9.0 weeks past lmp. Ultrasound showed gestational sac - no embryo

[Kitty2412]

Looking for your advice and help.  Today makes 9.0 weeks since my last menstual period.  I went in this am for my first OB/GYN appointment/ultrasound. I have had lots of pregnancy symptoms, no bleeding or strange cramping, and taken a HPT weekly (all positive) since I first found out i was pregnant.  My body definitley thinks it's pregnant. This am, the dr said she saw a large gestational sac, but no fetal pole. She sent me for a 2nd ultrasound over at the hospital.  The did both the stomach and transvaginal type, and they saw a gestational sac measuring 8.2 days, and embryo measuring 6.3, but no heartbeat.  They were going to evaluate more closely the ultrasound pics and refer back to my OB/GYN.  I am waiting to hear what their final conclusion is.  It has been 9 weeks since the start of my lmp.  They are concerned that the gestational sac is much larger then the embryo development, and with no heartbeat, it doesn't look promising.  Is there anyhope, or should i prepare myself for a miscarriage.  This will be my 3rd in the last 9 months. Could it just be my dates are off, and maybe the baby needs more time to show itself and a beating heart, or is that just wishful thinking.  I have lost perspective.  Any thoughts or stories you could share would be most helpful.

[Dr. Kokil Mathur]

Hi!
I am sorry to hear that you are having such a bad phase in life with repeated miscarriages. Yes, the dates could be off, if the ovulation occurred late in your last cycle. Normally a gestational sac with a yolk sac appears at about 5 weeks (calculated from your last missed period date) of pregnancy and can be well visualized by 6 weeks on a transvaginal (through a vagina) ultrasound (so it can be missed at 5 weeks), when you can see a fetal pole too. Fetal heart beat usually appears by 8-9 weeks. This is why it is best to repeat the scan a week or two later.

At times the sac appears but there is no baby inside. This is called blighted ovum. This is confirmed if an ultrasound through vagina reveals a sac with gestational sac diameter greater than 13 mm and no yolk sac, or diameter more than 18 mm with no embryo. Follow-up ultrasound is done after 10 days to verify diagnosis. Normally it is wise to wait until 10-11 weeks of pregnancy for a confirmed diagnosis of blighted ovum or fetal death. Meanwhile monitor the HCG levels at 48 hours intervals. If the HCG levels rise and almost double in 48 hours, then chances of pregnancy carrying forward are high.

Also, if you have a history of recurrent miscarriages then this should be investigated. Generally first trimester abortions or abortions occurring in first three months are due to fetal abnormality, genetic causes, Rh blood group incompatibility and low progesterone hormone. Infection of the uterus, endometriosis, fibroids, etc  are some other causes for early abortion. You need to consult your gynecologist and run some tests to rule out these causes. Eliminating these causes will increase the chances of full term pregnancy. Please discuss with your gynecologist. Take care!

[Kitty2412]

Thank you for taking the time to write back.  I wanted to provide an update and close the loop.  After receiving a 2nd round of labs, we found my HCG dropped from 26,000 to 20,000, and with an embryo at 6 weeks w/ no heartbeat, but the gestational sac measuring 9 weeks, my dr felt confident that the embryo stopped growing and diagnose this as a missed miscarriage.  I opted for the vaginal pills to induce passing the baby.  I have a follow up appointment this week to be sure everything has been passed, and figure out next steps.  I am 41 yrs old, and fear my age is the issue.  I hope with testing, we can find what the issue is and possibly try agaiin soon.  My Progesterone level was 8.8 the same day my HCG dropped to 20,000.I am hoping that fact that i have been able to ovulate and get pregnant may mean that i could possible have a successful pregnancy, and maybe i just need some hormone tweeking.  It is all very difficult, both physically, and emotionally to get to 9 weeks, only to find our baby did not make it.  Very rough stuff.  Thank you for writing and if you ahev any additional thoughts, please don't hesitate to send!

[jesim6540]

Dear all,

Kindly suggest me what should we do if anyone has experienced the same. My wife had an m/c last year at 6 weeks . We cam to know at 8 weeks. This time we had our 1st ultrasound at 5 week 3 days according to LMP but it showed 4 week 5 days. We did our second ultrasound at 7 week 2 days lmp but usg showed 5 week 4 days and again we did it on 9 week 1 day when it showed 5 week 2 days with no heart beat and no fetal pole. We have not received any heart beat yet. Kindly suggest. My wife also figuring out some blood spotting currently. Is there any chance that the baby is ok. Please kindly share if any one has experienced the same.