I understand your concern and will do the best I can to answer your question. I am so sorry. That is the worst news a parent can get. Right from the moment we find out we are expecting, we think about what the pregnancy and what the baby will be like and losing that is very painful. I am sorry. The baby s heartbeat is usually seen when the hCg is 20,000. The tiny gestational sac is seen at 3-6,000. If your hCg is over 40,000 and they don t see the heartbeat the pregnancy isn t healthy, the baby may have passed away very early on. It is nothing you did wrong and nothing your doctor could have done to avoid it: most pregnancies affected with a major birth defect (random and unlikely to ever happen to you again) end very soon. I am sorry. The placenta can keep growing after the baby has passed away - the hCg comes from the placenta and membranes and can continue to rise for several weeks The options I usually offer my patients are - wait 2-3 weeks for a natural miscarriage - plan a D&C immediately or after a week or 2 - use medications to trigger a miscarriage at home - another ultrasound in a few weeks to make sure There is no right answer or best plan: it is a painful, awful situation and I let people decide what is best for them. My heart goes out to you and I wish you the best