Pelvic Ultrasound

Please explain this prelimanry report for me.

Clinical Indication:  Vaginal Bleeding.  Positive beta-hcg 16,609.  Last menstral period 10-6-08 correlating with 7 weeks 2 dates by dates.

Real time sonographic evaluation of the pelvis was performed in transverse and sagittal planes through the physiologically distended urinary bladder.  This was followed by endovaginial examination.  Color doppler was utilitzed.

The uterus id of normal appearance and size measuring 9cm X 6 \cm X 7cm.  Uterine contour is smooth.  The myomertrium appears grossly homogeneous without ultrasound eveidence for focal abnormality.  Within the endometrial canal, a gestational sac is measured at 1.3cm mean diameter correlating with 5 weeks 4 days by measurement.  No fetal pole or yolk sac is demonstrated.  here is no cul-de-sac fluid visualized.

Both ovaries are of normal appearance and size.  No eveidence for ovarian cyst nor adnexal mass.

Does this sound about right for 5 weeks and 4 days pregnant.  Is it abnormal not to see a sac and/or fetal pole?  I thought I was about 7 weks and they said that it shows 5 weeks and 4 days.  This this common amongst pregnant women?
I appreciate your help.

[Elaine Brown, MD]

Hi!
What they are seeing on your ultrasound is VERY common.  Unfortunately in most cases it means a blighted ovum.  This is a pregnancy in which a sac develops and everything else happens that normally would, except no fetus develops within the sac.  As far as I know, no one knows why this happens.  We do know that it is not the "fault" of the mother--she has probably done everything appropriately.

In your case, I would probably order another ultrasound in about one week.  There is always a small chance that the dates are off and you are earlier than calculated.  In that case, there is still a chance that a heartbeat will develop and the pregnancy will continue.

Unfortunately, the bleeding and the high number (16000) of your  beta-HCG are not good signs for this  pregnancy.

I wish you all the best!

Dr B