QuestionI have some confusion, regarding my pregnancy.
I had my last period on 15 December.
On 17 January, I did a home pregnancy test, and it was positive.
We consulted a gynecologist, and according to her advice, we did the first ultrasound on 4th February.
However, in this ultrasound, only the sac was visible, and cardiac activity was still not visible as predicted by the gynaecologist. In our subsequent discussion of the gynaecologist, she explained that, it may be a case of delayed conception (?) or miscarriage. She prescribed a hormone (Progesterone), and advised us to do a repeat ultrasound after three weeks. We are waiting to see the result.
Just for sake of my peace of mind, I want a second opinion from you.
1. Do you think this first ultrasound was too early?
2. Is delayed conception harmful for my baby?
3. How much chance we have for a baby or miscarriage?
I am 27 and perfectly healthy. This is my first pregnancy. I will be grateful for your cooperation in this matter.
God bless.
AnswerHello Ashwini from India,
Based on your last menstrual period, and if you have regular predictable periods, you were 4+ weeks gestational age when you did your home pregnancy test, and that would have been an adequate time to pick up the pregnancy. If you had a delayed ovulation, it would not have shown positive at that point because the level would not have been high enough for the home test to detect.
Based on your LMP, you were 7+ weeks when the ultrasound was done. At that gestational age you should have see a gestational sac with obvious fetal pole and fetal heart motion. The sac and fetal pole should have measured consistent with 7 weeks. Since only the sac was seen, it could be either an earlier pregnancy (5-6 weeks) due to late implantation or an abnormal pregnancy that has not continued developing. It is hard to know which it is at this point and so the ultrasound needs to be repeated after two weeks.
In answer to your questions:
1. I don't think this ultrasound was done too early. We usually do our first ultrasound at six weeks gestational age. In most cases we will see a gestational sac, fetal pole and fetal heart motion at this point. The heart starts at around 5-1/2 weeks gestation.
2. Delayed conception is not harmful for the baby. It has no effect on the baby or the pregnancy.
3. Based on the information you have given, and as you can see from my explanations, I think that there is a high chance that this pregnancy is not a good one and will end as a miscarriage. Up to 40% of pregnancies end in miscarriage. Because the pregnancy is not as far along as it should be, there is no fetal pole present and there is no heart motion, I think the chances are not good. But that being said, we cannot know for sure at this point so we will have to wait and see with the next ultrasound. I would recommend that you ask for the ultrasound in two weeks rather than having to wait three. There is no reason for the extra time.
Keep in mind that even if this pregnancy ends as a miscarriage, 85% of couples that have miscarriages eventually are successful.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereyb
