Posted on July 6th, 2017 by wombwithaviewblog.com

Gender Determination in an Ultrasound Report?

I’ve received questions lately regarding where to find fetal sex or gender determination in an ultrasound report. Can you always find this information in a report?
The short answer? No, not always.
Actually, we mostly do not record fetal sex, and it’s mostly not important to your doc. Typically, fetal sex is not pertinent information to the examination. Though parents may desire it, physicians don’t need the gender determination to manage your care and that of your baby if both are healthy. The above is true for most general OB practitioners in the US. However, every physician practices a little differently, and one can certainly dictate if he or she wants this info on all patient reports (if possible to determine). The case may be different if you are seeing a high-risk OB doc, aka a perinatologist. Their reports consist of much greater detail and may possibly include a fetal sex/gender guess.

Example of a Blank Report

gender determination
In the images of a sample report taken from a monitor, you’ll notice there is a whole host of blanks to fill, but fetal sex is not one of them. On the first page where you see Sex: Other, this refers to the patient. Patient demographics were not entered here, so the Sex option defaulted to Other. We always include your LMP or EDC/EDD – aka baby due date. The larger blue space would be filled with fetal measurements, estimates of gestational age, and fetal weight as they are obtained.

OB ultrasound report

OB ultrasound report
In the pages above, you’ll note the list of fetal organs and structures we attempt to document on a mid-pregnancy anatomy screen. We only fill out the section called BPP in the third trimester when your doc orders this particular examination. And the CVP is usually only filled out when performing a Fetal Echo or detailed heart examination.

Exception to the Gender Determination Rule

There always seems to be at least one exception to every rule. Because the responsibility of a sonographer is to search out structural malformations, we also have to report suspicions of abnormal external genitalia. In other circumstances, we may see particular abnormalities that we might group together, as in the case of certain syndromes. Sometimes, knowing fetal sex helps physicians either support or rule out a particular chromosomal or structural problem. Some of these are gender specific. In the pic below, we have a designated space on a Comments page to expound on our findings. We can add fetal sex here if we feel it is pertinent information to the findings.
OB ultrasound report
In some countries, fetal sex is neither reported nor discussed with parents due to the cultural preference of one sex over another. And some facilities are beginning to incorporate policies against providing parents with this news due to litigious reasons. Unfortunately, such is life in the good ol’ US. Facilities want to limit their liability for guessing incorrectly by simply not allowing their sonographers to guess at all.
So, if you don’t want to know your baby’s sex (or even if you do!), don’t expect your ultrasound report to disclose that information. Your sonographer creates the images and report. We only include what is needed and leave out what is not!
Best wishes for happy and healthy! As always, you can email me with your comments and questions at wombviewerblog@gmail.com.

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Posted on July 5th, 2017 by wombwithaviewblog.com

Baby Gender, How Do We Know?

Determining baby gender by ultrasound is not as easy a task as most think. Actually, gender misconceptions pertaining to ultrasound are so common that I thought it worthy of yet another post.

Making a male vs female determination requires far more expertise than just sticking probe to belly. And babies do not just automatically cooperate! Baby’s legs need to be wide open and other parts cannot be covering over external genitalia. If so, the chances of holding that “reveal” party are slim to none.

Another common misconception is that we can force Baby to move. I promise you that every sonographer on earth would use a magical “make Baby flip” button. A girl can a dream, but I think this technology lies in our distant future. Unfortunately, babies get comfy and only move into another position if they get the urge. And not a moment sooner!

Determining sex accurately is all about angles. Being far enough along with Baby in the right position is only part of the task..when I’m the one scanning, that is! Most of my emails come from people who want a second opinion. However, most of the time, it’s one I cannot give! Either Baby is too early or the image is just plain, well..terrible. In these scenarios, the truth is I just can’t comment on what I can’t see.

Most sonographers don’t mind telling you your baby’s sex, by the way! The problem for us comes when we can’t see what our patients want to know.  Even if we explain all the reasons, patients sometimes become upset or angry. I have scanned tens of thousands of babies. Anyone who has scanned as much can recognize when this information is obtainable and when it isn’t.

Tips For Your Baby Gender Ultrasound

So, here are a few recommendations for you to follow before your next ultrasound. No guarantees! But if you are busting at the seams to find out what you’re having, these tips just might work!

  • Try eating or drinking something about 30 minutes prior to the exam. Baby typically becomes more active after eating. Now, I’m not condoning a double espresso and Snickers combo (yummy, yes; smart, no). We don’t want your fetus launching into orbit. Instead, try enjoying a hearty and healthy lunch or breakfast prior to your scan.
  • Keep an open mind! Understand that not seeing the sex is definitely a real possibility. Whatever you do, not planning a gender reveal party for the same day is a smart idea.
  • Don’t shoot the messenger! In other words, your sonographer can only tell you what she sees. If that is an uncooperative fetus or if visualization is poor, she may not want to risk a guess. Remember, that you want an accurate guess, not just any guess. Most importantly, an experienced sonographer knows when not to guess. I so hate it for parents when they get excited about one sex, only to discover differently on a future scan!

Believe me! We would love to do our part to help you plan your party, shop for baby clothes, or decorate a nursery. It’s the most fun when we can! And when we cannot, it’s a real bummer – for you, because you leave disappointed and for us, because we’re (sometimes) blamed as the party poopers.

Textbook Baby Gender Images

I’ve posted these before, but below are a couple of really great images of external genitalia, first boy then girl.

male baby gender determination ultrasound

male fetal sex, around 28 Weeks

female baby gender determination ultrasound

female fetal sex, mid-second trimester

Also, if you send an email asking for a second opinion earlier than 18 Weeks, you may receive the links below to other posts containing very easy, no-mistake pics of boys and girls!

Female Gender Scan

16 Week Ultrasound

Boy vs Girl Ultrasound

Twin Gender Ultrasound

3rd Trimester Ultrasound – Male

Thanks for reading! You can email me with your comments at wombviewerblog@gmail.com!

You can also subscribe to receive a little something special (and free!) when my book on first-trimester ultrasound is published!

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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 March 13th, 2017 by wombwithaviewblog.com

Deciphering fetal sex can be a very difficult job, especially when trying to read an image taken by someone else.  Sometimes, it’s a piece of cake!

So often, when readers send me their images for a second opinion on fetal sex, I just cannot provide a confirmatory guess. This is either due to too early gestational age, too poor an angle, or too poor an image. Sometimes, it is a combo of all three!

Ultrasound is such a different animal because it is nothing like a photograph. In a photo, you can see what’s in the distance or up close to the camera. With ultrasound, we cannot. We can only see exactly what is directly under the probe. It is a 2D (two-dimensional) image only, and we have to move the probe around to obtain different angles to create that “photograph” in our minds. And there are so many variables that go into creating a good ultrasound image.

Since ultrasound is completely subjective and observer-dependent, some sonographers take great images and some…well…don’t. It’s much like comparing a professional photograph to an out-of-focus, too dark, cell phone group portrait where everyone has red or white eyes. You know, the ones you always see posted on social media?

I am too much of a perfectionist. This wasn’t always a good thing when trying to take keepsake photos for patients because it caused me to run late on more than one occasion! And everyone knows people don’t like to wait in a medical office! Factors to take into consideration are maternal and fetal position, angle, magnification, depth, as well as brightness and contrast of the image. It’s a learned skill and some are simply better at it than others. Some just don’t tweak all the knobs as much as they should. Maybe they were never really taught how to do so very well.

A Poor Image Can Limit a Fetal Sex Guess

Some factors that cause a poor image are just beyond a sonographer’s control…like an uncooperative fetus, extra weight around a patient’s abdomen, or a gassy patient. The laws of ultrasound physics dictate that the further sound waves have to travel, the poorer the image. Also, sound does not travel well through air or gas. I’ve scanned heavier patients where I could see pretty well and thinner, gassy patients where I struggled to see at all!

That said, I can tell when someone else’s image is not great or when she didn’t work with all the knobs. This can make reading an image snapped by someone else extraordinarily difficult. One image represents only one angle. Scanning real-time allows me to look from all angles possible, where I can subjectively determine my confidence in fetal sex – or whether a guess is too risky at all.

ALL that said, sometimes taking a second guess is easy-peasy! Check out the email I received from a reader about whether her baby is a boy. Her images didn’t leave much of a question in my mind:) She was just over 20 Weeks along. Can you tell what she’s having?

mama: Hello, I’ve been following your blog, and I was wondering if you could take a look at my baby’s scans and give me your opinion on gender. We were told it’s a boy, but I’ve read that girls can have parts that look similar to boys? I agree that it looks like a boy, but wanted a second opinion. Thanks!

male fetal sex

male fetal sex

wwavblogger: LOL No ma’am! Little girls don’t normally look like that at 20 Weeks! I will wager my bet on a baby boy:) Congrats!

mama: Lol! I wasn’t quite sure but I’ve had a feeling it’s a boy from the beginning of the pregnancy!

Reader mom: I forgot to mention in my reply to you that, yes, girls and boys can indeed look similar, but that is truer between the 12-16 Week range when parts are small, just developing, and when combined with other factors that come into play which result in limited visualization!

Did you guess boy? If so, I agree! Compare the images I’ve edited below.

fetal sex, male gender, ultrasound, second trimester, 2nd trimester

 

male fetal sex, male gender, second trimester, 2nd trimester

Even though it would be quite unusual for this to be a baby girl, I’m still always a bit cautious about guessing fetal sex based on someone else’s image. When I’m casting a vote for Team Blue, I like to ensure I see a scrotal sac which requires a slightly lower angle. Sometimes, you can obtain both scrotal sac and penis in the same image, sometimes not. I get a slight impression of a scrotal sac here where I placed the circle. The sac at this age can appear quite small, and testicles are not expected to descend until about 26-28 Weeks. This is why scanning real-time helps; it allows me to see Baby at all angles possible while moving and stretching and opening his legs more.

Stay tuned! My next post will be one where a questionable and poorly technical image comes into play. Mom wrote back saying she delivered the opposite sex. Oops!

Email me at wombviewerblog@gmail.com!

wwavblogger, RDMS
wwavblogger, RDMS

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Posted on May 12th, 2016 by wombwithaviewblog.com

Anatomy Screen Ultrasound Exam: The Breech Fetus

What’s the worst position a fetus can be in if you want to determine fetal sex? You guessed it! Look no further than the image below to answer this question. The breech fetus compromises most of what both you and I want to see.

What You Don’t Want to See

breech fetus

This image is really an example of just how much position plays a part in how well we see. This baby (above) is not only lying in a breech position, or butt-down, but baby is also facing Mom’s back (prone).

The wait for your 20 Week ultrasound exam and whether you’ll be shopping for pink or blue may have you losing sleep! The LAST thing you’ll want to see is your baby looking like the image above. It spells one word…disappointment. If baby stays in this position throughout the examination, the possibility of seeing anything cute is essentially nada.

20wk facial profile

 

Above is an example of baby flipped over and looking up. How much better do you see baby’s face?

Here’s hoping you have more luck than this patient did for her anatomy screen ultrasound exam!

Email me with your questions and comments at wombviewerblog@gmail.com!

Subscribe to my blog for reliable ultrasound information including more the breech fetus, fetal sex determination, and more.

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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!

You can also subscribe to the right:)

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Posted on February 25th, 2015 by wombwithaviewblog.com

..those babies, that is. I can scan them all day long but, I can promise you, no woman in this world would want me at home plate wearing the catcher’s mitt.  That being said, MOST docs (granted, not all) do not make the best sonographers.

Some docs try to scan a little more than others and feel comfortable in some aspects of the modality.  At the end of the day, however, most call on their sonographers for reliable ultrasound information. Unless they are perinatologists (high-risk OB docs), most obstetricians are not vastly trained on the equipment to the extent of an experienced sonographer nor do they know how to obtain particular images.  We have an aviator’s panel of knobs and buttons that help us in obtaining quality ultrasound images.

Read an email below from a reader who was scanned by her doctor as he attempted to determine gender:

mama-to-be:  First of all, I love your blog.  It took me forever to find it!  I am a mother of three and expecting.  I have two boys and one girl.  I went in for my 17 week u/s scan just to make sure I was not further along.  My doctor said that by how the baby was positioned, he could “guess” 80% that it was a BOY. But it could also be the umbilical cord that’s in the way.  Baby was giving us his back at all times and my question to you is, based on these u/s pictures, can you tell gender?????!!!

one doc's images one doc's images

wwavb:  Thanks for reading and I’m so happy you are enjoying my blog!  I hope you’ll subscribe for future posts.  First, if you do a search for gender determination on my site, you’ll find several topics on the subject..especially ones that say if the image isn’t a good one, I can’t tell a thing.  I am sorry to say these images for gender certainly fall into that category!  Physicians are not always the best sonographers so don’t go painting blue yet.  And I can provide that advice with 100% confidence!

Please feel free to send me images again later in the pregnancy if they are able to get a great potty shot.  I’m sorry I couldn’t help you more!

Best wishes,
wwavblogger

***

I really hate it when I can’t help someone who has taken the time to write me for my opinion but, holy cow, let me count the ways in which these images stink.  Any seasoned OB sonographer reading this is laughing hysterically.  Oh, well, we’ll give her doc a C for effort, but I am 100% confident that he should never be 80% confident about his scanning abilities and 100% confident that she should not paint her nursery in blue whales and sailboats just yet. I’m also 100% confident that he has a good 50% shot at being correct:)

I always joke with my doctors and tell them not to get too good at ultrasound because I need my job. Make no mistake about it, I sure can’t do theirs. And with images like the ones above, we’re talking serious job security for good sonographers everywhere!

 

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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 August 12th, 2014 by wombwithaviewblog.com

On July 25 I posted images of twin gender at 16+wks, one a boy and one a girl! A confident guess. Babies are 18+ Weeks now…and still looking the same. Enjoy!

 

SONY DSC

This, of course, is a side-by-side of each baby with Baby Boy on the left and Baby Girl on the right.  It’s an underneath view so all we are seeing are babies’ butts and legs to the knees essentially.  All parts labeled for better understanding.  The “three white lines” for the baby girl are a little harder to see in this image but you’ll see it more clearly in the one of her below.

 

SONY DSC

This is the same view and very obviously a proud baby boy!

 

SONY DSC

You can see how much different this baby girl looks compared to her brother.  No wee wee here!

 

These are GREAT images of gender, people!  Clear potty shot and no question..just how I like to scan them! Below is the link for the first images at 16+wks.

http://www.wombwithaviewblog.com/boy-girl/

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Posted on July 30th, 2014 by wombwithaviewblog.com

I have some great images for you today of male gender.  This baby is about 19wks and the images are of the side view of baby and bottom view.  See below:

SONY DSC

This is a bottom view of baby if you imagine baby sitting on a glass table and you are looking up from underneath.  I have all the parts annotated for you.  The arrows, of course, are pointing to the wee-wee (my technical term).  This is about as straightforward a potty shot as one will find.  No guesswork, all boy.

SONY DSC

Now this is a side view of baby.  The head is not in the picture; imagine it to the left.  Again, all parts are labeled.  Now the legs are not in this image.  Not to be graphic but for demonstrative purposes, imagine slicing the body in half lengthwise; this is the view we have right down the middle of the torso.

SONY DSC

The penis and scrotal sac from the side resemble a turtle sticking out of his shell.  If you can appreciate the tiny dotted line, you will see it is drawn around the “turtle”.

You can see how parts look different from different angles.  These, people, are great images of baby boy stuff…no question, no nonsense, no guessing..  Just all boy!!

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