Abstract
ObjectiveTo provide guidance on ultrasound review of the fetal perineum as well as fetal sex determination and disclosure. Target PopulationAll individuals with ongoing pregnancies. OptionsTo include a review of the fetal perineum and determination of fetal sex as a component of the anatomic review during the routine second-trimester obstetric ultrasound and adhere to patient wishes regarding the disclosure of fetal sex. OutcomesPrenatal diagnosis of fetal genital and sex anomalies or variants, parental and pregnancy caregiver knowledge of fetal sex, and adherence to parental wishes regarding knowledge of fetal sex. Benefits, Harms, and CostsBenefits include the potential to improve perinatal outcomes through the diagnosis of fetal genital anomalies and respect for women’s rightful autonomy over personal health information. Potential harms or costs include a possible error in fetal sex determination, increased time for patients and health care providers in scheduling and performing the imaging, and the minimal risk of patients choosing to abort a pregnancy if the fetus is not the desired sex. EvidenceEvidence built on the literature from the prior version of this statement through a review of international guidelines, Canadian legal rulings, and a literature search of PubMed and the Cochrane Database. English language research articles, review articles, and systematic reviews between January 1, 2003, and December 31, 2023, were included. Search terms included fetal ultrasonography, sex determination, and genitalia. The references of relevant articles were assessed, and applicable articles were included as well. Intended AudienceAll care providers for pregnant individuals in Canada. Social Media AbstractFetal genitalia should be examined in pregnancy and the sex safely disclosed to the patient if they want this information. CONSENSUS-BASED GOOD PRACTICE STATEMENTS1.Diagnostic imaging providers and other health care providers should respect parental wishes regarding the disclosure of fetal sex.2.Diagnostic imaging providers should make every effort to determine fetal sex during an obstetric ultrasound examination from the second trimester onwards and should include this information in the ultrasound report.3.If fetal sex cannot be determined, re-examination or appropriate referral is recommended.4.The obstetric ultrasound examination reports should contain a visible alert at the beginning of the report regarding the presence of information on fetal sex, thus giving parents the option of not reading any further.
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