23wks

wwavb:  Hi and thanks for reading!  I hope you’ll subscribe for future posts.

So, yep, looks pretty girly to me (remember this is just one single frozen image I am evaluating!) and babies are just starting to develop a little fat now so this is why labia are starting to look more like typical little girl parts.  Also, keep in mind this image is HUGELY magnified!!

Congrats and have fun shopping for Team Pink!

wwavblogger

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Posted on August 25th, 2014 by wombwithaviewblog.com

A reader sent me an email with an early guess at a gender pic..she was about 15+wks.  As I usually tell all my inquiring readers about that age, there’s just no way to truly confirm gender then, especially when I didn’t scan you!  She is 19ish wks now and wrote me again, hoping to confirm female gender on ultrasound.

What do you think, readers???

unnamed

Mom wrote:

Here is our girl photo – 100% girl? 🙂

wwavblogger:  We still never say 100% as nothing is in life or medicine IS except taxes and death but as far as ultrasound goes…yep, pretty darned girly:) Yay, team pink!

Congrats and have fun shopping!

***

So, did you get it right?!

This is a typical shot between the legs and typically what girly stuff  looks like at this age..the 3 white dots.  If you thought girl, too, you’ve probably had a baby girl or two in your day! Or you’re a sonographer 😉

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Posted on January 16th, 2014 by wombwithaviewblog.com

Okay, readers, if you are searching for the perfect shot of 3rd Trimester female gender, check out this photo. This image is shouting “Am I a girl or what?”

 

unnamed

 

This is a great image of labia as seen later in the pregnancy.  Baby has more fat in her skin now and looks nothing like the “3 dots or lines” you saw at halftime.  Now, granted, not every baby girl looks exactly like this one.  We are not all built EXACTLY the same, right?  However, I think no one can argue that this looks nothing like any little boy I’ve ever seen.  This mom and dad are so excited for their second precious baby girl and were so happy to share:)

Now, THIS, people, is a GREAT ultrasound image if I do have to say so myself!! I just LOVE a great ultrasound image.  I’m such a geek.

 

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