Watching and Taking Precautions During Initial Weeks of Pregnancy
Q: Hello Doctor, I am pregnant. My LMP date was 5th August. I got my early pregnancy sonography done on 17th September. The report mentioned- “GS measures 0.87 cm corresponding to 4w6d.” Rest all was reported normal but was asked to repeat sonography after 10 days to check for fetal heart beat. I got it done on 26th September. This time the report mentioned- “GS measures 1.36 cm corresponding to 5w3d CRL measures 0.25 cm corresponding to 5w6d; FHB was 103 bpm”.
Please let me know if there is any cause of concern. Is this abnormal? I have had a miscarriage when the fetus did not grow beyond 6 weeks. Hence I am stressed if this is abnormal. The doctor has asked me to repeat sonography after a week. Thanks and hope to hear from you.
Reply:
Everything appears to be normal. Detection of fetal heart beat at this stage is promising. There is no visible cause of worry at this point.
Detecting Fetal Growth in Early Pregnancy
Let us discuss the journey of your baby till this stage. Your LMP was on 5th Aug. Sometime, 11-20 days after that, your egg may have got fertilized by a sperm. Fertilization occurs in the fallopian tube. There is nothing in the uterus at this stage.
Uterine wall start preparing for implantation of this egg. Ultrasound at this stage (1-2 weeks) is unable to provide any information.
As the fertilized egg travels through the tube to reach the uterus, it continuously divides to form a ball of cells. Any chromosomal anomaly which could have been a cause of abortion in early pregnancy occurs during this multiplication.
If there is no problem with the fetus, it gets implanted in the uterus.
A healthy pregnancy can be assured at this stage by two ways:
- Measurement of levels of two pregnancy hormones- Progesterone and HCG.
- Ultrasound uterus (done trans-vaginally preferably) shows thickened lining of uterus.
Gestational sac or the fetus inside it can still not be appreciated. The baby is of the size of an orange seed.
After 4th week, gestational sac can be seen. Fetus is usually seen in 5th week. Though these signs are not very suggestive of how the baby is performing.
The next important sign which clues to normal growth is fetal heart beat. We usually wait till 6th week to hear it.
Most of the cases of inevitable abortions occur in the 1st trimester (till 12 weeks) of pregnancy. After that, pregnancies are usually safe.
What to Monitor at This Stage?
It is good that your doctor is closely monitoring you. Repeat ultrasound is being done just to assure further that all this well. The gestational sac grows at the rate of 1mm per day till the end of pregnancy. Also, the fetal heart rate will slowly increase to 130-140 bpm.
In closely monitored pregnancies, the hormonal levels of the patient are also measured. Both progesterone and HCG needs to be measured. HCG increases in its level every 48 hours in early pregnancy.
Their optimum levels are essential for the maintenance of pregnancy. Any deficiency in their level is promptly compensated by giving external supplements.
Symptoms of Pregnancy
Another important and reliable clue of healthy pregnancy are the symptoms a women experiences during this phase. It is healthy to perceive a lot of smells, feel tired more often, nausea, vomiting or being emotionally more sensitive. All these symptoms tell us that the hormonal milieu of the body is alright.
We would advice you to take care of the following points:
- Take rest whenever required.
- Avoid lifting heavy weights or strenuous activities like climbing up a lot of stairs.
- Limit on your exercises.
- Take your antenatal vitamins regularly.
- Avoid taking any other medicine; if you have to take any, consult your doctor first.
- For a close monitoring of the development of pregnancy, get your hormonal levels checked regularly (HCG in particular).
- If required, weekly injections of HCG can be given throughout the first trimester.
When to Notify Your Doctor:
Contact your doctor Immediately if you feel any of these signs:
- Contractions in your uterus
- Any pelvic pain
- Spotting of any kind.
Take Care,
Buddy M.D.
I am currently over 19 weeks pregnant and have experienced vaginal bleeding and abdominal discomfort for 14 consecutive days. I have had 2 Ultrasounds performed, both finding the fetal development on target and heart beat normal. My placenta was found to be posterior, amniotic fluids with standard range. The only finding available was ‘internal debris, not at internal cervix os’. This is my second pregnancy, I have no previous issues and my first pregnancy was full term and delivered naturally. I was released from the ER with Vaginal Bleeding and told to be on pelvic rest 11 days ago. I still feel fetal movement. I have lightheaded spells when standing (my blood results show a slightly anemic level which is no surprise since they have drawn blood 3 times in one week). I have been to 3 OBs and none could find a cause for my bleeding. It is fairly regular, with stringy clots varying from bright red to dark brown in tsp amounts throughout the day. It seems to lessen if I lay down for several hours. My blood work came back normal other than lower RBC. Ovaries were measured at
Maternal Structures:
Cervix: Cervical length: 27 mm.
Right Ovary: visible.
Right Ovary size: 19 mm x 19 mm x 18 mm. Volume: 3.4 ml.
Left Ovary: visible.
Left Ovary size: 34 mm x 21 mm x 25 mm. Volume: 9.3 ml.
Any ideas of what could be causing the bleeding or if I should be alarmed? I do not have any sharp pains, just muscle discomfort.
The good news is that your baby is healthy, shows normal heart beats.
It is difficult to talk about the cause of vaginal bleeds. It may be a cervical bleed. Such bleeds are bright red, almost painless and occurs in second or third trimesters.
However, you need to take precautions. Take a lot of bed rest. Avoid bending or lifting any heavy object.
Do not jump or move with jerks. Also, it is important to monitor your pregnancy closely by repeated U/S.
If the bleed is from the cervix, as it appears to be, there is nothing to worry. Stay relaxed and take care!
I had 3 misscariages bcz of no featal heatbeat & cardial activity absent evey pregnancy. Plz tell me reasons & solutions
This indicates that the fetus doesn’t grow after a certain point. Did she and her husband go for genetic testing. Was genetic mapping of the dead fetus after abortion done?
I was told yesterday that my baby has a strong heartbeat but the gestational sac is small. Baby is 8 weeks and sac is measuring 6 weeks. Is there anything I can do to increase sac size?
A small gestational sac is not always a sign of worry. Since your baby is growing well, it’s alright. The growth of the sac would soon catch up.
Did your doctor check your progesterone (hormone) levels? That’s important. If they are low, a small sac may be due to it and this needs immediate correction to secure pregnancy.
One and a half year earlier i had a missed miscarriage there was only gestational sac n nothing else i had to abort it medically. Again i am pregnant and my 6 weeks tvs scan showed tiny gestational sac only thn after 15 days means on 8 weeks tvs scan showed yolk sac and fetal pole and sac measuring 21 mm my gynecologist told me to repeat scan after 15 days. I don’t want to lose my baby this time. Is there anything i can do to save my baby this time?
What reason did your doctor gave for your last abortion?
If it was any infection or hormonal problem, we can intervene. However, if it was a chromosomal anomaly, we can’t do anything. It would be sheer luck, whether the fetus wants to survive or not.
My doctor didn’t bother about it she just gave pills to abort n said the baby is not forming…this time my tvs is due in 4 days and i lost almost all my symptoms of pregnancy which is worrying me. Is this a symptom of missed miscarriage?
You’re likely to be fine. Stay relaxed. Let’s wait for the TVS report.
Today i had my tvs done and it showed only empty gestational sac Of 32 mm n nothing else. Where has the yolk sac and fetal pole gone which we saw in previous scan with decidual reaction well seen? Is this possible? I am just very much confused how can a fetal pole and yolk sac disappear?what should i do now?
This is likely to be due to chromosomal aberrations in the fetus. Sorry dear!
Above post is mine
But please tell what can I do so that next time it won’t happen.. my n my husband karyotype test is also normal so no genetic problem. Please guide me what should I do. I am very much stressed. My age is 33 n husbands age is 38. And after 35 for women n 40 for men it will be more difficult. Please guide what should I do.
It’s very difficult to comment till we know the cause of this miscarriage. Your doctor needs to investigate this.
Was it lack of maternal hormones or blood supply, was it a fetal cause, that is, chromosomal issues, was there a difficulty in implantation in the uterus due to any growth there?
You may read here about a similar case- https://buddymd.com/normal-pregnancy-after-miscarriage
Thank you doctor for your support
My doctor said it maybe due to chromosomal problems but she didn’t test or did any investigation about it.. i am now going through abortion process through mtp kit..she had done some of my tests almost 6 months earlier and they are torch test ,ana ,apa, amh/Mis, prolactin,lh,fsh,serum,estradiol tsh, karyotype All tsys were normal except…ama 11.68 and progesterone 0.15 so she supplemented me with progesterone tabs in this pregnancy and in torch test
Toxoplasma igg 8.93
Cytomegalovirus igg 11.34 she said it’s ok
Now please suggest which more tests do i need to confirm any problem…once again thanks for your replies
And my husband sperm count is 32 million with 20% brisk tail movement and 60 % immotile for which she prescribed medication for three months
Well, your doctor seems to be working well with the case. You need to follow up with her. If it’s a chromosomal problem, nothing much can be done. IVF babies are the next option.
It’s important to keep adequate hormonal levels next time. That’s the only intervention that’s possible. Stay relaxed when pregnant. This is difficult but quite necessary.
I am soooo thankful for your support ….one more question, is the ivf only way out and if yes will it be successful…i heard it’s very costly process…or is there anything else we can do… iread about clomid can we try with that?
You’re welcome. Clomid is unlikely to be useful in such cases.
IVF usually gives good results.
Hello, I’m 21; I have a healthy 4 year old! June 2017 I suffered a miscarraige due to low progesterone level, there was a gestational sac but no fetal pole. I’ve been ttc ever since. My last cycle I believe was 9/14/17, I took a hpt 10/12/17 it was positive with a faint line; today was my 1st doctor appointment I should be about 4weeks5days but I had a vag ultrasound but doctor couldn’t see a gestational sac & sent me to my 1st lab, I go back Thursday for my 2nd lab and hopefully will have good news by Friday; I just cries for hours, but then I took another hpt and this time my line was much darker than the 1st! That gave me some kind of hope; has anyone else experience this & been
successful? I really want this baby.
You may hear a good news by Friday.
You need to be careful about your progesterone levels this time. If required, additional progesterone injections may be needed to maintain pregnancy.
I went to doctor for checkup unfortunately doctor said there is not seen yolk sac and fetal growth I’m more than six pregnant I m worried about this please advise me what should I do
Was he able to hear fetal heart sounds?
I have pcos. I had two 5 day blactocytes transfered through ivf. The 4th week after the transfer day i went or my 1st tvs. D doctor said the gestational sac of one is small and the other isnt visible. And in fact the gestational age did not appear for the visible sac.The small gestational sac is measuring about 10mm. He said he was expecting like 18mm. Thankfully though a little heartbeat was detected. He placed me on daily progesterone for a week to then repeat the tvs afterward. Is there a chance my baby will survive? Can the injection help increase th sac size?.what of d second embryo. Is there a chance it can still come up?This is my second attempt?. I am so scared
Keep getting those injections and stay relaxed. They work well in most cases. Your sac is likely to grow is size.
The second embryo in unlikely to come up now.
I was 7wks3days n 3days pregnant when my body decided to spontaneously abort my baby. The issue was the yolk sac was “minimally irregular” meaning it was behind the growing rate of the embryo/fetus by one week. The baby measured exactly to date and a heart rate of 131 was found in the ultrasound. I would like to understand undeveloped yolk sacs better, if it was my fault and what should I do now to prepare from this happening in my next pregnancy.
Your doctor is the best person to investigate and let you know the cause of abortion. May be, your body was not making enough pregnancy hormones to maintain pregnancy. Or else, you had some infection in your pelvis.
It may also be a fetal cause, where the baby’s genetic makeup is not complete to survive longer.
I had my first ultrasound at 8 weeks according to my Lmp but it showed that i am only 6 weeks and 5 days. the doctor told me that i have a small gestational sac syndrome. the baby measure 6mm and the sac is 9 mm so the difference is only 3mm and there is no cardiac activity yet. i was told to repeat the scan again in one or two weeks. before i had my ultrasound i had a very small brownish spotting and after i just had that ultrasound i had frequent spotting and sometimes red spots coming out. my doctor prescribed me duphaston to drink 3x a day and 10 days of progesterone hygest to be inserted internal once before bed time until i go back for another ultrasound. i had a miscarriage 2 months before i got pregnant again because of blighted ovum due to chromosomes problem and now i am afraid that i will miscarry again.. what is my chance for my pregnancy to progress?
At my 9 week appointment the gestational sac was measuring small, 2 weeks later it was caught up and measuring fine. Now at my 16 week appointment it’s measuring behind again. I am already on progesterone. Why is it growing so irregular? Is there anything I can do?
You just need to continue taking the hormone.
Commonest reason why this happens is when your body is not able to produce enough hormones required for pregnancy.