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Sonographic Fetal Sex Determination

Odeh, Marwan MD*†; Grinin, Vitali MD; Kais, Mohamad MD; Ophir, Ella MD§¶; Bornstein, Jacob MD∥**

Obstetrical & Gynecological Survey: January 2009 - Volume 64 - Issue 1 - p 50-57
doi: 10.1097/OGX.0b013e318193299b

Although sonographic fetal sex determination is feasible in most pregnancies, in some cases, it may pose difficulties.

An attempt to determine the fetal sex should not be made before 12-weeks’ gestation because this early, it is relatively inaccurate. After 13 weeks, it is accurate in 99% to 100% of cases without malformed external genitalia.

Sonographic fetal sex determination in the late second trimester is based on direct visualization of the external genitalia, whereas in the late first and early second trimester, it is based mainly on the direction of the genital tubercle (the “sagittal sign”): downward direction of the genital tubercle indicates a female fetus and upward direction a male fetus.

Other sonographic landmarks, such as the fetal scrotum, the midline raphe of the penis, the labial lines, the uterus, the descended testis, and the direction and origin of the fetal micturition jet in males may contribute to the correct determination of fetal sex. Inaccurate fetal sex determination may occur when the external genitalia are malformed. Three-dimensional ultrasound, although of generally limited diagnostic value for fetal sex determination, may aid in better definition of congenital malformations of the external genitalia.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Leaning Objectives: After completion of this article, the reader should be able to select the appropriate sonographic finding for determining fetal sex according to gestational age, list indications for sex determination in the fetus, and name abnormalities of genitalia that may alter sonographic findings.

*Accompanying Lecturer, ‡Senior Gynecologist, §Senior Lecturer, ∥Associate Professor and Head of Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya; and †Accompanying Lecturer, ¶Senior Lecturer, **Associate Professor, Rappaport Faculty of Medicine, Technion, Haifa, Israel

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2009. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprint requests to: Marwan Odeh, Department of Obstetrics and Gynecology, Western Galilee Hospital-Nahariya, POB 21, Nahariya 22100, Israel. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.