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Gender Determination–Is It Listed on My Report?

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, ultrasound report
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, gender determination, ultrasound report

OB ultrasound report, gender determination, 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, gender determination, 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 we need and leave out anything we don’t!
Best wishes for happy and healthy!

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gender determination and ultrasound!

 

 

Baby Gender Misconceptions

How Do We Determine Baby’s Gender?

baby gender misconceptions, fetal gender

Sometimes, there are just so many shades of gray between pink and blue. Determining Baby’s 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 a probe to a 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 only in our very 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! Most of my emails come from people who want a second opinion. However, most of the time, it’s one I regretfully 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 commit.

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. And anyone who has, too, can recognize when gender 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!

baby gender misconceptions, making baby move

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.

 

baby gender misconceptions, fetal genderKeep 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.

 

 

 

breech fetus, prone fetus, ultrasound picturesDon’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. You can read more about a breech fetus here–it’s merely one of many potential problems with fetal position that can hinder a guess. Remember, that you want an accurate guess, not just any guess. Most importantly, an experienced sonographer knows when not to guess. Neither one of us wants me to guess the wrong sex . . .

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. Poop–I hate when that happens!

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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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The Nub Theory–What’s in a Nub?

What’s This Nub Theory Thing?

12 Week, Nub Theory

12 Week Nub Theory

One hormonal mama (self-proclaimed) wrote me to ask about The Nub Theory. If you want to know all about it, too, read on!

hormonal mama:  Hello!! 🙂 I just wanted to let you know that your blog has been a complete saviour to me and my sanity over the past few nights. It is brilliant and informative and just what I needed in my hormonal state.

I have one question that I have been searching the web for a definitive answer to, and I was hoping you could shed some much needed light. We had our 12 Week NT scan, and the US machine seemed to be a LOT better than the photos I have seen posted, videos I have watched, etc. We could see extraordinary detail of the baby. The sonographer was checking all the usual parts and suddenly without warning he showed us the perfect potty shot (I was 12w1d).

Now I know from reading that people say they all look the same at this stage. But what I cannot get over was how much the image showed a perfect little penis poking out the top of a round bulbous structure.

I’ve googled and you-tubed 12 Week girl vs boy potty shots, and I just cannot get a girl scan that looks like an actual penis. I’m clinging to the smallest shred of hope that I may still get my girl after seeing this, but it was just so obvious and so so so clear.

Thank you so much in advance for any advice or insight you can give me. I’m so disappointed in myself for feeling gender disappointment. I didn’t realise how much I wanted a daughter (this is our last baby) until I saw that potty shot.

Please tell me honestly; I can take it!!

Yours very gratefully 🙂

PS: I think what you are doing for ladies like me is fantastic. I cannot believe I found you after all my searching for answers! An actual professional who answers silly, hormonal women’s questions! Not a forum full of people who claim to know it all and actually know very little! 🙂

My Response to My “Hormonal” Reader!

wwavb:  Thank you for all the nice words you’ve sent my way! 😉 I appreciate it and am so happy you are enjoying reading my blog!

So, maybe you haven’t yet come across my posts on the subject. Click away! Boys and girls can look EXACTLY alike early on. The link below will give you more information:

https://wombwithaviewblog.com/early-gender-pics/

All that said, it’s okay to have a preference, but we all get what we need in the end. Having another boy means you needed one another for whatever reason!

Reply from Hormonal Mama

hormonal mama: Thank you for replying. I’m so grateful! I have posted a link to your blog on our pregnancy group page. I hope it gives some other ladies peace of mind. (And a good giggle!)

I was recently told by an US tech in the group that there is a “nub” on my image. But I am notoriously useless at seeing them. Would you be able to confirm (or deny) if there are any genital parts visible? All I’m seeing is legs and a cord. I know the angle of the dangle is not a reliable theory (from your blog!). But for someone to say she can see it on my scan, it would be helpful if I knew if it was even visible!

Many thanks again and again! 🙂

12 weeks pregnant, nub theory, male and female ultrasound

wwavb: Thanks so much! I, too, hope they get some useful info and a giggle, also!

Does the sonographer in your group practice OB? Experienced or new to OB? I question because I entirely disagree. Every baby has a nub at this age, but one cannot be sure whether the nub represents boy or girl. If she is referring to the thing sticking out near the butt, that is too large to be the nub in question so my thought is it’s Baby’s cord.

Actually, to see the nub, the plane needs to be centered between Baby’s legs which means you would not be able to see the legs in this view. See the image below:

12 weeks pregnant, nub theory, male and female ultrasound

No legs here! That could be a tiny foot way above the arrow, however.

This tells me the angle on your baby is not perfectly centered and is a little too far lateral, whereby the leg is included in the image. I hope this makes sense! What a cutie, by the way! 😉 Keep me posted!

Final Advice?

I’m so happy this mom realized that everything you read on forums are expressly the opinions of other moms and that they may not be the most reliable source. They can only share their image and their experience–and it’s just not yours!

Moreover, it’s entirely possible to get excellent images at 12 Weeks. If you are one of the lucky ones with these incredible pics, you WILL see something protruding between your baby’s legs. This is because external genitalia is just beginning to develop. This protrusion doesn’t necessarily mean you’re having a boy.

Finally, the angle of this protruding part creates the basis of the Nub Theory, but it is reported to be about 70+% correct. If you do the math, that leaves 20+% with clearly-defined guesses which turn out to be the opposite! I only recommend asking about a guess on your NT scan if you can remain mentally neutral!

Good luck on your NT test! (for healthy, that is!)

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Ultrasound Questions–Email Me With Yours!

First, I’d like to extend a huge congratulations to a reader who recently delivered! 👶 I love answering your ultrasound questions. I love it more when I actually help a reader. This is what she had to say…

Hi! I hope you had a lovely time on your holidays. Just had 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 me!

 Feedback and Your Ultrasound Questions . . .

I’m always excited to get your feedback! The whole point of my blog is to answer questions you have about ultrasound accurately. Considering the vast forums on pregnancy where everyone chimes in on their personal experiences, taking to heart unreliable information has the potential to do harm to you or your baby. Everyone is an expert; everyone has an opinion. Though I believe most genuinely care and try to help, I have found much about ultrasound to be misleading or incorrect in some way.

I have loved breaking the news to expectant parents about whether they would be shopping for pink or blue!

female sex, 2nd trimester

Definitely Pink!

male sex, 2nd trimester

Definitely Blue!

And I’m happy to try to decipher someone else’s images for my readers (as long as you’re 17 Weeks and further–just click on the link, leave your email address, and email me!). In my effort to bring to you factual and truthful information about your ultrasound examinations, part of that truth is doing my best to help you understand your exam and info about results.

Ultrasound will always be, first and foremost, a medical examination of mother and child. Your sonographer needs enough quiet and concentration to ensure your baby appears healthy! Afterwards, break out the party hats, and let’s have some fun!  🎉 Of course, the level of fun completely depends on how photogenic your new addition is feeling that day. You can read more about that here. Poo, sometimes, it just isn’t what you expected, even when you lost sleep in anticipation. 😫 I hate when that happens!

That said, the highlight of many workdays revolved around very happy couples who were mindful of why they were there–so happy to be expecting and loaded with ultrasound questions! I love to impart ultrasound knowledge to anyone willing to learn it. If I could also deliver a few awesome keepsake images of the precious little bundle and enjoy a few laughs in the process, all the better. I still feel honored to have been a third objective party who was privileged to orchestrate it all!

Best wishes for a beautiful experience!

Just shoot me an email with your comments, questions, and suggestions!

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Male Sonogram But Wishing For Pink

Is it Pink or Blue?

Are male sonogram images always easier to read than girls? Not when they aren’t great images to start. And especially not for some moms who have always dreamed of buying pink! Here’s an email from a reader who was really hoping for some estrogen in the family after two boys. Sometimes, wishful thinking prevents us from seeing what is really there.

Email from Mom KB:

kb:  At my 17-Week ultrasound, the tech took a photo saying the baby was a boy pointing to what is clearly the foot between the legs. She also said the umbilical cord was between the legs.

male sonogram, 17 Weeks pregnant

kb’s 1st pic at 17 Weeks

At my 21-Week ultrasound, the baby was breech with cord between the legs. When asked what we thought, we saw two lines and nothing else . . . so, we guessed girl. In the next view, she said boy.

male sonogram, 21 Weeks pregnant

kb’s pic at 21 Weeks

Where the tech called a penis looks like a foot to me. I have two boys already, and you could see the scotum and tip clearly. I feel different and not even pregnant. The heart rate was 170, 171, 157. I can’t shake that it’s a girl. Am I wrong and just hoping? What do you think?

wwavb:  Hmm, what do I think…

Well, as far as “feeling” different goes, each pregnancy is a different universe in and of itself. The way you feel with one pregnancy has nothing to do with how you “feel” in another. People historically want to contribute that difference to gender, but there just is no relevance there. And Baby’s heart rate can vary quite a bit, just as ours does with respect to fetal activity. So, you can’t go by that, either.

It’s entirely possible that your sonographer could tell it was a boy, but it wasn’t clear to you because the cord was in the way. It’s also possible that you just want a girl so much that it’s hard for you to really “see” boy parts in the image.

(I labeled the images she sent–see below.)

The first image isn’t very clear. But see the labels for the second image. No foot here! Where I have the arrows of the legs, you are only seeing part of the thighs. The rest of the legs and feet are not in the image.

male sonogram, 21 Weeks pregnant


male sonogram, 21 Weeks pregnant

kb:  I don’t see the scotum because she said the cord was between the legs.

male sonogram, male gender

wwavb:  Holy cow, this is totally a boy! All boy! See my edited image attached below . . .

male sonogram, male gender

Congrats! 😉 I always say it takes a special woman to be a mom of all boys! Little boys love their mamas, and you have the perfect opportunity to teach them to be loving, respectful, and helpful to their future wives. Your daughters-in-law will thank you!

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Patients have a really hard time believing their eyes in a male sonogram image if all they want to do is shop for frilly dresses! However, I do stand by my advice to her–we women have a unique opportunity to instill great character in our little boys.

Chivalry doesn’t have to be dead!

To conclude, all mamas should teach their sweet little boys to hold open doors and show respect to the next generation of women. Not only can you teach him to respect all the future women in his life–his girlfriends, his wife, and potential daughters–but one more very important woman who is arguably the most important of all.

YOU!

Best wishes to all you moms out there of all boys!

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