Clinical Consensus No. 455: Fetal Sex Determination and Disclosure.

Objective: To provide guidance on ultrasound review of the fetal perineum as well as fetal sex determination and disclosure.

Target population: All individuals with ongoing pregnancies.

Options: To 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.

Outcomes: Prenatal 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 costs: Benefits 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.

Evidence: Evidence 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 audience: All care providers for pregnant individuals in Canada.

Social media abstract: Fetal genitalia should be examined in pregnancy and the sex safely disclosed to the patient if they want this information. CONSENSUS-BASED GOOD PRACTICE STATEMENTS.