Is It Difficult to Find Sex of Baby at 36 Weeks
Niger Med J. 2012 April-Jun; 53(2): 71–75.
The accuracy of 2D ultrasound prenatal sex conclusion
Blessing Ose-Emenim Igbinedion
Department of Radiology, University of Benin, Republic of benin
Theophilus Oriazo Akhigbe
aneIrrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
Abstract
Background:
Significant women have been curious near the sexual practice of their unborn child. The advent of ultrasound, its application into medicine, and the revolutionary changes in its resolution and part has led to the ability to assign a sexual practice to these unborn children, thereby allaying the anxiety of these women but with consequent emergent ethical, moral, psycho-social, and medico-legal issues. The objectives were to determine the accuracy of sonographic prenatal sex conclusion, perform binary nomenclature test, and the impact it has, including mis-diagnosis.
Materials and Methods:
A prospective prenatal sonographic sex determination report on 205 consecutive consenting pregnant women aged 20-40 years in a individual hospital in Republic of benin between August 2010 and Oct 2011. Questionnaires were administered to these women before and after the browse and the women were told the sex of the fetuses and their feelings on the determined sex recorded. The sex at nascency was confirmed and compared to the scan determined gender by their instance note and phone. Relevant discussions during the scan and afterwards on were recorded on the questionnaires. The statistical package used was SPSS version 17 and binary classification tests were performed.
Results:
The sensitivity (98.2%) and binary classification components values of prenatal sex determination were high with the sensitivity of detecting a female person college than that of males. Two males were misdiagnosed as females. Most of the women were happy even when the sex activity differed from that which they desired.
Conclusion:
Prenatal sonographic sex determination has a high sensitivity index. Consequently nosotros advocate its employ prior to more than invasive sex tests.
Keywords: Accuracy, gender determination, prenatal gender, prenatal sexual practice, sex determination, sonographic sex, ultrasound sex
INTRODUCTION
Ultrasound is used in most parts of the globe for prenatal sexual activity determination. Indication for prenatal sex determination tin be medical or nonmedical. The medical indication for its use include in families at gamble of x-linked disorders, testicular feminization syndrome, pseudo-hermaphroditism, genital anomalies, cryptic genitalia, and conclusion of zygosity in multiple pregnancy.1 – 5 In families predisposed to x-linked disorders it leads to the reduction in invasive procedures as sonographic prenatal adamant females would non crave further invasive genetic screening. The nonmedical reasons given by women for sonographic sexual practice decision include preparturition shopping, marvel, husband/relatives' request, and to confirm suspicion.four
Get-go trimester sonographic prenatal sexual practice determination can be done from 11 weeks gestation using the direction of the genital tubercle and the "sagittal sign." The downward direction of the tubercle is considered a female while the upward management a male.1 ,2 In sagittal sign, examination of the genital region in the midline sagittal plane demonstrates a caudal notch in females and a cranial notch in males.6 ,7 Ultrasound scan washed in the second and tertiary trimester places emphasis on visualization of the anatomy of the genitals or pelvic structure in determining the fetal sex. In the early publications on sonographic prenatal gender consignment male sex was identified by the presence of the penis and scrotum while females were by the absence of both scrotum and penis.8 But with improved mod ultrasound resolution engineering science visualization of the vulva, clitoris, and labia is considered a female fetus whereas demonstration of the scrotum, penis, descended testicles, and penile midline raphe is assigned to males. Visualization of the internal pelvic structures of the fetus such as the uterus and ovaries also assists in assigning advisable sexual practice to the fetus.
Unfortunately first trimester ultrasound sex determination has significant fake negative rate.2 ,9 Studies done in the second trimester accept better sensitivity values. 9 The sensitivity of sonographic determined sexual practice is dependent on the operator, motorcar, and habitus. Comeback in the sensitivity value increases with high proficiency and experience also equally high-quality machine. Incorrectly determined sexual practice tin can accept some psychological effects on the family unit. 2 Hence an attempt must be made to place an authentic sex blazon on the fetus. Thus nosotros undertook this written report to determine the prenatal sonographic accurateness and sensitivity pattern in our environment.
MATERIALS AND METHODS
This is a prospective report conducted at a private hospital in Benin from Baronial 2010 to Oct 2011. Blessing for the report was sought and granted from the radiology department and the direction (which acts as the upstanding board) of the private institution where the written report was conducted. In the written report 205 sequent consenting meaning women with pregnancies in the second or third trimester that were referred for obstetric ultrasound had the procedure explained to them and questionnaires administered later signing the informed consent section. Sonographic prenatal sex determination was conducted in these consenting women and the adamant sexual activity communicated to them. They were then asked how they felt about the determined sexual practice and their feelings recorded. Data such every bit phone numbers, gestational age at scan time, estimated date of delivery, case note number, and other relevant data were entered into the questionnaires. Their case notes were retrieved most 3 weeks after the expected date of delivery and the sexual activity of the infant at nativity entered into their questionnaires. The patients were also contacted by telephone and the sexual practice at birth confirmed with relevant comments entered into the questionnaires. The sex at nascency was then compared with the prenatal sonographic determined sex.
The ultrasound machine used was Fukuda Denshi FF Sonic, UF-4100, Tokyo, 2007. The browse was performed by one of the researchers. Identification of the vulva, clitoris, and labia was used to assign female sex to the fetus [Figure 1]. For male person fetuses visualization of the scrotum, testicles, and penile shaft was utilized [Figure 2]. After the scan the women were asked how they felt after knowing the fetal sexual activity. Their responses were then entered into the questionnaires. Relevant oral communications were also recorded in the questionnaires as other findings.
Female genitalia, encircled
Male fetal external genitalia (circled)
The data were analyzed using SPSS version 17. Descriptive analysis was performed on the patients' biodata and gestation of the pregnancies. Binary nomenclature examination such equally sensitivity, specificity, positive predictive value, negative predictive value, and accurateness were performed for either fetal sex and the results tabulated. A chi-foursquare exam was also washed with significant value set at 0.05.
RESULTS
Two hundred and v pregnant women participated in this study with the youngest anile 20 years while the oldest 40 years. The average historic period of the participants was 29.5 years; median 29 years; and mode 28 years. The mean time at which the scans were conducted was at 29.2 weeks gestation; median, 30 weeks gestation; mode, 35 weeks gestation. The earliest browse was at 17 weeks of gestation while the latest was at xl weeks with the range spanning 23 weeks [Figure 3].
Histogram showing the frequencies and gestational ages at which obstetric scans were done
All the females were accurately detected sonographically as females, but 2 males were mistakenly reported as females [Table 1]. These two males were scanned at 33 and 36 weeks of gestation. The positive predictive value for ultrasound male sex detection is 100% [Table 2]. Information technology thus means that if on ultrasound a male sex activity is detected, then the probability of being male is 100%. On the other mitt if sonographically a female sex is detected, then the probability is 97.9% that information technology may turn out to be a female at nascence. Furthermore, the sensitivity, specificity, and accuracy for either sexual practice are loftier [Table 2].
Table 1
Cross-tabulation of the sex as detected during obstetric scans confronting the actual sex at nascency
Table 2
Binary classification tests for ultrasonic detection of male and females sexes respectively
Afterwards conducting the scans and the clients told what sex of infant they expect, ii (0.9%) felt resigned; 8 (three.v%) were unhappy; 18 (vii.eight%) were indifferent; 194 (84.0%) were happy with the ultrasound fetal sex. 9 (3.9%) opted not to fill in their feelings virtually the outcome of the obstetric sex determination scans. Some of the women who were unhappy or resigned to the sex of the fetus every bit detected sonographically made comments like: "It is God's will, who are we to judge?," "God knows meliorate," "Oh no! I have already bought clothing for the opposite sex," and "I will effort again." One woman jokingly said, "Md I volition give y'all the child" – information technology was to exist her quaternary male child.
DISCUSSION
In the past women had made guesses of the sex of their unborn child which was confirmed just at parturition. The advent of ultrasound has allowed conduction of sexual practice decision in utero with consequent anxiety alleviation associated with marvel over the fetal sexual activity experienced in the past. In medically indicated fetal sex determination to determine if the fetus is a male in ten-linked disorder, 100% accurateness is desired. For instance a medicolegal case may arise if a female fetus is mistakenly identified equally a male in a family with history of x-linked disorder and the pregnancy is lost Mail-amniocentesis. In many studies 100% accuracy in prenatal gender assignment was achieved.one ,10 – 12 Yet lower sensitivities values have been reported with accuracy ranging from 93% to 99% in scans done inside the second and third trimesters.thirteen – 17 Our study recorded a similarly loftier accurateness of 99% for sonograhic prenatal sex determination of fetuses greater than 17-week gestation.
This report demonstrates that ultrasonography is an effective fashion of identifying fetal gender in the second and third trimester. Out of the 205 pregnant women in this study merely 2 had the sex of their babies at birth different from what was adamant past ultrasonography. All females were accurately detected sonographically as females but ii males were wrongly reported every bit females yielding 100% sensitivity for females and 98.ii% for males. The women whose children's sex were wrongly identified did not fail to vent their anger citing that they had to become through shopping for new set of clothing for the babies leading to wastage of scarce resources and psychological stupor at seeing the opposite sex to that expected at parturition. In similar situations hospitals had been sued for false results.5 Information technology is possible that these mistakes occurred due to inability to identify the male genitalia with consequent consignment of a female gender instead of ensuring that the female external genitalia (the vulva, clitoris, and labia) is fully visualized, or that folded/coiled umbilical cord which hands mimics scrotum may have been the cause. However coiled umbilical cord can be easily differentiated from scrotal sac if the gain setting is optimized or reduced if the gain was initially high. Application of Doppler on the suspected umbilical cord may show color menses while no pregnant menstruation will be seen if it is the scrotum.
In a study carried by Efrat et al.i to assess the accuracy of fetal sex determination at 11 to fourteen weeks of gestation it was institute that the accuracy of sex determination increased with gestational age with the accuracy increasing from 70.3% at eleven weeks gestation; to 98.vii% at 12 weeks; and 100% at thirteen weeks. Male fetuses were wrongly assigned as females in 56% of cases at 11 weeks gestation; iii% at 12 weeks gestation; and 0% at 13 weeks gestation. In our written report the sensitivity at detecting a female fetus was 100% which is higher than that of detecting a male person, 98.2%. Efrat et al.one as well recorded similar findings every bit only v% of the female fetuses at 11 weeks were incorrectly assigned as males with reduction of the false positive charge per unit to 0% at 12 and xiii weeks. Other studies likewise support the observation that the sensitivity of female person sexual activity determination is higher than male and that gender determination sensitivity increases with advancing fetal age.2
In the ability to assign a male person gender we got a reasonably high sensitivity of 98.ii% and specificity of 100%. All the female fetuses were accurately assigned as females just the ability to dominion out a fetus as not beingness a female person was 98.2% (specificity). We achieved an accurateness of 99.0% which shows that 2D sonographic prenatal sex determination has a loftier clinical application in assigning gender in utero. Wrong gender assignment may occur if the pelvic floor muscles or the anal orifice is mistaken for female genitalia. Sometimes it may be difficult or impossible to visualize the ballocks to assign a sex activity to the fetus. Factors that may hinder easy visualization of the ballocks include breech presentation, closely apposed fetal thighs resulting in covering of the ballocks, close proximity of the fetal peritoneum to the placenta or myometrial wall, oligohydramnios, maternal obesity, technical problem with the machine or probe causing poor paradigm quality.
Revealing fetal sex during obstetric scans raises numerous psycho-social, ethical, and legal dilemmas.5 Especially because of the outcome falsely assigned sex will take on the women and their family which tin can boomerang on the sonologist/sonographer every bit a legal adapt against the infirmary. Consequently some sonologists exercise not perform ultrasound sex activity decision. Bashour et al.18 proposed that abstention of incorrect diagnosis was the reason for refusal past some doctors to inform their patients of the fetal sex in Syria.18 Many of the women in our study were relieved when the fetal sex activity was told to them. A meaning proportion (84.0%) remained happy fifty-fifty when the sexual practice was unlike from that preferred with the expression that "it is God's will, who are we to approximate?" Nosotros perceived the expression every bit a sign of resignation and it was expressed by 2 (0.9%) women. Just 3.5% of the women were unhappy with the prenatal sex report most likely because it is contrary to the preferred sex activity.
Application of 3D ultrasound is an effective and fast way of identifying fetal sex in the offset trimester using its volume rendering capability and multiplanar reconstruction including the midline sagittal plane which is essential for the "sagittal sign" of gender identification associated with the direction of genital tubercle angulation.iii ,19 In the detection of facial bibelot such every bit cleft palate and other function of the body's physical abnormality 3D ultrasound is indispensable especially with its surface rendering mode office. However studies have shown that 3D ultrasound does not confer increased accuracy at gender assignment over 2D.20 Consequently 2nd ultrasound remains the gold standard in fetal gender assignment.
CONCLUSION
The sensitivity and binary nomenclature test values are loftier. Hence we recommend the apply of prenatal sonographic sex conclusion when requested and communication of the study to the women provided it is washed past a competent trained health personnel.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530251/
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