No fetal heartbeat detected w/ultrasound; 6-8 weeks pregnant. What now
March 4, 2013 2:07 PM   Subscribe

That's pretty much the situation. Depending on how the pregnancy date is calculated, my wife is 6-8 weeks pregnant. Otherwise, the midwife said the amniotic sac and embryo looked OK. We are going out of town for two weeks, so can't get a follow-up until then. Should be be worried? What should we expect?

If the fetus isn't viable, will my wife continue to show increasing signs of pregnancy over the next two weeks? Any precautions? Any advice?

We have been trying for a couple of years; we are in a good situation, because we have a healthy son (age 3, just about) but this is still causing a lot of worry and upset. Thank you so much.
posted by soulbarn to Health & Fitness (24 answers total) 2 users marked this as a favorite
I am so sorry for you and your wife, as I know firsthand how stressful this is. I am not a doctor, but in my first pregnancy, the fetal heartbeat was undetectable at first, then very slow. It was extremely difficult to just watch and wait. My son was born full-term and healthy. In my second pregnancy, the fetal heartbeat was also slow, and then slowed more until it stopped around 8 weeks. I had a D&C at 10 weeks. My third pregnancy was uneventful and the baby was born full-term and healthy.

It sounds cliched to say, but truly, the best thing I think your wife can do is try not to worry too much. (Impossible, I know.) Sadly, there's really not anything she can do to affect the outcome. I wish the best for your family and hope you get good news at your next appointment.
posted by justonegirl at 2:16 PM on March 4, 2013 [6 favorites]

What a hard situation. I'm so sorry. You say that you are going to be travelling, but I think it might put your mind and your wife's mind at ease if you could find a doctor to follow up with next week, especially in case your wife is going to miscarry and may need medical assistance.
posted by roomthreeseventeen at 2:18 PM on March 4, 2013

This exact same thing happened to me.....even at the same time frame.....We had a trip to the keys planned, no heartbeat at 7 weeks, and I was a wreck. Currently, that healthy little guy is chasing the dog downstairs.....Almost 6 years old. Try and relax.....sometimes they don't want to show their "goods" till they are good and ready. Congrats!!
posted by pearlybob at 2:19 PM on March 4, 2013 [1 favorite]

You really need to ask your doctor these questions. We can't possibly answer them for you here, and your doctor is going to want to give you these answers. Your doctor cannot give you the best care if you get your medical advice from the green. Doctor, not midwife. Doctor.
posted by Capri at 2:22 PM on March 4, 2013 [4 favorites]

This exact same thing happened to me at my 6 week appointment, my daughter turned 6 two weeks ago. I hope you experience a similar outcome.
posted by dadici at 2:24 PM on March 4, 2013

When you say "depending on how the pregnancy is calculated," how do you mean? Those two weeks are really important for calculating fetal heartbeat. If you mean that her cycles are irregular and her date of conception isn't known, then it's possible everything is fine -- a 6 week embryo (dated from LMP, or conception date +2 weeks, which is standard) might not show a visible heartrate; mine didn't. If you mean that the fetus is 6 weeks from date of conception and 8 weeks from last menstrual cycle, then yes, a heart rate probably should be showing by now, and this is not a great sign. Not a done deal by any stretch, but not great.

Assuming the latter case, it's really unclear how things will go. Even with a failing pregnancy, your wife could still continue to feel really pregnant for some time, possibly even weeks. Or, she could begin bleeding tonight.

I've had 4 six to eight week miscarriages, and in all cases, the physical experience was like a particularly awful period; severe cramps, heavy bleeding, but nothing that I couldn't handle at home. Since I am Rh- and my husband is Rh+, I got a Rhogam shot after every one to avoid Rh sensitization; this was probably not technically necessary, but the shot is cheap and safe and Rh sensitization sucks, so if you're similarly serodiscordant, you might need to make sure that happens. Otherwise, the primary impact of a miscarriage this early is emotional, and it SUCKS.

However, if the midwife said the embryo and sac looked OK, I might be doom-and-glooming for nothing. As terrifying and stressful as it is, the only thing you can do is wait. I'm so sorry; feel free to memail if you want to know more or even just to chat.
posted by KathrynT at 2:32 PM on March 4, 2013 [3 favorites]

Ask a doctor ask a doctor ask a doctor. That's what they exist for - to solve medical mysteries and head off possible medical problems.
posted by IAmBroom at 2:36 PM on March 4, 2013 [2 favorites]

IANAD. Not able to hear a heart beat at 6 weeks is somewhat common, at 8 weeks it could be a sign of possible miscarriage. I will assume that this is your first pregnancy so it seems like you should *do something*. There is nothing to be done. What will be, will be, so as much as possible try not to dwell on either outcome. In a couple weeks you will be able to go back and check again. You can also tell yourself that all this stress is because of the exam which is not conclusive. If you hadn't seen the doctor you would not be feeling this worry now so take a deep breath and hope for the best but know that going or not going on the trip or anything else you do will change the outcome.
posted by saradarlin at 3:21 PM on March 4, 2013 [2 favorites]

When I called to make my first appointment after I found out I was pregnant, they wouldn't schedule the first ultrasound before 9 weeks, precisely because the heartbeat sometimes can't be detected before 9 weeks (and why freak out people when you don't need to, right?) -- so don't worry yet. 6-8 weeks now is 8-10 weeks when you get back from your trip, so if I were you, I would schedule a follow-up for the week after you come back (when you will be in that 9-week window at the earliest estimation), and try to not worry about it until then.
posted by rabbitrabbit at 3:43 PM on March 4, 2013 [1 favorite]

2 pieces of advice (and although I am a doctor/not your doctor, this isn't medical stuff):

1. Try your best to distract yourself until you can get the follow up. The trip is a good thing because it is a distraction. I know it is so hard not to be tracking and worrying about every symptom (i.e. "I feel less nausea today than I did yesterday - does that mean miscarriage?!") - but you just can't live like that. Symptoms of pregnancy can normally wax and wane and more obsessing is not going to help, as many others have noted.

2. Do not, I repeat, do not repeatedly google things like "miscarriage 6 weeks" or "risk of miscarriage" or etc. etc. - again, doesn't change the outcome, will only freak you out. And if you can't help yourself - or your wife can't, just like I couldn't when I was in a similar position, just remember that no matter how much you think about miscarriage, thinking about it does not make it real. If googling about it and constantly thinking about it made it happen, I wouldn't have a baby girl right now. I am repeating because it sounds ridiculous, but I know that people beat themselves up thinking "it was a self fulfilling prophecy" - no. If it happens, it happens, but it isn't your fault. It's not because you didn't want it badly enough, it's not because she drank that cup of coffee or that glass of wine. I hope you don't need to remember that, but if you need to, I hope you will.

You can MeMail me if you want. I've been thru infertility and I know what it's like to have your heart hanging in the balance on that early ultrasound.
posted by treehorn+bunny at 3:52 PM on March 4, 2013 [8 favorites]

Just like rabbitrabbit my midwife doesn't do ultrasounds before 9 weeks because its just cruel to stress someone out about a lack of heartbeat when that is entirely normal.

I hope everything turns out alright, I suffered 2 miscarriages before my current healthy little girl. Please give your wife a hug from me.
posted by julie_of_the_jungle at 3:57 PM on March 4, 2013 [3 favorites]

#1 advice:
Do not use Google Doctor. I know this is really hard. Every time you have the urge or are typing it into your computer STOP STOP STOP. I know it's so hard to stay in the moment, be on your trip, with this sort of thing hanging over your guys' head. It's easy to fixate on things like pregnancy symptoms, like that maybe her nausea is getting better (which could just be totally normal and fabulous! but you might freak out like it's a sign that the pregnancy is being lost).

If your wife starts bleeding, cramping, whatever; remember that you can call your midwife or her office even when you're away on a trip! to ask for advice if things change, warning signs, anything. That's what she's there for, that's what her office is there for, you're an established patient now and she's your provider.

And when you get back, assuming nothing's happened, you need to get a real dating ultrasound from an ultrasonagrapher for your follow-up, a 2 week difference in dates really does change care in pregnancy, and is straightforwardly resolved (early ultrasound is the most accurate). unless as mentioned above, you're saying date by last menstrual period vs. date from conception?

I wouldn't get an ultrasound while you're on your trip; hold out for the two weeks and get one when you're back - the more time you give it, the more likely that you'll either find a heartbeat, or you'll have a better picture of what's happened.

be kind to your wife; be kind to yourself. your wife needs a lot of support in this time of uncertainty, but it's easy to neglect that you need to take care of yourself too.
posted by circle_b at 4:38 PM on March 4, 2013

This happened with the pregnancy I miscarried. My symptoms tapered off until I started bleeding, and then it was all over. There's not much you can do, which is frustrating. I hope your outcomeis different that mine was.
posted by christinetheslp at 6:14 PM on March 4, 2013 [1 favorite]

Given that the dating is not certain, I would sit tight and wait. With my son, we didn't have a heartbeat on ultrasound until 8 weeks. Sometimes, it's just too early to tell.

I know how hard that wait is, though. Peace be with you both.
posted by Leezie at 6:49 PM on March 4, 2013

I had a very similar situation with my first pregnancy. I went in for my first ultrasound at 7 weeks (dated from LMP) and there was no heartbeat. Unfortunately that pregnancy was not viable.

The doctor had me go back in two weeks for a follow-up ultrasound, which showed the embryo was beginning to break down. In those two weeks I had no symptoms, no bleeding or cramping, absolutely no changes at all. I waited almost two weeks after that before taking medication to induce a miscarriage, since my body wasn't doing it on its own.

I hope your experience is different from mine. My thoughts are with you and your wife.
posted by apricot at 7:47 PM on March 4, 2013

Can you get HCG blood testing done? If you get tested 2-3 times over a few days, and the numbers are slowly but steadily increasing, you are likely to have a viable pregnancy. If the numbers are declining, then you can prepare for a miscarriage. I had a heartbeat on my successful pregnancy at I think 9+ weeks, after early miscarriages with a range of symptoms and unclear ultrasounds, and the HCG testing was a big help reassurance before then. It's a small simple blood test and it was relatively easy for me to get at diffferent OBGYNs.

My practical advice is to bring along a bunch of heavy sanitary napkins and painkillers for cramps. An early miscarriage is often just like a very very heavy, fast and painful period, a few hours of bleeding with nothing truly visible.

I wish your family the best.
posted by viggorlijah at 10:50 PM on March 4, 2013

Just came to add another positive story, i.e., the doctor was actually quite surprised to detect my daughter's heartbeat (after a lot of searching/re-positioning the ultrasound device) when I was about 7 weeks pregnant. (Granted, technology has changed a lot in the past 23+ years, but he was using a vaginal/wand ultrasound and I was pretty thin/a few pounds underweight.)

Frankly, I'm glad that Dr. Google wasn't available to me at the time because the pregnancy was touch-and-go for several months. I imagine that you are already aware of the stats re early miscarriage and of course you need to know what symptoms indicate a medical issue/emergency. I hope that you are able to put these facts in the back of your mind rather than fretting over what might go wrong. I know—so much easier said than done. Fortunately, you have a 3 year old to distract you in the meantime.

Good luck to you and your family.
posted by she's not there at 12:30 AM on March 5, 2013

My wife is pregnant. she is 25 weeks.

Fro mwhat I remember your 6-8 weks pregnant is a HUGE span. Specially for fetal heartbeat if she is 6 weeks its very possible it just cant be detected yet.

You need to find out really what week she is . I would go to an actual doctor. A lot of sites state heart beat at 9 to 10 weeks maybe not even till 12 weeks.

Here in the US first I am pregnant doctors appointments are not till 12 weeks. So no heart beat is not bad yet since the baby shouldn't have a heart beat yet.
posted by majortom1981 at 4:34 AM on March 5, 2013

If your wife is not having any cramps or blood that's a good sign. Also don't count on morning sickness. My wife is having a boy and has not had any morning sickness.
posted by majortom1981 at 4:36 AM on March 5, 2013

As others have said, there's no reliable way to know anything definitively right now. I can chime in with further anecdata and tell you that this is the pattern that my wife's miscarriage followed last year, but that's not normative and the symptoms and outcomes vary so widely that you're going to drive yourself crazy if you try to track every little symptom.

That said, I would urge you in the strongest terms possible to postpone whatever plans you have that are going to take you out of town for the next two weeks, because if this does turn out to be a miscarriage, Dante did not invent a circle of hell deep enough to correspond to "miscarrying in a hotel room far from home."
posted by Mayor West at 5:41 AM on March 5, 2013

Well, it turned out that the lack of heartbeat was just that; the second ultrasound showed that the pregnancy wasn't viable, and my wife miscarried not long after. Sad, but we have a beautiful two-year-old boy, and we will continue to try.

Thanks to all for the advice and support.
posted by soulbarn at 12:13 PM on April 4, 2013

I'm so sorry. Early miscarriage is common, but it can still be devastating. Be kind to yourselves, and memail me if you want to talk to someone who's been there.
posted by KathrynT at 2:01 PM on April 4, 2013

I am so sorry for you and your wife and wish you the best.
posted by saradarlin at 11:31 PM on April 4, 2013

Very sorry soulbarn..... Thoughts and prayers to your family....
posted by pearlybob at 7:52 AM on April 9, 2013

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