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What are the ways to tell whether the pregnancy is a miscarriage or normal one?

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Practicing since : 2005
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I had a miscarriage a few years ago. I then went though 4 ivfs and 4 iui's before having a fibroid removed through hysteroscopy with another doctor (previous doctors said it didn't need to be removed) in October. We conceived naturally on our own in January on the 12th day of my 26 day cycle. At my first trans-vaginal ultrasound at 7 weeks 5 days, the fetal pole measured at 3.6 mm or 6 weeks. We were told I was going to miscarry and told to schelule a D&C. I chose to miscarry on my own as I did the first time. And come back for another ultrasound a week later for confirmation. At the 2nd ultrasound (9 weeks), it was difficult to see the sac and the embryo ( everything was moving around and I think their transvaginal machine is very old as the pictures are lower quality than at my previous OB). The Doctor, my husband and I all thought we saw a flicker in the fetal pole on screen in the midst of trying to get a steady and clearer image. But everything was kept moving and distorting. He had me empty my bladder but I think I've been very constipated from hormones. He bought in an ultrasound tech who was very quick and short. They managed to get a very blury sac/ fetal pole image (still a lot of movement). The fetal pole measured at 4.1 mm. So it grew. Based on the growth and the fact that doctor says he is not sure what he saw, he said he didn't want to give us false hope but he is not certain if we were watching movement from the fetus. He said he cant say I am miscarrying but the dates are concerning. I do not have cramps. I am not bleeding. My boobs are still sore. The week I thought I wasn't pregnant I was getting nausea for the first time, had my fist craving and had ultravivid dreams again. He did not want to do HCG as I suggested and wanted to just see the ultrasound. Is it possible if I see growth this week that it is possible to have a normal pregnancy if the heart is beating and the embryo is 3 weeks behind? We are certain of the dates ( My periods are like clockwork,I get mittlesmertz and my husband travels a lot for business) but that month even though my pregnancy tests showed a strong beta 9 dpo that quadrupled 2 days later and a very strong progesterone, I felt certain that i ovulated from my other ovary 4 days after my first ovulation (thus expected twins). Is it possible that I could have had a chemical pregnancy with the first released egg and that this "slow growing fetus" is actually normal for its age and not 2-3 weeks behind? Should I go get a second opinion with someone with a clearer and newer vaginal ultrasound? If so what do you ask for to ensure they have better machines? (I am 42) I am just trying to hold onto any hope.
Posted Tue, 25 Mar 2014 in Menstruation and Miscarriage
Answered by Dr. Rhea Chanda 15 minutes later
Brief Answer: get a better ultrasound Detailed Answer: Hi, Firstly, by 9 weeks plus, you should see a heart beat, fetal pole and sac, well-defined. Even with low quality imaging, heart beat should be seen and heard. I suggest that repeat the ultrasound with a high quality machine. Nowadays, better machines are widely available. The last menstrual date is important. We calculate the dates from the last menstrual date. Delayed conception does occur, which will show a lesser gestation, but its not common. If your dates are sure, then that is unlikely.Slow growing fetus at this early stage is not an option. Repeat the ultrasound. Just ask them if they have a latest machine with doppler.
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