QuestionQUESTION: Hello Brenda,
I have had some conflicting information that I was hoping you could clarify for me. I am early in my pregnancy, and had an ultrasound done due to spotting. I had an ultrasound done 13 days after intercourse( 3wks 6 days), and there was nothing on the ultrasound. I had some information given to me that at this time I should have been able to see a gestational sac measuring 3-6mm. I was wondering your opinion about this. Of course i am freaking out even more now since they did not see anything. From everything I have read, a 3-6mm gestational sac correpsonds to a 4 1/2 to 5 week pregnancy. Also, I have read that gestational sacs correlate to HCG levels. At 13 DPO I have never seen HCGs higher than like 500, which at that time I wouldn't think a geatational sac would be visible. I am very confused, and stressed out. Your advice is greatly appreciated.
ANSWER: Dear Ashley,
The size of the gestational sac is typically approximately 5mm at 4-5 weeks from LMP. That is 0.5cm. Now - at approximately 3 weeks, 6 days, the size would be less and may very well not be visible yet. This would not be anything I would panic about yet.
Now, in relation to hCG levels, the data is this -
visualization of gestational sac can typically take place under these circumstances:
- via transabdominal ultrasound: hCG level > 1800mIU/ml
- transvaginal ultrasound:
hCG level < 500 mIU/ml - 20% visualized
hCG level 500-1000 mIU/ml - 80% visualized
hCG level > 1000 mIU/ml - 100% visualized
Also, the statistics are that, relative to menstrual age, the average time the gestational sac can usually be visualized via TA ultrasound is 5.5 weeks (10-12mm) and is pretty routinely seen about 5-5.5 week via TV ultrasound.
Your hCG level is not anything to panic about yet either. The normal range for hCG is very broad. At 3 weeks gestational age, the normal hCG level would be 5-50 mIU/ml. At 4 weeks, it is 5-426 mIU/ml; 5 weeks is 18-7,340 mIU/ml. The more important factor to indicate if the pregnancy is progressing normally is whether the hCG level is doubling every 48-72 hours.
Spotting is also not necessarily a sign that anything "bad" is going on. Vaginal bleeding can occur frequently in the first trimester of pregnancy and may not be a sign of problems. Bleeding can be a sign of miscarriage but does not mean that miscarriage is imminent. Studies show that anywhere from 20-30% of women experience some degree of bleeding in early pregnancy. Approximately half of pregnant women who bleed do NOT have miscarriages.
Unless you begin to experience cramping (like strong menstrual cramps) and/or clots or tissue passing with heavier bleeding, I would not be overly concerned.
Please be aware that you should never wear a tampon or introduce anything else into the vaginal area such as douche or sexual intercourse if you are currently experiencing bleeding. It is also useful to wear a pad or pantiliner so that you can accurately judge the amount of spotting/bleeding.
I suspect your doctor will do another ultrasound at approximately 5-6 weeks gestation which will be much more informative. I hope this has helped you and answered your questions. I wish you well.
Brenda
---------- FOLLOW-UP ----------
QUESTION: Thanks Brenda, you have put my mind at ease. When I go in for my 5.0 week ultrasound, what should I expect to see ( how big of a gestational sac, yolk sac, etc...)
AnswerDear Ashley,
There are norms which we expect to see, but keep in mind that if gestational age is questioned at all, results can vary by only a few days. Typically, the gestational sac can be visualized as early as 4.5 weeks of gestation and the yolk sac at about 5 weeks. The size of the gestational sac at 5 weeks is usually approximately 7-10mm. The embryo can usually be observed and measured by about 5.5 weeks. A visible heartbeat can often be seen and detected by ultrasound at about 6 weeks and is usually clearly detectable by 7 weeks.
Hope that helps. Be well!
Brenda
