Help interpreting test results and next steps

[lilly00000]

My LMP period started around 8/12.  I am 41, 1st pregnancy.  I've had two dr appts, results below:
First u/s and blood test on 9/24.  The u/s showed a sac and yolk but no fetal pole.  HCG level  28,100.  2nd  u/s  on 10/6.  The u/s showed a sac, yolk and now “a group of cells which is the baby” (they did not use the term “fetal pole” and I’m not sure if it is the same thing or not).   But now there was no hb detected.   A midwife told me there was a “100% chance” my HCG levels would come back lower.  My HCG level came back at 48,100. At both appts baby termed “non viable”.  Dr today wanted to sched a D&C for 10/8. I asked him if we could do an  u/s next Th and D&C next Fri, he said ok but  sounds like he sees no hope.  If I put off the D&C to next fri will I recover as well from it (to try again) or have some complications? Who is eligible for a D&S vs D&C?  I have a stressful job, long hrs, in the back of my mind wondering if the stress could just have slowed the baby's development beyond the "norm"?   I have told my job I am ttc and given a viable pregnancy I can reduce my hours, but I need a confirmed preg. to do so.  Does stress, drinking, lack of sleep, flying or other lifestyle issues affect viability at this stage?
Lastly, the dr has not told me anything about the size, progesterone or anything else.  I'm not even really sure how far along I am – gestational  vs fetal age thing is confusing I never know what ppl are referring to. Thoughts on how far along I might actually be here would be helpful.
I live in a major metro area and am seeing the head of the dept, but the baby's daddy thinks the dr is busy and a D&C is just an easy call and lets him bill some OR hours... I dont want to be that cynical.  I also dont want to prolong the inevitable.  If a D&C appt is available before next Frid should I try to take it?  I have another stressful week coming next week.   Could more or less rest between now and next Thurs affect anything? Thanks

[craig2010]

i am distraught
I found out i had a miscarriage the 9th of August and found out I was pregnant the 6th of sept.
i had an hcg level of 51 on the 6th
my dr. monitored my levels and they were rising at a normal rate ..
i had an ultrasound the 22nd and ther was a sac no yolk
my levels continue to rise  and after my ultra sound the 9th october my dr. saw no yolk even though the sac has grown she wants to terminate the pregnancy we have no idea of conception because miscarriage but it was very early.
i refused dnc
i called another obgyn office the nurse told me i could by to early.. and seriously research done by me and my fiance uncovered that identicall twins grow in same sac with no yolk appearance till later..
am i just to hopefull
i just need help to either believe i did the right thing
i have morning sickness and tiredness.. sore breasts( they are geating bigger already)
i feel more pregnant this time then i did last time..
i have 2 beautiful daughters but this is my fiancees first we already lost one HELP PLESE
any and all help appreciated

[Kimbertini]

DON"T GIVE UP HOPE!  I am 42 and pregnant--9 weeks.  I had 6 losses--4 were spontaneous and 2 were D & Es.  I have a 2 yearold son in the middle.  First--everybody's body develops differently.  Second, many women have one ultrasound around 20 weeks--so who knows what happens these first stages of life (?)

Recommendation--have your progesterone checked.  I take prometrium and did for my son until week 16--helps the baby grow.  I also take a baby aspirin daily--shows that helps keep the blood flowing.  Ask your dr.

Also--for me--saw fetal sac at 5 weeks, 6 weeks saw yok sac.  7 weeks saw heartbeat but measuring smaller.  Didn't see a heartbeat last week.  Recommended D & C.  Also asked for another US.  I will be waiting it out.  I have hope.  There is power in prayer.  It is not over until it is over.  

My friend went in at 11 weeks--said baby was not viable.  However, her daughter just turned 2 in August!!!  She had a tipped uterus--harder to see things.  I did too.  Maybe you do.

Hang in there. I am too.  I know it is not easy.  But if you were meant to have this baby--you will.  Hugs.  Going through the same thing and both of us in our 40s too.  

[Elaine Brown, MD]

Hi!
If you were my patient, I would repeat one more ultrasound, as I always like to be absolutely certain that there is no mistake.  If one more ultrasound failed to show any further development, then I would offer three options:
1) let nature take its course--advantage--lower cost; disadvantage you go through a miscarriage and when it happens is very unpredictable.  Sometimes you still end up needing a d&c
2) a medication to speed up the "natural" process.  advantage, lower cost, no surgery necessary--disadvantage, you go through a miscarriage, timing is a little more predictable though, doesn't always work
3)d&c  advantage everything is over and done with so that you can move on.  More expensive, surgical risks involved.

The MOST likely reason for a pregnancy to stop developing is that there is something wrong with the pregnancy.  For example, the wrong number of chromosomes.  This is relatively common at any maternal age but increases fairly dramatically after age 35. Its possible but unlikely that lifestyle played a role.  A healthy pregnancy will continue to develop despite some pretty adverse circumstances. Also, babies develop at the same rate.  They are all almost exactly alike until about 20 weeks, so that is probably how your doctor knows that something is wrong.  I always do one more ultrasound as I mentioned above just to be on the safe side, but unfortunately, it usually confirms our suspicion that the baby is not developing normally.
I'm sorry that you are going through all this.
I hope things go better next time!
Good luck!
Dr B