Confused about gestation and location of pregnancy
Question: I am very grateful to Pregnancy Bliss for educating me on the state of
my pregnacy related complications. God bless you for the good job!! Just a little
reminder; i reported abdominal pains and brownish discharge two weeks ago. Pregnancy
Bliss advised i carry out a Beta HCG test which i did. The results indicated i was
4 to 5 weeks pregnant and there was a mass in my left ovary. The right ovary was
normal As explained in an earlier read literature, the fetus will be invisible at
this stage so the scan result indicated an empty uterus. My gynea put me on Primolut
and recommended bed rest, which improved my condition. I stopped spotting and when
i reported back to the gynea on the 5/04/2011, he recommended a repeat of Beta HCG
and abdominal scan scheduled for 15/04/2011.
Now on the 9th April 2011, i woke from
bed with severe pains in the region of the joint between my inner left thigh and
abdomen. It became so severe like menstrual crubs and started bleeding too; i called
my gynea who requested i report immediately at the hospital. A scan was carried out
immediately (and by my LMP (21/02/2011) I was 7 weeks pregnant). There was no gestational
sac. The gynea confirmed an ectopic pregnancy and gave me an antibiotic -Amoksiklav-
and asked that i report back on the 13th April 2011. On the eve of 9/04/2011, i miscarried.
I saw my baby. I was able to see its eyes and nose. It looked like a large tadpole.
My question for today is that with the above history, where exactly was the pregnancy
Secondly, now that the fetus has been aborted, are there any remains? I did
not discharge any thing like a sac with fluid and is there any such thing?
my gynea has recommended a D&C. He explained that due to the ectopic pregnancy, the
uterus will need "washing". My question is that once the scan showed that there was
no activity in the uterus, is there really the need for the D&C? Alternatively, can
the D&C be carried out at the region where the fetus was implanted? MP (Ghana)
Answer: I’m afraid the information does not quite add up. Please bear with me and
I will explain why. What is now beyond doubt is that you were indeed pregnant. What
is far from clear is what gestation you were and indeed where the pregnancy was located.
At 7 weeks, a pregnancy inside the uterus should always be seen using an ultrasound
scan. That is, unless the operator is not competent, the machine is of very poor
quality or the woman is extremely obese (or a combination of these). You said when
you miscarried you saw the baby. Your description is very convincing so I have no
reason to doubt you. However, that suggests the pregnancy was more advanced than
your dates suggest. You know, at 7 weeks, the fetus is really tiny, averaging about
9 -10 mm (that’s just a centimetre at most. You can imagine how tiny that is!) When
somebody describes what they have seen as “like a large tadpole”, it makes me think
this pregnancy was clearly much more advanced than the said 7 weeks. Just to give
you a full picture of the size of the fetus at various stages of the first trimester,
I am including a table of the average size by weeks up to 14 weeks (below). The abbreviation
CRL stands for Crown Rump Length, which is how the length of the fetus is measured.
Now to the other issues.
As I said before, I think what you have described is a classic spontaneous miscarriage,
unless there is ongoing active bleeding, there is absolutely no need to have a D&C.
Standard D&Cs after a miscarriage is a practice that was abandoned more than 30 years
ago. It serves no useful purpose and could do harm. The fact that you did not see
any gestational sac or fluid should not surprise you. You are really not expected
to see these in most cases of early pregnancy miscarriage. The membranes (of the
sac) will usually rupture in the miscarriage process and the little amount of fluid
there is at this stage will just mix with blood. Was this an ectopic? Most probably
not. The products of conception you saw were definitely coming from the womb cavity.
In other words, a normal pregnancy. There is a type of ectopic called ‘heterotopic’
whereby you, in effect, have twins; one in the womb and the other one outside (ectopic)
usually in the fallopian tube. This is rare, with an incidence of 1 in every 30,000
pregnancies. Unless you had this, yours could not have been an ectopic. As I said,
this is rare and in the absence of symptoms, it can be discounted. I am puzzled and,
frankly, disappointed by how your doctor proposed to manage what he/she thought was
an ectopic. Ectopic pregnancy is always an emergency and when strongly suspected,
the woman should be offered surgery immediately. Remember, an ectopic has to be removed
abdominally. It cannot be accessed vaginally. There is more information about ectopic
pregnancy here: I will summarise by saying that you most probably have had a complete
miscarriage of a normally located pregnancy of uncertain gestation. The fetal size
(CRL) table is below. Best wishes.
Scan does not show the pregnancy
Question: Is it possible for me to have a blind pregnancy even though the blood
test and pregnancy test are both positive but the ultrasound doesn't show any sign
of a baby or is it simply too early to be seen.What does it mean? Please help. L
Answer: There is no such thing as a ‘blind pregnancy’. An ultrasound scan should
show a pregnancy at 6 weeks gestation or above as long as it is located inside the
womb cavity. If you have a definite positive pregnancy test and your gestation is
over 6 weeks, the possibility of an ectopic pregnancy needs to be looked at and actively
investigated. If you are uncertain about the dates and there is a possibility that
the pregnancy is significantly less than 6 weeks, that may be the reason why nothing
is seen on a scan.