Early Pregnancy Ultrasound Causing Confusion

Jane Foley's picture

QUESTION

Dear Ms. Ultrasound,
My boyfriend and I have been through hell the past few days. This past Thursday, we went in for our first ultrasound and the doctor said there was one gestational sac, but couldn't find the heartbeat. She said the I was either earlier that I thought, or I could be miscarrying. (I have very irregular periods, so she said I might have ovulated later, or something like that) So she set up another appointment for an ultrasound for four days later (today - Monday), and told me if I started to bleed to go to the E.R.

Sunday afternoon, I started to bleed and cramp and went to the E.R. The doctor there gave me two ultrasounds (one vaginally, one on the belly) and also took blood. He told me that there were three babies and two sacs. My bloodwork showed that a baby was still growing, so based on that and the ultrasounds he concluded that I was losing two babies but one would be okay. My boyfriend and I were so excited. We went to our OB today and got yet another ultrasound (done vaginally) and she found two sacs, and saw one baby but still no heartbeat. She concluded I was miscarrying.

This confuses us immensely, because we don't know who to believe. The OB would be the one to believe, I'm assuming, but not once did she tell me how far along I was or did she do blood test to see if the pregnancy hormone was increasing and what not. We're just really confused and scared and we don't know what to do.

ANSWER

I am sorry to hear you were having trouble with this pregnancy. In the early stages of pregnancy, ultrasound can have problems determining if the pregnancy is growing properly or not. Imagine how small the embryos are at 5-6 weeks. This is usually the stage in which a pregnancy starts to show signs of trouble if the development is affected in some way.

The questions always arise- has the pregnancy stopped growing? Is it too early? Is there bleeding with a clot in the uterus or a second collapsing gestational sac? There are quite a few possibilities, some up to the interpretation of the doctor reading the ultrasound.

Here's one thing we can determine, if we see the fetal pole which is the embryo, we must see a heartbeat within. If we see the fetal pole without a heartbeat, then the pregnancy has stopped growing. The Ob/Gyn is the expert in this area. He/She seems to have seen the fetal pole and determined there was no heartbeat. The ultrasound would have looked into all the gestational sacs identifying any fetal pole. This is how your doctor knew you were having a miscarriage.

At that moment the hormones do not come into play, there is a heartbeat or there is not a heartbeat when looking at the embryo or fetal pole.

I know how confusing and hard it is to feel the elation of, yes one baby will make it, to you are having a miscarriage. The first trimester is precarious this way. One can never trust that the pregnancy is well on its way until you get to that 12th week. Then you can relax a bit.

Nature is an amazing thing. It seems to know when a developing human is doing well or not. If the development is not perfect, many times nature steps in, and a miscarriage follows. Ultimately this is a good thing as the baby may have had major problems.

I like our mommies to embrace the fact that they had a life with its own little spirit within them, even for a short period of time. Connect and love the time you had. I know that is what I did after a miscarriage and it helped so much!

-- Jane, RDMS