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Vaginal ultrasound showed flat gestational sac and missing heartbeat. Am I miscarrying?

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Practicing since : 1999
Answered : 1587 Questions
I had a vaginal ultrasound last week at 5.5weeks, and there was a small round gestational sac seen and my HCG and progesterone numbers were good. Yesterday during the ultrasound at 6 weeks 5 days, they said the gestational sac looked flat, and they could not detect a heartbeat nor could they see an embryo. Is this a likely miscarriage? I have not heard back about my current HCG lab numbers. The doctor did not seem optimistic. Any information would be so appreciated! Thanks!
Posted Sat, 3 Nov 2012 in Women's Health
Answered by Dr. Timothy Raichle 30 minutes later
Hello, I would be happy to help you with your question.

I am assuming that you were fairly certain about your last menstrual period, so in this regard, the dates and gestational ages at the times of the scans are assumed to be accurate in terms of my response.

At 5.5 weeks, it might still be too early to see a fetus with a heart beat. At this point, though, they should have been able to see a yolk sac. Depending on the ultrasound used, most high end ultrasounds would probably detect the flicker of a heart beat this early, though.

The unfortunate thing is that one week later, at 6.5 wks, they could not see a fetus with a heartbeat. This usually becomes apparent at 6.0 weeks, but it sounds like this was not seen. The other part that is unfortunate is that the sac itself seems to be collapsing. Taking these two facts together, I am sorry to say that this does sound like a miscarriage. I am terribly sorry, but this is my impression based on what you are saying.

The risk factors for miscarriage in your case incldue:
1. Your age
2. Hypothyroidism
3. PCOS and possible diabetes

Make sure that your thyroid numbers and treatment are uptodate and make sure that they have adequately screened you for diabetes. If you have a D&C, it might be possible to send the fetus for a karyotype to see if genetic causes related to abnormal chromosome number was a cause.

I hope this helps - please let me know if you have more questions!
Above answer was peer-reviewed by
Follow-up: Vaginal ultrasound showed flat gestational sac and missing heartbeat. Am I miscarrying? 22 minutes later
Thank you so much for your speedy response! I very much appreciate it. We have tried to get pregnant for so long (failed IUI's)that we were keeping our fingers crossed when this pregnancy occurred naturally without any assistance(ie.clomid). I am having a follow up vaginal ultrasound in a few days to confirm was was seen Monday and to see any potential changes and will get my hcg labs then too. My thyroid level is 1.56, and I am neither insulin resistant(took the glucose test and was normal) nor do I have diabetes. I weigh 125lbs and am 5'8". All the docs say I do not look like your average PCOS patient until they see my ovaries and again there is my 'advanced maternal age'. Anyway, thank you so much for answering my question. I totally trust my doctors, but it is always good to hear another opinion. Have a good night!
Thanks again, XXXXXXX
Answered by Dr. Timothy Raichle 3 minutes later
XXXXXXX I wish you the best of luck. Do not lose hope about the potential for a healthy pregnancy at some point. If you have more questions now or in the future, I am happy to answer them. Please start a question with "This is for Dr. Tim" and I will get back to you.
Above answer was peer-reviewed by
Follow-up: Vaginal ultrasound showed flat gestational sac and missing heartbeat. Am I miscarrying? 25 minutes later
Great! Again thank you for the information and how to address any questions with you in the future. I will see about the D&C and potential abnormal chromosome number testing on thursday. I had full genetic screening at CCRM last year and was told all was normal. We will keep our fingers crossed for the immediate future!
Thank you, XXXXXXX :}
Answered by Dr. Timothy Raichle 16 hours later
Thank you and good luck. If we are done and you are satisfied, I think that you can close the question.
Above answer was peer-reviewed by
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