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!

You can also subscribe to the right:)

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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!”, no matter whether they are heard in the delivery room or the ultrasound room.  While no one ever invites news that something is not quite normal, it’s rarely expected that the problem will be with regard to fetal sex determination. 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 to hold our hands and help us navigate through the 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.

Comments: 2 Comments »

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 25th, 2014 by wombwithaviewblog.com

Okay now, readers, this is a perfect example of how sometimes I can determine gender < 17wks!   Not much less but at 16w4d, it’s pretty easy to tell on these twins they are one of each. ..Baby boy AND girl gender images in a side-by-side comparison. These were very easy potty shots..hardly an effort to obtain and you can see the side by side difference.  I’ve even labeled parts for you!

Check them out below!

SONY DSC

boy and girl gender determination

 

SONY DSC

female gender on the LT, male gender on the RT

 

Happy comparing and have a great day!

wwavblogger 🙂

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Posted on July 11th, 2014 by wombwithaviewblog.com

We all know that our family and friends can be quite nosy, opinionated and sometimes even rude when it comes to all things pregnancy related.  After all, they’ve been there and done that and they know better than you because this is your first and you know absolutely “nothin’ ’bout raisin’ them babies!”  Hopefully, they don’t really speak like that.  I’m sorry if they do.  That is, sorry if I offend and sorry you have to listen to it.  (lol)

In the course of conversation during a scan, especially with my weekly patients, we glide from the political correctness and appropriate medical office pleasantries to cutting up about life happenings.  My patients take this opportunity sometimes to vent about just such personal offenses.  One of my readers recently did the same!  Read on about her dilemma..

irritated mama:  Hello!  Firstly I would like to say what a great blog you have and I’ve really enjoyed reading it.  Secondly I’m wondering if you can take a look at my scan pic from my 20 week scan. I’m now 25 weeks. We didn’t find out the gender as my husband didn’t want to but his family are convinced its a boy from the scan pic and are even calling it a he which is quite annoying.  I’m just wondering is there anything on this scan pic that confirms the gender? Obviously we didn’t get a potty shot.  I hope you can help.  Thanks

unnamed

wwavb:  This email cracks me up as you are not the first to be annoyed by in-laws who think they are ultrasound aficionados!  Everyone is suddenly an expert.  You’ll be happy to know gender is nowhere to be found on this image!  It’s a great side shot of Baby but when you get down to baby’s bottom, part of the hip is in the pic so it’s not a side shot between the legs.  So, now you can tell your in-laws to mind their own biz! Ha ha.

Best Wishes!
wwavblogger

irritated mama:  Brilliant thank you – that settles it I will tell them haha!

***

So just know, all you pregnant moms out there with in-laws who are driving you to drink..firstly, wait until Baby is born and secondly, you have to stick up for yourself!  There are nice ways to say anything so next time your mother-in-law (who doesn’t know what a femur is) attempts to read into your ultrasound image, kindly thank her for her oh-so-professional opinion and say something like “Wow, you are so good at this. Maybe they should let you do my next scan.”

Yes, I am a smartass at times but I blame it on my brother, the ultimate King of Smartassness, one-liners and wisecracks.  It’s a crown he wears proudly.

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Posted on July 4th, 2014 by wombwithaviewblog.com

Early gender pics can be deceiving. Many of you who want to know your Baby’s sex as early as possible with ultrasound may be tempted to believe the tempting promises of your street corner 3D ultrasound business. Before you pay your money to one of these places, I encourage you to first read the above link!

The early fetal parts of external genitalia look nothing like they do later on, just as an embryo doesn’t look like a baby or an embryonic chick look like a chicken! It’s also the  reason we do not perform the screening of anatomy until 18 Weeks. Structures like the brain are ever-changing until about that time. Even at 17 Weeks, the brain looks a little different. The same applies to external genitalia – later is most always better.

Because these parts are just starting to develop at 12 Weeks, boys and girls can look alike. Over the next month, your baby’s external genitalia are still developing and changing in appearance. That is to say, boy tissue starts to get bigger and girl parts shrink. Eventually, the scrotal sac and penis take a more recognizable shape, and the labia and clitoris take on the appearance of three tiny white dots or lines. Fetal boy parts can appear different from other boys, just as girls can appear different from other girls. We’re all different!

Please take my word for it. Any guess at 12 – 14 Weeks is simply a guess. You may as well flip a coin. At 15 – 16 Weeks, it’s still a guess. Now, have I guessed gender at 16 Weeks? Definitely! But it had to be someone I was scanning personally, baby had to be lying butt-up in a perfect position with legs wide open, and I had to have a clear image otherwise. There are many factors that play into how well we can see at any point in a pregnancy. It just all has to be textbook perfect and not every patient/fetus is a textbook scan. I might feel confident enough to provide a second opinion of your baby’s gender if you are 17 Weeks with a perfect potty shot!

Links for Great Images of Fetal Sex/Gender

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/

The Nub Theory and Genetic Testing

Even if the parts appear very straight-forward based on the nub theory, it’s only a theory and only about 73% accurate. That’s a lot of room for error. So, just because a girl might look like a girl based on the nub, don’t be surprised to find a penis at your anatomy screen! Only genetic tests like first-trimester blood tests for DNA or amniocentesis are 99+% accurate for fetal sex.

***

All that said, you are welcome to email me with questions at any time in your pregnancy. However, sending me pics with a request for gender confirmation earlier than 17 Weeks will probably get an “it’s just too early” response. As much as I would love to, I just can’t provide you with helpful information in most of those cases. I can never be more confident than the person who scanned you! Especially if your sonographer said she couldn’t get a great shot, I likely won’t be able to tell, either.

If you’re greater than 17 Weeks and your sonographer has given you a potty shot where she’s annotated boy or girl, subscribe and email me your pic. I’ll be happy to try and provide a second opinion!

Good luck at your next scan!

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Posted on June 15th, 2014 by wombwithaviewblog.com

Firstly, I’d like to extend a huge congratulations to a reader who recently delivered!  This is what she had to say..read below!

***

Hi I hope you had a lovely time on your holidays ,just to say I had a little boy at 38+5 and he was a MASSIVE 8lb 7oz :) not half as bad as I imagined ,many thanks for your help to mel

***

I’m so happy and the whole point of my blog is to answer questions you have about ultrasound accurately rather than your reading and taking to heart some of the garbage found randomly on the internet.  Everyone is an expert, everyone has an opinion..and MOST of them are wrong!  Especially when it comes to medicine, just because your cousin Becky had several ultrasounds during her last pregnancy doesn’t mean she can now read yours.

And this is not only in reference to gender, which is what most people question.  Though I can never provide medical advice to anyone, I can surely explain the why’s and how’s of ultrasound better than your aunt, mother or sister who just had one done.

As for gender, I think I’ve made it no secret that determining gender has become the bain of my existence.  When the only thing a patient is interested in is gender, everything I need to do to complete an exam is hurried, or rushed or simply ignored to get to the pink or blue, which may or may not be detected.  People have come to expect that they will in fact know what they are having at this appointment, make it a social event and become upset, sometimes enraged when it cannot be determined or if family is asked to wait outside for a portion of the examination.

Don’t get me wrong!  I love to tell people whether they are having a son or daughter!  The fact remains and should be respected that this is first a medical examination of mother and child.  The sonographer should be able to take the time she needs in a non-disruptive and quiet atmosphere to obtain all required information to complete this exam for your doctor.  This means excited grandmas who want to talk through the whole exam about the nursery and names need to stay out, as well as the toddler siblings, nieces and nephews who scream and squeal for attention.  Believe me, they have no clue they are looking at a baby on that monitor.  And, honestly, any noise in the room other than the sonographer talking is a distraction.

That all being said, I will say it is still the highlight of my day when I have a very happy couple come in for an exam who are mindful of why they are there, so happy to be expecting and are full of questions.  I love to impart some ultrasound knowledge, provide awesome images of this future addition to their family and am still honored to be this third objective party who gets to orchestrate it all.

Best wishes for a beautiful experience,

wwavblogger

 

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Posted on May 10th, 2014 by wombwithaviewblog.com

It’s a Boy! Male fetal gender on ultrasound is a pretty obvious and easy guess when it looks like this!

Not much question here!

male fetal gender

 

You can email wombviewerblog@gmail.com with any comments or questions!

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