QuestionQUESTION: Hello,
My LMP was between september 21st and September 27th, i am unsure of the exact date but know it occured between these dates. On October 21st i had a positive pregnancy test. I know that the only possible dates of conception were between October 6th-16th as those were the days i was sexually active. Last week Nov 1st i had an U/S. Only a gestational sac was found it was measuring at 5 weeks 4 days . A follow up was done Wednesday Nov 3rd, still only a gestational sac could be seen, and what she thought could be development. She discussed the possibility of a blighted ovum. And prompted me for hcg level testing that day and 48 hours later. And a follow up U/S a week from the original. On Friday she received my blood work and said it had risen appropriatly and that we will see what Mondays ultra sound shows. Today Nov 7th i had my ultrasound and there was a "good" looking yolk sac which was not there in previous ultrasounds. And what the technician thought could be a begining of a fetal pole, but was not definate and too small to measure. She said the.development of the yolk sac and rising hcg levels are a good sign. But still the gestational sac is meameasurimng large, at 6 weeks 4 days..according to all information I've seen a fetal pole and heart beat should be seen by this date. Could my gestational sac just be large, if it was a blighted ovum would a yolk sac developed between the ultrasounds. My doctor is out in surgery until next week and the waiting game is making it impossible to sleep. Thank you so much.
ANSWER: From the information you give me I conclude that this is probably not a case of blighted ovum. These are the reasons why I think so:-
1. Your HCG levels are rising. This will not happen in a blighted ovum. Can you tell me the value of the hcg last measured? It will help me confirm my conclusions.
2. Your second USG showed a yolk sac and a foetal pole. This again is possible only when there is a viable embryo growing inside your womb.
3. In all probabilities, this seems to be a case of wrong dates. I understand that you are not very sure of your date of last period which is quite normal, as many women do not remember the dates correctly.
I think that the best course of action now is to undergo a USG once again in a week. I am sure that this time you should be able to see the foetal cardiac activity. Do feel free to contact me in case you have any further questions.
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QUESTION: Again, thank you so much for taking time out of your life to provide answers for those of us in need. You were right. It was not a blighted ovum. Although, this pregnancy seems to be full of complications. Its hard to be hopeful with everything thats going on. After my ultra sound on the 7th i went in for a follow up with by obgyn which was the 9 th of November. After anothe transvaginal u/s she found a baby measuring at 0.44cm (6 weeks 1 Day) and a flicker of a heart beat. It could not be hear 2 days prior the baby wasn't even visable and at such a early stage It was Ok. I scheduled a follow up 6 days later for November 15 ( this last Tuesday) another u/s showed a baby measuring at 0.57 cm (6 weeks 2 days) and a heart beat that could be measured in the mid 90's. She didn't mentioned the heart beat was low, but didn't notify me of any concerns. She did however say for being 6 days between u/s she was concerned with the lack of growth. The baby is noticibly bigger in terms of looking at diameter, but not by measurements of CRL. The following day (Nov 16th) i had a extremely small amount of brown discharge. Of course i was heart broken and called there office. They said if there was bright red blood to go to the er otherwise they would see me Friday. Then the next day Thursday (nov 17th) saw it, a tiny amount of red blood mixed with mucous like discharge. And of course in a panic i rushed to the ER . Unable to do an U/S
They did a pelvic exam. My cervix was closed. The examining doctor said she saw no blood coming from my cervix, but instead saw a spot of irritation on my cervix that was producing a small amount of blood. They also did and HCG draw and said it was an appropriate level. The following day, today ( nov 18th) i again had a follow up with my ob doc. Another pelvic exam showed a very irritated cervix that was closed. An U/s was performed and there was much more development with the baby. It was measuring at 1.10 cm. (7 weeks 1 day) which made her happy. But the heart beat was low still at 98. She did say it " appeared" to be beating faster, but thats what it measured at. That was her greatest concern but because there was a good amount of development from the U/S just 3 days priority she hadn't lost hope. Now its just the waiting game until December 6th. With so much pointing at a negative outcome its hard to not lose hope. I have a few questions, in 6 days the U/S showed 1 day of development. But then in 3 days it showed a week of development. So in 9 days between U/S there was a week of development just in weird uneven spurts. Is this normal? Or a cause of concern.? I'm completely unsure if of how far in gestation i am, but the CRL as of today is 7 weeks 1 day. From everything i see ( of course obsessivley searching online) the low heart rate of 98 pretty much shows fetal death is inevitable. Does this hold true for most cases. I also wonder if the pregnancy does continue does a low heart rate increase the chance of fetal defects? I feel like with all these complications i am just doomed. I in some ways feel like my doctor is not straight foward with risks and complications. When i want to know the truth. I don't want false hope. She did say the heart beat concerned her but nothing like I've read. I think its worth noting i continue to have and have had throughout the pregnancy have period like cramps. And have had (sorry) thick yellow discharge today (no bleeding). A pap was done results will be in monday. Although i expect the results for infections to be negative for infection as i had a pap 3 months ago and have only been with my partner.
AnswerYour question is quite long and I had some problems understanding your concerns, but I will try to answer your questions in as accurate and forthright manner as I can.
1. The low heart rate is quite a concern for me. I am not sure if a low heart rate leads to miscarriage as I am yet to see something like that in my practice, but nevertheless this low heart rate is very concerning.
2. The sonogram is very operator dependent. Plus there are many factors which influence its results, foremost amongst them being the quality of images and the expertise of the operator. Therefore it is not impossible for wrong conclusions being drawn from a sonogram. I have infact come across a case where the sex of the baby was mentioned as girl and when I actually delivered the baby, it was a boy. So sonograms are not 100% accurate and I think you need to understand this fact.
3. It is quite normal for women to notice a yellowish white discharge during pregnancy. This is due to the increased blood flow to the uterus during pregnancy. Moreover I think you may be having some infection or inflammation of the cervix which should also be a cause for this discharge.
I understand your concerns, but why are you besotted with all the negative outcomes. Instead why not focus on the positives. Your HCG is rising appropriately and the foetal sac seems to be growing. I am not trying to belittle your concerns, but I strongly believe that focusing on negatives only leads to a negative outcome. Therefore stay positive and I hope things get sorted out. This is the best advice I can give to you. And anyways if this pregnancy is going to abort there is really not much anybody can do. So why add to the chances by stressing yourself out over the outcome, especially when you have no control it.
