Is the baby alive?

March 11, 2005 10:11 AM

A friend who is 8 weeks pregnant recently had an ultrasound. The computer said that she was only 6 weeks pregnant. She suspected that the baby might have died two weeks ago, which is why it has remained at a 6 week size. However, the levels of hormones in her blood continue to rise as if she were pregnant. Is more likely the the baby is just somehow undersized, or that the baby has died but the pregnancy has continued?
posted by stray to health (22 comments total)

Why isn't there a doctor involved in all this?

I don't mean to chide you or your friend, and IANAD, but this is something she _really_ needs to talk about with a doctor--especially if she got the ultrasound done in one of those "Get a picture of your unborn child!" outlets.

In any case, there's _no_ reason to take a machine's estimation seriously, at all, without having a medical professional interpret the actual data. The machine is, at best, taking the various measurements and projecting the likely age of the fetus, based on statistical norms--having a fetus that was either just smaller than normal, or a technician who didn't quite mark off the measurement points correctly could both probably introduce an error. _Especially_ at this early a stage.

Enough speculation, though--get your friend to a doctor. As _soon_ as possible. (For her peace of mind, if nothing else.)
posted by LairBob at 10:19 AM on March 11, 2005

Exactly.
posted by ThePinkSuperhero at 10:21 AM on March 11, 2005 [1 favorite]

The baby may just be small- the ultrasound can sometimes definitively answer the question if the fetus had died- even in very early ultrasounds, the technician can sometimes identify the flash of the heartbeat- I take it that was not the case with your friend?

If there's a blighted ovum or an incompetent attachment, the fetus stops growing but HCG levels continue to rise slightly. A natural miscarriage usually follows in the next few weeks if that's the case. Everybody's body is different, so the only thing to do now is to schedule another ultrasound and HCG level- time's pretty much the only thing that will tell whether it's just a small fetus or an incompetent pregnancy.
posted by headspace at 10:25 AM on March 11, 2005

Agreed. Even at 8 or 9 months, doctors can only estimate the birthweight of a baby to within 1 or 2 pounds. Thats a huge difference when you're talking a 7 pound baby. An embryo that is only 8 weeks old probably is only about an inch long, and weighs the equivalent of 3 raisins. Link.
posted by grateful at 10:26 AM on March 11, 2005

LairBob and ThePinkSuperhero- Yeah, I agree. But her doctors have been keeping her at arms length. As it stands, she's trying to get an appointment, and should be able to get in sometime next week but is understandbly anxious in the meantime. I'd never heard of those "see your kid" places, so I thought the fact that the ultrasound was done at a hospital would be implicit.

Headspace- There was no heartbeat. The technician seemed to feel that that wasn't uncommon in such a tiny fetus.
Thanks all!
posted by stray at 10:44 AM on March 11, 2005

stray - the tech is right, it isn't uncommon to not find a heartbeat in a six week fetus. If she is confident that her dates are right, there is a possibility that she is in the process of a miscarriage. If there's a chance her dates are off, she may just be earlier than she thought and should wait it out (as agonizing as that is). I don't feel it's necessary to reiterate that she needs to see a doctor.

Does she have any symptoms like heightened sense of smell, nausea? Have those symptoms decreased in the last two weeks?
posted by annathea at 10:53 AM on March 11, 2005

Sounds to me like she might want to seek out a second opinion with a doctor more sympathetic to the (understandable) anxieties of being pregnant. Is there a good women's clinic in your area?
posted by desuetude at 10:56 AM on March 11, 2005

Annathea- Yes, she is experiencing a fair amount of nausea from what she tells me. And she's pretty sure about her dates.

Desuetude- As far as I know, she's trying to get a second opinion from a local specialist in high risk pregnancies- I will suggest that she look for a women's clinic also, thanks.

She has a retroverted uterus, I don't know how much of an impact that could have.
posted by stray at 11:02 AM on March 11, 2005

I'm confused as why this thought even exits. Why? the embryo would still grow, anybody know for sure?
I'd be more concern that worrying about an known could cause more damage by putting her body under heavy stress.
posted by thomcatspike at 11:07 AM on March 11, 2005

Second opinion. Second opinion. Second opinion.

I had friends who were in the exact situation, and they had a doctor who basically informed the mother that she was going to have a miscarriage and wanted to schedule a DNC (read this link for similar story).

Well, they got a second opinion, and to make a long story short, they now have a 8 month old baby girl, where if they had listened to the first doctor, they would have nothing except sadness.
posted by jeremias at 11:10 AM on March 11, 2005

...an unknown could cause more damage by putting her body under heavy stress..

Maybe the answers provided will help her with the stress.
posted by thomcatspike at 11:11 AM on March 11, 2005

How are those ages being calculated? There are different ways to calculate age (like starting from date of conception vs. starting from date of last menstruation), so it's important to use the same baseline. Don't know if that's the issue here, but it's something to consider.
posted by GhostintheMachine at 11:31 AM on March 11, 2005

IANAW (...not a woman) but if such a thing happened to me, I would demand to see a doctor right away, no waiting till next week or whatever. If it came down to it an Urgent Care visit or ER visit, whatever it would take if she has real concerns about this. There is no way any of us can offer meaningful advice, other then, "well it might be alive or it might be dead, or perhaps somewhere inbetween". The sheer amount of fright she must be dealing with is staggering. See a physician by whatever means necessary.
posted by edgeways at 11:37 AM on March 11, 2005

I second the advice about double-checking to make sure everyone's referring to the same dates: 6 weeks' gestation counting from conception, a.k.a. "fertilization age," is equivalent to 8 weeks' gestation counting from the last menstrual period ("menstrual age"). So it's important to find out how your friend determined she is 8 weeks along and compare that to the computer's info.

Also, ultrasound can detect a heartbeat right around 6 weeks, but a few days too early and it won't! It seems to me that she should be calm, wait a day or two or three, and get another one.
posted by xo at 12:07 PM on March 11, 2005

Why was she getting an ultrasound so early to begin with? IANAD, of course, but it is sort of unusual to get one at this stage, I would think, unless they think the pregnancy might be ectopic, there's a history of pregnancy/infertility issues, unsure of fetal age, something like that. Usually a blood test is enough confirmation of the pregnancy for now. Is she worried because the doctor already told her there might be problems?

Even if she thinks she's sure of her dates, they could be off. I had a first-term ultrasound done with my current pregnancy and I thought I knew when I'd conceived (but I'd had a stick test say I wasn't pregnant when I should have been by the date I took it and wanted to definitely confirm fetal age, which is easiest to do early on). When the measurements came back a week and a half smaller than I'd thought, I did some pondering, research, and discussion with my midwives - and realized I'd must've had an extra-long cycle that month (breastfeeding can really alter your cycle). And recent research shows some women may ovulate much later in their cycle than they think - Day 21 instead of Day 14 - or even ovulate twice in a cycle. With this new information, the measurements were right on target with another possible date of conception.

Anyway, no, it's not always possible to see a fetal heartbeat that early, and if she's showing other signs of pregnancy, really she has to just wait and see. It could be the tech measured wrong, it could be her dates are off, it could be the baby is just small, it could be so many things; in the first term, it's premature to jump to any conclusion, rather precarious to assume anything. Anywhere from 20% to 50% of pregnancies end in miscarriage (yes, the statistics do vary that widely, just Google around), most in the first trimester, some before you even know you're pregnant, which is heartbreaking but normal since many miscarriages are prompted by abnormalities in the fetus. I know that is not pleasant to contemplate, but if there is a problem like that there's not going to be much she can do about it.

Please get her a second opinion before she freaks herself out any more. A midwifery practice may provide much more sympathetic and understanding assistance than her doctor. I don't see why a high-risk specialist would be necessary yet unless she's had a history of pregnancy or infertility problems already. Good luck.
posted by Melinika at 12:19 PM on March 11, 2005

A spontaneous abortion at that period of gestation isn't an emergency, and the medical advice she'll likely get is to let nature take its course....UNLESS she has severe pain or symptoms of infection.

You can perhaps help her try to relax. If she's aborting, there's not anything to be done to change that, and if she's not, she'll know soon. A midwife would counsel and support, but there really isn't much to be done. Letting a woman's body pass the conceptus is the desirable thing if the fetus is dead. D&C is invasive. Invasive is usually to be avoided unless there are symptoms of infection. This isn't ectopic, or the Ultrasound Tech would have noticed.

I'm speaking as a medical-type, and also as a woman who has experienced that fear and disappointment. I hope she appreciates what a good and caring friend she has in you.
posted by reflecked at 12:57 PM on March 11, 2005

To bring up a larger point, it's also very, very important to take into account that--assuming things go well here--this is only the _first_ real scare she's likely to encounter along the way. And that's just in the pregnancy, let alone the actual _birth_.

I say this just to stress that if she is actually overreacting, and translating a "Huh, the baby's a bit smaller than expected" into "Oh my god, I'm carrying a dead fetus!", then she's really, _really_ going to need your help--or someone's--in keeping a level head through all this. A weird ultrasound is just one of the things can come up in a pregnancy...there's spotting, and cramping, and indeterminate test results, and _so_ many other things that can, and probably will, come up.

And I don't mean "overreacting" like "being hysterical"--I mean "overreacting" like "taking one piece of data, and drawing a conclusion that's just not justified by that single point". If she's in a place, internally, where every inconclusive test means "Oh my god, it's got Down's syndrome!", and "Oh my god, it's got spina bifida!" then she's in a totally understandable place, but she's going to have a really rough time. If you can use this to help her got to a point where she realizes that pregnancy makes _everything_ scary, and she needs to get more information before she jumps to a conclusion, then you'll be doing her, and the baby, an enormous favor.

There's a very good chance, of course, that if it's an overreaction, it's really a response to something _else_, like a fear of becoming a mom, or something about her specific circumstances. I don't know want to play armchair psychiatrist, but you might have a perspective on any other things that are scaring her, and help her deal with those, too.

If there really is a problem with the fetus, of course, then this is all moot, and she'll really just need your support. But if it is a false alarm, she really needs to be braced for the fact that's probably just one of many.

Oh, and I'd emphatically second the idea of seeing a midwife or nurse/midwife. She is definitely not seeing the right doctor for her right now, and if she's going to need a lot of emotional hand-holding--which is OK--she needs to see someone much more empathetic. If you were in the NYC area, I'd gladly refer you the practice my wife went to, but I'm sure you can find one in your area.
posted by LairBob at 1:03 PM on March 11, 2005

Just a data point: In my (close, not personal) experience with miscarriage, the pregnancy symptoms (breast soreness, strong nausea in this case) abated completely. It was seen as a good sign, until it was clear that it wasn't.
posted by RikiTikiTavi at 1:38 PM on March 11, 2005

In my personal experience, when I had a fetus die in utero (at 11 weeks), my pregnancy symptoms dissapeared. On a happier note, in a subsequent pregnancy, I had an early ultrasound that showed no heartbeat and my doctor wasn't sure if it was a viable pregnancy. A later ultrasound showed that all was fine, and he's about to turn 1 year old. If your friend has the option to see another doctor, she should try. If they understand how much anxiety she is having over it, they should at least be able to squeeze her in for a quick ultrasound to check things out. If they know she is stressing about it and don't really care, they sound like a practice I wouldn't want to be going to. When I didn't know what was going on when I had my fetal death, my doctor's office got me in for a ultrasound within a few hours.
posted by Shoeburyness at 9:46 PM on March 11, 2005

What Shoeburyness said. This didn't happen to me but to a good friend a couple of months ago: she was in almost exactly the same situation as your friend, stray - small fetal size, strong hormonal levels and nausea - and she did in fact have a miscarriage a few days after the diagnosis. But the most important thing here is that she shouldn't have to play the waiting game. A good doctor or midwife should be attending her needs with the awareness that this is stressful to the mother and hence stressful to what may or may not be a healthy baby. My friend had to wait overnight for her results and that was bad enough.
posted by tracicle at 10:26 PM on March 11, 2005

Thanks all, there's a lot of helpful stuff in here, some very comforting, or at least informative personal stories too. Thanks, I will pass it along.
posted by stray at 11:12 PM on March 11, 2005

What xo said about fertilization age vs menstrual age, and what LairBob said about the mother, and trying not to panic so much all the armchair psychology things, times ten.

In short, two weeks difference in size on a fetus under 11 weeks could easily happen. Is she bleeding, cramping or having other abortion/dead fetus symptoms? No? Spontaneous abortion/dead fetus is not very likely then. Heartbeats are seldom found at this stage, I'm wondering why she had an ultrasound so early. Also, I'm wondering how she could have left the doctors office where I presume this ultrasound was done, and still feel so worried and full of questions. Doesn't sound like a very good doctor if s/he hasn't explained that everything is ok.... Second opinion sounds like a great idea.
posted by dabitch at 6:49 AM on March 12, 2005