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Ultrasound shows thickened endometrium but no gestational sac. What is the problem?

Sep 2012
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General & Family Physician
Practicing since : 2008
Answered : 1416 Questions
Doctor it is 6 weeks since my LMP. The ultrasound shows thickened endometrium but no gestational sac. I m getting little bleeding since last 2 days.. Kindly explain what might be my condition?
Posted Wed, 3 Apr 2013 in Pregnancy
Answered by Dr. Das Arindam 20 minutes later

Thank you for posting here.

Look, the ultrasound indicates presence of thickened endometrium which means possibility of secretory phase. That means an impending period.

Absence of any gestational sac indicates absence of any pregnancy at the time of doing ultrasound scan. If you had a positive pregnancy test result previously, then there is high chance of missed abortion. If you had a negative pregnancy test previously, then it is just a delayed period.

Now, you have to wait for few more days for starting of spontaneous period. After 7 days, if you do not have any period, then you have to consult with a gynecologist for prescribing progesterone pills. You will have your period within 7 days of stopping the progesterone.

If that method fails, then you have to undergo dilation and curettage. In that case, you have to be evaluated for presence of any hormonal abnormality.

So, right now, you have to wait. After that you have to consult with your gynecologist.

Hope this information suffices. Let me know if you have any more question.

Above answer was peer-reviewed by
Follow-up: Ultrasound shows thickened endometrium but no gestational sac. What is the problem? 33 minutes later
Thank you for your response.

Actually I had my periods on 2-feb-2013 and I went to the gynec today 17-feb-2013. They have taken blood test for hcg and report is yet to come. The home pregnancy kit should weak positive result. The doctor said there is no visible sac even in Fillopian tube. But very less bleeding with dark red discharge since last 2 days. Is it possible that sac is not yet developed or am I having a miscarriage. I do not have any cramps or pain in my stomach. If it is miscarriage then the bleeding should be heavy or light? Also the doctor has prescribed Susten 200 tablets for 15 days. What is the purpose of these tablets? Please advice as I m having lot of confusion and scared if there is any complication.
Answered by Dr. Das Arindam 19 minutes later

Thank you for writing back.

Look, i have previously told you that absence of sac means absence of pregnancy. It is nearly impossible to have a gestational sac after this day. Another problem is thickened endometrium. It indicates a secretory phase that means this type of thickened endometrium is seen around the days of period. In case of pregnancy, the endometrium should be in proliferative phase, where endometrium does not get a thickened appearance. This thickened endometrium practically exclude pregnancy.

As there is no sac in fallopian tube also, then the chance of having an ectopic pregnancy is also ecluded. You have to wait for the HCG report.

So, it is less likely a missed abortion. But, heavy bleeding does not always present in missed abortion. We have seen many cases with light bleeding.

Now, the susten contains progesterone supplements which prevents any impending abortion. In your case, i think this drug should be taken only after getting the level of bet HCG in blood. In case of low level of HCG, susten will not be of much effect.

But, in case of high HCG level, the susten may be considered with a very close observation by ultrasound scan regularly to prevent development of any ectopic pregnancy.

Hope you have your answers.

Above answer was peer-reviewed by
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