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Ultrasound Gender Determination

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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Ultrasound Facts–What’s True vs What’s Not

General Ultrasound Facts

Patients have asked me these questions on a regular basis for years. Let’s get some ultrasound facts straight, shall we? I hope it’s helpful!

What’s the difference between ultrasound and sonogram?

Technically speaking, ultrasound is the study of the subject (the field of ultrasound) and a sonogram refers to the examination itself. Although we’re really not picky about what you call it.

Is ultrasound safe?

Biohazard testing over the past forty years reveals no ill effects of ultrasound on the fetus, mother, or sonographer. However, increasing levels of heat after scanning for several hours in one area can cause cavitation or the creation of bubbles. This is much longer than the time required for performing a diagnostic test. Since no one can predict the long-term effects, only the prudent and diagnostic use of the technology is recommended by ACOG, AIUM, and ACR. The benefits of the information from diagnostic exams for patient and physician currently outweigh any known risk.

Is Ultrasound radiation?

Ultrasound technology uses sound waves, NOT radio waves. I dedicate an entire post to just that subject in the link above. No radiation is emitted by ultrasound equipment or Dopplers utilized by your physician to detect Baby’s heartbeat. X-Ray emits radiation which is why, for example, your pregnant belly would be covered with a protective shield at your dentist’s office for X-Rays on your teeth.

Can my baby hear ultrasound? 

Nope, Baby cannot hear the sound waves:) Ultrasound is just that…sound waves that operate at a frequency far beyond human hearing. Human hearing ranges from 20Hz to 20,000Hz. Diagnostic ultrasound operates in the millions of Hertz. Ultrasound probes range from about 2 – 13MHz.

True story ~ I became a little distressed once when a patient asked me if ultrasound sounded like a jet to a fetus. She had just read this in a pregnancy magazine in our waiting room! I reassured her this was inaccurate. This experience marked one of the many reasons I wanted to start my blog–to get reliable info to new moms like you!

What’s the difference between 2D, 3D, and 4D?

Almost everyone has seen the gray clouds of 2D ultrasound at one time or another. 2D allows us to see through organs and inside your baby.

Most people are familiar with 3D imaging as a fun way to see the outside of their baby. Additionally, the best and cutest 3D images are obtained later in the 2nd Trimester or early in the 3rd. Baby’s skin has developed more fat at this point which makes for chubbier cheeks! Occasionally, a high-risk practice (MFM or Maternal Fetal Medicine) will usually also use 3D to assist in visualizing a fetal abnormality. We also frequently use the technology for GYN scans to attempt a better look at uterine shape and/or IUD placement.

4D can be described as 3D in motion or a live 3D image. So, where 3D is a still image, a 3D video of Baby moving is actually 4D.

ultrasound facts, 3D, 9 Weeks pregnant

3D 9-Week Embryo

Ultrasound Credentials for Sonographers

What’s your title? Are you a nurse or in X-Ray?

We’re not nurses, though some of us do cross over from RT (X-Ray) or other areas of Radiology. Sonographer, Ultrasonographer, or Ultrasound Technologist are a few of our titles. We are specifically and formally educated in the field of Ultrasound.

RDMS stands for Registered Diagnostic Medical Sonographer. A sonographer earns these credentials through ARDMS when he or she has passed a registry examination in Ultrasound Physics as well as his/her ultrasound specialty. A certified sonographer typically has at least two years of experience under his/her belt.

DMS refers to someone who has completed some sort of formal or on-the-job ultrasound training but has not yet taken/passed the registry examination.

What do you think of those 3D places?

Having posted on this often, I understand a patient’s desire to go, but I’m not a fan. Not everyone who scans an expectant mom in a 3D non-medical business is a certified OB sonographer. Some have no formal ultrasound training whatsoever! I know you may be surprised by this little-known fact, and so was I.

These businesses are not regulated like medical practices. They may not be knowledgeable of or follow guidelines for equipment maintenance. Ultrasound equipment that is not properly maintained can be an electrical hazard for mother and/or fetus! Do your research and at least ensure your sonographer possesses RDMS or, at least, DMS credentials. Please read the post in the link above!

Performing Your Exam

When can I expect to have sonograms in my pregnancy?

Every practice is different. Most physician’s order a first-trimester ultrasound examination to date the pregnancy. This is usually performed with a transvaginal probe. If no other problems necessitate another scan, you’ll receive your next exam around 18-20 Weeks. Most women know this scan as the anatomy screen where we evaluate fetal and maternal parts for abnormalities.

*Your doc does not order this exam to determine fetal sex!* However, most sonographers will happily provide the info if at all possible (as long as policy allows)! Also, important to note here is that determining sex is never a guarantee nor should it be an expectation. Sometimes, those Little Sweet Peas just won’t cooperate! You can read more here about those limitations. Note of advice for moms: Don’t pre-plan your Gender Reveal party for the same day as your ultrasound! The health of your pregnancy determines whether you will receive more ultrasound scans later in your pregnancy.

Can you predict how much my baby will weigh at birth?

While we can measure your baby’s head, belly, and femur for an educated (called EFW or Estimated Fetal Weight) guess for weight at the time of your scan, a large discrepancy for weight determination exists due to fetal position and sonographer skill. We can typically track a trend for large or small babies. We know the average gained weight in the last few weeks is about 1/2 lb per week. However, every baby is different!

Ultrasound Facts About Fetal Sex

Most expectant moms today already know this little fact. The ultrasound machine is never “wrong” in determining fetal sex. Actually, it is the observer who is incorrect!

Guessing the wrong sex can be due to one or a combination of many factors. It is possible your baby was in a difficult position to see well. Maybe you were too early in your pregnancy for an accurate guess. In addition, an overall poor view can also limit fetal sex determination!

Facts About Your Results

Yes, the sonographer can read your examination. However, your OB/GYN physician or radiologist must ultimately interpret the images and report we create. Consequently, only your physician can legally give you results! Read more about why here.

However, most of us are more than happy to educate you about what you see on the monitor (minus a diagnosis!). I loved sharing how we measure and pointing out all your Baby’s parts for any inquisitive parents or family.

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Feel free to email me at wombviewerblog@gmail.com with your comments or questions!

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A Case of Mistaken Fetal Sex

OOPS! Mistaken Fetal Sex Happens

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.

It’s All In the Eye of the Beholder

mistaken fetal sex, wrong gender guess

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.

The solid truth is that some 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. Cue scary movie music.😱

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 those waves make their long trek back to the monitor.

That said, I could sometimes 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. But this is typically only an issue early in pregnancy.

One Mom’s 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 it’s a real disadvantage from my end. The image has to be technically great, or the guess 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!

A mom wrote me from India. But I was a bit hesitant with this one. Initially she felt confused. She was 20 Weeks but couldn’t make out typical girl or boy parts. This was the image below. Same for me! 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 that her image was not a very clear one but did seem to be a good angle–both thighs are clearly seen in the image and appear to be far enough apart. I didn’t see anything sticking out, so I guessed girl based on that alone. However, I did say that possibly a future ultrasound might be more clear. I closed out apologizing that I could not be of more help.

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!

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Now, obviously, we all look different from one another and abnormally developing parts can cause confusion on sonography.  Was this a case of undescended testicles? Was this baby’s penis abnormally small or just out of the angle of this shot? I didn’t scan her personally, and 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 you had a similar experience? Feel free to email me at wombviewerblog@gmail.com!

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Deciphering Male Fetal Sex

Male Fetal Sex Determination

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! male gender, male gender guess, male fetal sex

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. It’s just 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 from the start.

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 male. Her images didn’t leave much of a question in my mind! She was just over 20 Weeks along.

Can you tell this is a boy?

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 this 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 view!

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

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

 

fetal sex

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!

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The Breech Fetus

Why a Breech Fetus Is Such a Challenge

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, gender guess, gender ultrasound

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 ultrasound exam between Weeks 18-20 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.

Below is an example of baby flipped over and looking up.

20wk facial profile, fetal face, gender ultrasound

How much better do you see baby’s face? (Hint–it’s way better!) Here’s hoping you have more luck than this patient did for her anatomy screen ultrasound exam!

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Fetal Sex Determination–Some Want a Surprise

Can Anyone Make a Fetal Sex Determination?

(The short answer is no.)

I LOVE IT! What a breath of fresh air I received from a reader–someone who actually wants to avoid fetal sex determination! Now, don’t get me wrong. Though I held off on the potty shot for my first child, I was a full-time certified sonographer working several years by the time my second came along. I personally couldn’t wait to see for myself. I even scanned myself in the process (we all do this, by the way)!

This post comes from someone who definitely fits into Club Minority. She wanted to wait for The Stork, but that was just not good enough for everyone else in her family–especially her sister.

distressed mama:  Hello, I’ve really enjoyed reading your blog. From everyone’s posts, I can see that I am in the minority–my husband and I want to be surprised with the sex of the baby on the day I deliver.
We got the anatomy scan a few weeks ago, and the tech was very respectful of our wishes. She didn’t reveal the sex to us, and we left with the attached pictures. We sent my sister this picture in a text message.
unknown gender, fetal sex determination
Upon seeing it, she immediately said, “I think I know what it is . . . ,” and blurted out her guess. That really bothers me because it seems that the rest of my family believes her and is taking her opinion as fact. I still don’t want to find out, but I don’t want anyone else to be so certain that they know, either!
Based upon the first picture, is the sex of the baby obvious to you? I figure that if you can’t tell, then my sister who is NOT a trained ultrasound tech can’t tell, either!
Thanks for your blog, it’s always fun to hear what you think about these ultrasounds from “the other side” of the wand!

wwavblogger:  I LOVE IT!! First things first. Absolutely, positively NO genitalia in that shot whatsoever! The black oval in the pelvis is Baby’s bladder, and I’m guessing she thinks she sees something just above that which is a very small section of umbilical cord at abdominal insertion. Either way, you are totally correct in that if I can’t see parts, neither can anyone else! Tell your fam they have a 50/50 shot at guessing! 😉

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Everyone the expert, right? And, yes, the desire is overwhelming for patients to know gender as soon as the pee stick shows the little plus sign. However, sometimes the desire comes more from the family than the patient!

From the other side of the wand, I can tell you people often believe what they want to see, not what’s really there. Distressed Mom, be sure to let us know what The Stork drops at your door!
Thanks for reading!
Have a similar story? Do you desperately want a surprise?
Is your family driving you nuts with constant harrassment to find out?
If so, email me with your experience at wombviewerblog@gmail.com!

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