An Ominous Ultrasound Report

QUESTION

Dear Ms Ultrasound,
Hello again. I wrote to you a couple of weeks ago and you responded. I have attached that correspondence. I have some serious concerns regarding a follow-up u/s in which the radiologist found "Several indicators are of non-viable pregnancy or impending non-viability." I will attach a scanned copy of the report, but my concerns are:

  1. Report says "Mean sac diameter corresponds to 5 weeks, 5 days gestation"

    MY CONCERN: My LMP was May 30, 7 weeks and 5 days from this u/s. Gestation should be approximately 2 weeks less, or approximately 5 weeks 5 days.

  2. Radiologist noted that gestation should be 6 weeks 5 days gestation based on his finding on July 13 (when he found 5 weeks, 2 days.)

    MY CONCERN: I wrote to you about the July 13 u/s. I said that it didn't make sense, that if it was based on LMP then it should have been more like 6 weeks 2 days, otherwise, gestation should have been about 4 weeks 2 days. I quizzed everyone about LMP vs gestation and the hospital said that gestational age was what was being reported. So, it should have been 4 weeks 2 days and 10 days later. July 23 (date of 2nd u/s) it would be 5 weeks, 5 days which is exactly what he reported it was.

  3. No fetal pole was detected.

    MY CONCERN: No fetal pole WOULD necessarily be detected at 5 weeks 5 days gestation, correct?

  4. Heartbeat at 50 bpm. The report admits that might have been a reverberation of my heartbeat, but if it was a fetal heartbeat that would be a poor prognostic indicator.

    MY CONCERN: A fetal heartbeat isn't usually found until 6 weeks anyway, correct?

  5. Yolk Sac of 7 mm.

    MY CONCERN: If this is accurate, a 7 mm yolk sac is not good, right? I believe the normal yolk sac is about 4 mm? Abnormally large yolk sacs are indicative of abnormal pregnancies, and this is really my only big stumbling block. However, in the July 13 u/s he said, "probable yolk sac detected." Could it really go from "probable" to "abnormally large" in 10 days? Is it possible that there may be 2 yolk sacs (twins) and the differentiation not seen and perhaps read as one big sac? If, in fact, it did grow quickly to being abnormally large, does that ALWAYS mean a problem exists?

  6. Historical data was incorrect. It stated that I had vaginal bleeding and abdominal pain for 7 days prior to the u/s (strangely corresponding to the reported 3 day advancement of the pregnancy between u/s). HOWEVER, I was merely staining a panty-liner for 2 days (now 3), not 7, and had zero abdominal pain.

The doctor, who is not an OB, that I am seeing right now, wants to do a d and c. I'm not convinced. I am not trying to hang on out of desperation, if this is an m/c, or partial m/c or otherwise unviable pg, ok. But I wonder. At the very least, I think the original u/s was incorrect, and a lot of the diagnostic information reported on the subsequent u/s was based upon expected findings since the first one.

Don't try to be gentle with me if you think I'm grasping at straws; I just don't want to terminate a healthy pg. I still have morning sickness. I still have sore breasts. I am still spotting, but in no way have soaked even one pad if you totaled all the blood over 3 days. Do you not think this story merits a follow-up ultrasound?

Thanks for reading,
Jackie

ANSWER

Hi Jackie,
I think I will start out explaining the way a pregnancy is dated. There are not two ways of dating, as you have described. There are 40 weeks in a pregnancy starting from the first day of your LMP. No one counts from conception.

When you had your first ultrasound on July 13th, with a LMP of May 30th, you should have been about 6weeks 2days.(the radiologist was only a couple days different; it's all how you read the little slash marks on a chart we use). I'm not sure who you would have talked to in the medical profession, that would have given you the incorrect information of the 'gestational weeks'. You may disregard that information and count from the LMP. So on July 23rd when you had your follow-up ultrasound, a 10 day growth should have been noted, no matter how you count weeks. You had no growth in 10 days. From your LMP of May 30th, on July 23rd you should have been about 7 weeks 4 days.

You were concerned about misinformation in days spotting or bleeding. This information plays no role in what was said on the ultrasound. 2 days bleeding, 7 days bleeding, it doesn't matter. The ultrasound will still have the same results.

Your 'historical data' isn't really going to affect what the radiologist has read on these two ultrasounds. All the other statistics you quoted about the yolk sac and heartrate are reported, but the fact remains, there has been NO growth in 10 days. A heartrate of 50 is ominous. A good sonographer would put their hand on your pulse while watching the slow fetal heart to see if it really is the Mother's heartbeat. Hopefully they did not mistaken your heartrate for the baby's.

It seems to me your doctor is on the right track. I think the worry you have experienced has been caused by confusing the dating process. I hope my explanation has allowed you to better understand the entire process and how it applies to your pregancy.

-- Jane, RDMS

Jane Foley

Jane Foley has worked as a Sonographer (Ultrasound Technologist) since 1979. Jane has lived and worked in many parts of the world including Saudi Arabia. She is a Registered Diagnostic Medical Sonographer or RDMS. She pulls a wealth of information from her experience in the field of Radiology and her interactions with such a broad cross-section of cultures she has visited. She now makes her home on the island of Maui with her English husband, Michael.