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8 weeks, 4mm fetal pole, told to have a D&C

(99 Posts)
enni Fri 26-Nov-10 12:17:26

Hi,

I am pregnant (I hope) with our first pregnancy. 4 weeks ago, I went for our first scan. At this time I thought I was about 9-10 weeks (based conception - my husband travels alot so I thought I knew the conception date), however as my cycle is irregular it could have been alot earlier or later. The sonographer was very good, and took quiet a bit of time. She could only see the gestational sac, but no fetus or yolk sac on the abdominal scan so did an internal scan. Here she found a yolk sac and fetal pole around 3 mm and estimated that I was 5/12 - 6 weeks. Doing some fast mental arithmetic I thought this was not possible, based purely on when we got a positive pregnancy test (exactly 5 weeks prior). She also couldn't find a heart-beat but was not too concerned about this. She did however refer me to the Early Pregnancy Unit for another scan a week later.

I then did some proper calculations with my calender at home, and spoke to my sisters who all confirmed they ovulate late in their cycles and tend to have very high pregnancy hormones (often the doctors suspecting twins when there is only 1). So I was quiet relieved - 5 1/2 weeks was very possible and everything else (gestational sac, yolk size etc) all aligned with the obstetric information I found on the internet.

When I returned the following week for a second scan, I was seen by a different sonographer on a different machine and my experiences could not have been any different. This time she spent less than 2 seconds on the abdominal scan before declaring "I can find anything but an empty sac, this does not look good, I think you have miscarried." I am not kidding about the 2 seconds either, it was 2 very fast swipes of the wand over my tummy, so fast my husband didn't think she'd looked at all.

She then offered to do the internal scan if I wanted it, but she doubted it would show anything. Naturally I said yes and we had the internal scan. This time however, she did the scan while I was in the same position as I had been for the abdominal scan. In the first scan when we moved to do the internal scan she asked me to lie back on a large foam pad. This placed my body in a very different position to the one I was in now. The sonographer was very surprised to find (and expressed her surprise) a yolk sac and fetal pole, the fetal pole now being 6mm. She confirmed the diagnosis of miscarriage on the basis that the fetus should have doubled in size and not grown by only 3 mm. She tried to find a heartbeat, but could not do so. However contrary to the fist sonographer declared that by now a heartbeat would definitely be present and therefore the pregnancy was not viable.

We were then shown in to see the midwife who strongly counselled us to have a surgical misscarriage as the pain of a natural misscarriage would be too much. I was also told they would not allow me to wait more than 2 more weeks to misscarry due to the risk of infection. They were referring to the fetus in the past tense and definite this was a misscarriage. I was in tears at this point and my husband really panicked and upset - he had wanted this baby so incredibly much and is horrified at the thought of me in pain (yet some how is happy for me to give birth without pain killers - that one I can't work out!!! Bless him )

All that said, I went home, determined to let nature take it's course. I also read up on the early days of pregnancy and may obstetric texts indicate the fetus grows 1mm a day after 6 weeks. If I had been 5 1/2 weeks with a 3 mm fetus, then it would only have grown 1mm a day for 1/2 a week between scans. Additionally, the sizes all matched up with several tables in several textbooks on the size of the fetus at different times. The gestational sac and yolk sac were all normal. No heartbeat but from what I read this was also normal. So, after a day I decided that they were wrong, I still felt very very very pregnant and so waited 2 weeks for our next follow up scan.

This week we had that scan. Now, according to the first scan I would be 8 1/2 - 9 weeks. And so far, no abdominal scan has shown anything. From what i read, this isn't unusual particuarly if you are overweight (I am BMI of 33) and if you have a retroverted uterus - a common occurance but one I do not know if I have. I also read that in the early days many things can interfer with a good image - air in the bowels, the fetus at the wrong angle to the ultrasound waves, the skill of the sonographer and so on.

I go in for the scan and have the same sonographer as I had at the second scan. This time she did spend more time on the abdominal scan. Around 3 minutes. Found a sac size of 30mm (this lines up with a pregnancy of 9 weeks) a yolk sac of 6 mm (also good) and a 4 mm fetus. On this fact alone she declared the pregnancy failed and the fetus dead. I told her that previously nothing had been seen on the abdominal scan so could we do an internal one. She refused saying it would not show anything and was too invasive. I told her (the truth) that I have had several internal scans, 2 with this pregnancy and at least 4 or 5 during fertility investigations and that I would be happy to do one, begged her for one but she refused. Surely if the baby had died, it's not going to shrink - i've had no bleeding, no cramps so where did the fetus go? Surely if they found nothing on previous abdominal scans only to find a 6mm pole on the internal scan, then 4mm on the abdominal scan could realistically be larger on an internal scan?????

The report that was written up confirmed a failed pregnancy, stated no heart beat was found. Only she hadn't looked for a heartbeat. I know this because they switch the machine into a different mode and various colours appear on the screen etc. This was definitely not done. When I mentioned this discrepency to the midwife she didn't believe me.

So, contrary to medical advice and pressure, and much to my dear husbands worry and concern, I have come home to let nature take its course. I am convinced that I am still preganant and the the sonographer was rubbish at her job. I am also concerned that her findings were not confirmed by another sonographer nor will did they grant my request for a different sonographer. They have not tested my hormone levels and didn't bother with the normal booking bloods as they didn't see the point if as this was a failed pregnancy.

So, one day I am convinced they are wrong, determined to wait as long as i have to to either have a healthy baby or misscarry naturally. The next day I think I am going mad. I don't want to go back for the next scan in 2 weeks as they have indicated that I will "have" to have a surgical or medical misscarriage at that stage if nothing has happened. I know that I am well within my rights to refuse but the pressure is extreme and unfair. Particularly when they refuse a second opinion. So I decided to self refer to another hospital, knowing it will take several weeks for the paperwork to go through and to get my first antenatal check and scan with the new hosptial. Hopefully by then I will be past 12 weeks and everything will be fine.

Am I making the right decision? I know you only have my side of the storey here, I have tried to be as objective as I can. My gut tells me I am pregnant, but sometimes I wonder if i am in denial and being delusional. I don't want to be stressed for the sake of the baby so thought it might help to get my thoughts out here.

shongololo Fri 26-Nov-10 12:27:12

could you go private for a scan?

enni Fri 26-Nov-10 12:35:18

I have considered it. I tried to find a private scan near where we live and couldn't, and it's a couple of hours (& expensive train fares!) into London - hence why I thought about registering with another hopsital. You are right though it might be worth the trek into the city.

GlitteryBalls Fri 26-Nov-10 12:39:37

Sorry to hear you are going through all this, and that the situation is so ambiguous. I don't really know what advice to give, but I hope things turn out well for you. Do you think there is anyone you can speak to about this and explain your entire situation - as you have outlined here? Perhaps your GP? They are objective to a degree as they are not directly involved with your antenatal care, but they could also make referrals etc. Also, if you went on the basis that you are also maybe a bit stressed by the whole thing, they may be more prepared to be more thorough/offer a second opinion for your own peace of mind. This then therefore allows it to be the GPs "business" i.e. it is concerning your own mental health. I don't think you are mad though, anyone would be reluctant to end a pregnancy that they wanted if they were not 100% sure it wasn't viable, and obviously not enough has been done to reassure you of this.

pinkpeony Fri 26-Nov-10 12:39:54

I would also recommend having another scan privately for a second opinion.
My 1st pregnancy ended with a missed mc at 8 weeks. I opted for an ERPC - didn't want to wait to miscarry naturally - as wanted to get "closure", and also didn't want the risks of a natural mc - you can bleed for days, have heard it's very painful, bigger risk of infection, and risk that you have some retained pregnancy tissue in the end and have to have an ERPC anyway. Also I was travelling for work a lot at the time, didn't want to risk starting to bleed heavily in the office or while in a different country. Because I had the ERPC, the hospital could analyse the fetus and found that it had chromosomal abnormalities, and would never have been viable. That was also helpful in getting closure, understanding why I had the mmc, and comfortable that I didn't make the wrong decision, and knowing that the risk of recurring MCs for me was low. Sorry about everything you are going through, and hope it all gets resolved for the best.

wilkos Fri 26-Nov-10 12:41:41

put your mind at rest and pay for a private scan

why quibble about an expensive train fare when this is so important to you and your husband hmm

enni Fri 26-Nov-10 12:54:47

Thanks Wilkos, the train fare was a bit of an aside (attempt at dry humor and dig at recent fare increases) it's more the logistics at getting there with my husband which is why I thought the second hospital option might be better. But I will talk to DH tonight and see what he thinks again.

Pinkpeony - the reading I have been doing indicates a higher risk with the ERPC and infection that with a natural miscarriage - also research seems to indicate that complications that can arise with an ERPC can prevent you falling pregnant again. When I spoke to the hospital they said that even if I did have an ERPC that they wouldn't test the fetus so I won't know the reasons anyway which won't help with closure. I am glad they analysed it for you.

Glitteryballs - I hadn't thought about the GP I think i'll give her a try. She is a mum herself and has always been very good.

insertexpletive Fri 26-Nov-10 13:16:54

What a nightmare situation. sad
I would be surprised if you had to travel two hours into London for a private scan - they are pretty widely available now, so worth contacting a private health organisation like Bupa for advice.

I know that this sounds mad, but have you done another pregnancy test recently? I had miscarried three times before I had dd and the last time, at about 8 weeks pregnant I went to the hospital with bleeding, and they did a test which was negative. They said with early pregnancy losses the HCG levels disappear very quickley. I am not sure how true this is, but I know that once I was pregnant with dd I did about 20 tests over the first twelve weeks; just to try and reassure myslf all was well.

FWIW, I too don't think that I could go ahead with an ERPC without being really sure that they were right - I wish you all the very best, I really do.

GlitteryBalls Fri 26-Nov-10 13:17:08

If anything, the GP may (or may not depending on how knowledgable they are on obstetrics) be able to at least explain better some of the results obtained from the scans, and how likely/unlikely it is from these that the pg is viable. Discuss with her everything you've read too and where you read it. And if she is a mum herself, she might understand why you need to know beyond all reasonable doubt before you go ahead with d&c.

pinkpeony Fri 26-Nov-10 13:27:27

Enni - hopefully everything will be fine for you and your pregnancy. But if it is indeed a mc, decisions of going for ERPC vs natural mc are very personal based on what each woman feels is right for her at the time - there are a lot of threads on here from women who have been through both or either and can give you both sides. Am not sure where you have been reading info (as I had the opposite info, that ERPC safer), but it is also good to get an opinion from your doctors (if you trust them!) for your specific situation. And either way can lead to complications, even though for most women it will be safe and fine. But your hospital can definitely not make you have an ERPC if you don't want one, and you should not feel under pressure.
I am now 31 wks pg with DC2 so ERPC definitely did not affect my fertility.

BayeauxT Fri 26-Nov-10 14:13:23

Hi Enni, I've had two mmc (and two ERPCS) - currently 18 weeks pg and all going well. I just wanted to say it is possible for the fetus to shrink - it sounds gross, but it can be reabsorbed into the body, leaving just the sac (which happened with me). I think the pg hormones can lead to the sac continuing to grow and measure correct for dates. On the other hand, when I was going through it I read stories online of people who waited it out and had good news at the end of it all. Whatever happens, try not to let them pressurise you. You can try for a natural mc, but be warned it can take a long time to happen. I tried waiting for my second MMC to happen, but after 3 weeks of nothing happening (11 weeks by dates) I opted for the ERPC. Sorry you are going through this - it's a horrible experience!

MedicalEd Fri 26-Nov-10 14:16:52

What a horrible situation.
I'd have a private scan as soon as possible.
If you are having trouble finding somewhere local PN me (can you do that on this forum?)and I'll help you.

electra Fri 26-Nov-10 14:21:05

Enni, I would not have a D&C yet - nobody could see anything when I had scans until I was about 10 weeks. I have a retroverted uterus so I'm hard to scan effectively. All women are different and how quickly the baby grows is certainly not an exact science.

I was scanned early for two of my three children and was told in both cases that I had probably miscarried. But I decided to just leave everything as it was and at 12 weeks the babies and heartbeat were both clearly visible.

There is a thread in the archives on MN where a poster was told her baby had died at an early NHS scan, and then had a private scan a few days later and the sonographer found a heartbeat.

electra Fri 26-Nov-10 14:22:29

My friend had just had a mmc but that was at her 12 week scan. I don't think any action should be taken until 12 weeks, personally.

Debs3693 Fri 26-Nov-10 14:38:58

Hi there i am sorry to hear about your experience. i agree with others, try and get hold of your GP. There is one other option - PALS. Most if not all hospitals should have a patient liaison service so if you are concerned or have any issues they can kind of act on your behalf. It might be worth speaking to someone there and see if they can help you get the 2nd opinion (which i think you are quite rightly asking for).

Wishing you lots of luck, Debs x

grumblinalong Fri 26-Nov-10 15:28:22

I was hospitalised at 8 weeks with hyperemesis and given a scan to check it wasn't ectopic as I was vomiting violently. At this internal scan they found two fetal poles and two yolk sacs but only one heartbeat. One fetus measured right on 8 weeks (the one with the heartbeat), the other had a fetal pole and yolk sac measuring 5-6 weeks but the sonographer couldn't find a heartbeat and my scan report stated it was a failed twin.

I'm having my dating scan at 12 weeks (I'm 10+1 now) where they will check to see if the remaining twin still has a heartbeat and is growing. Therefore if they are happy to leave me until 12 weeks to see if the pregnancy is viable surely you could argue that you too are in a position to wait until 12 weeks? Is a retrovated uterus where the womb is tilted towards the spine? If so, this is how my womb is positioned.

Hope you find out for certain anyway as at least you will feel you have been as informed as you can be.

Owlingate Fri 26-Nov-10 16:15:33

Enni do they have womens health counsellors at your hospital. They have previously acted as a liason / translator (!) for me with EPU / antenatal.

Have had lots of internal and external scans myself. I have to say they haven't had to do anything different to the screen to see the heartbeat, in fact at one 9 week scan I could see the little dot flashing myself. Also as I'm sure you are aware 4mm is really really small for 9 weeks, have just checked one of mine and it was 20mm by then.

Having said all this...I totally know what its like not to trust the professional dealing with you (I had one that swore she had found my baby's heartbeat and I knew damn well it was mine...it was going that fast cos I was so scared). I think another scan should be a priority for your mind. Doesn't Guys have a walk in (NHS) EPU? And your local hosp will often have cheaper private scans than a private hosp (eg 90 instead of 150). What area are you in?

bumperella Fri 26-Nov-10 16:45:01

I really feel for you. It's a horrible situation anyhow, but when you don't really trust the sonographer it must only be making it so much worse.
Obviously I've no idea if your judgement is being clouded by how much you want this child (I know mine would be) or not: I don't mean that to sound bitchy, but I know that in your shoes I would be all over the place and incapable of being remotely objective: you sound much more "together" than I would be.
A private scan may well be the least stressful option for you, even taking into account logistical problems physically getting there. Alternatively, maybe ask the GP to explain what could have happened / refer for second opinion/ recommend a private place to go get scanned.

enni Fri 26-Nov-10 16:55:41

Hi,
Thanks for the loads of responses, its been really reassuring.

To answer some of the comments:

* I am not an expert at reading ultrasounds, but I do know that every machine is different and the way the machine operates and displays information is different. The last 2 scans were on the same machine with the same operator. On the first one she clearly switched over to a different screen, that not only showed colours but displayed more information underneath the image and then with a few key strokes switched back. She then didn this again to show me what was happening. She even told me she was switching to a different mode to see the heartbeat. On the second scan she didn't do this. So, while I am sure there are machines out there that are different, maybe don't need to be switched into a different mode, I do know she did on this machine and that one screen showed colours and one didn't.

* In terms of the size I agree that 4mm for 9 weeks is small, but given that the previous scans showed nothing on the abdominal scan, that's actually an improvement. The 6mm fetal pole had been seen previously on the internal scan. I have read of many people who they didn't see any fetal pole until 10-12 weeks, so I don't know how they can say it so definitely is a failed pregnancy

* I am aware that I am an entitled to choose how to deal with this (wait or ERPC etc) what upsets me so much is the incredible pressure the hospital are applying

* Yes, you are all right, and ERPC decision is going to be a personal one and every situation is going to be different, encouraging though that some of you have gone on to have healthy babies. I just know that I have to be 100% certain before taking any action.

* PALS in our area are useless. I was once the chair of a patient liasion group and we dealt with PALS often. I do know they are very good in other counties and trusts, just not ours... its a postcode lottery with these things.

I have made an appointment for next Friday to see the GP (earliest available double appointment) and will ask her about private scans as she is likely to know this as well. I am then planning to go out tommorow to buy a pregnancy test - thats a good idea, many thanks.

I really just wonder if I am being delusional in not believing the sonographer, but today I decided it doesn't matter if I am, even if I did believe her then I wouuld probably best to wait till 12-13 weeks anyway given the number of people who see nothing or very little on their scans before this date.

jellyhead188 Fri 26-Nov-10 17:04:16

I personally would go back to your GP and ask for a 48 hour HGC blood test - that way you will know quickly whats going on - if your hormones are doubling then you are still pregnant if they are reducing then you're not. That way you can go back to the EPU armed with this info for another scan!

I had a mmc - I bled at 7 weeks, had a scan which only found a sac and measured 4+5, then had a scan 10 days later (longest tens day of my life!) to find nothing had changed. I opted for an ERPC because I had been bleeding for 2 weeks at that point and needed closure. However, I would not opt for an ERPC at the stage your at without being completely sure I was not still pregnant.

Hope you get some answers soon waiting is unbearable.

LadyBiscuit Fri 26-Nov-10 17:23:48

I really feel for you - I had a very similar experience and decided not to have the ERPC and to see what happened. I did miscarry after a couple of weeks and it was complete. That was the best option for me personally as I was really not convinced that my foetus actually had died.

What's very hard if you have had a missed miscarriage is that your body can carry on thinking it's pregnant - they told me that if I'd taken a test, it would still have been positive.

I suspect it probably isn't good news for you but please don't think that it means you won't go on to have another successful pregnancy - most women who have a miscarriage, whether natural or managed, go on to have a perfectly normal pregnancy after that.

It would be worth having another scan - you can get them loads of places so fairly sure you wouldn't need to travel to London. But you will probably have to wait until next week now. I know how dreadful the waiting is, it's agonising

DuelingFanio Fri 26-Nov-10 17:34:41

I second the suggestion to have your HCG tested. I had a missed miscarriage and was sent for a second scan too. It was very thorough. You've had 3 scans now and no heartbeat? It doesn't look good unfortunately but I do know how heartbreaking it can be.

Hope that you get some answers.

Janus Fri 26-Nov-10 17:37:09

Enni, I had a missed miscarriage at 12 weeks and they believed the baby had died at 8 weeks so that was 4 weeks of my body carrying the baby. I decided to have an ERPC as I didn't want to carry it any longer, it was something that just felt incredibly sad to me to have still inside. I don't know how long I would have then gone on carrying it else, Just wanted you to know, just incase, as it may take several weeks for your body to react as it should. I do distinctly remember that I too felt 'what if they've got this wrong', it was such a strong emotion that I asked if they could do another scan on the morning I went in for the ERPC, they refused. I do think some NHS staff are so insensitive, if it had just given me the peace of mind I think they should have done it but I guess it's all down to cost now?
BTW, I am now on 5th pregnancy! The mmc was my 3rd pregnancy and I then went on to have a dd3 and now pregnant again. I did choose to pay for an early scan as slightly nervous, I just googled something like 'private early pregnancy scan' and got 3 options within 25 miles of me, I saw a locum GP and he didn't really know where private scans were so it may be worth doing the work yourself?

banana87 Fri 26-Nov-10 21:25:59

Enni,

First of all, I am sorry you are going through this.

Second, please do NOT rely on a HPT to tell you whether or not you have miscarried. I am 6 weeks post miscarriage and had a positive pregnancy test from residual hormones the other night....hormones stay there for a long long time (usually 4 weeks AFTER ERPC or natural m/c)....so the result will be inaccurate.

I have to also say I agree with the sonographer No heartbeat and a fetus that has gone from 6mm to 4mm is not a good sign No heartbeat at that size is another inevitable sign that you have had a missed miscarriage.

Perhaps go along for a private scan on Monday and then decide what you want to do. I think seeing a GP is a waste of time, they will usually just refer you to EPU or a gynae...they are just GP's and do not specialize in pregnancy.

I wish I had something better so say. I have been where you are and I know how it feels

enni Fri 03-Dec-10 16:46:43

Hi All,

Just want to thank everyone for their responses/support - it was very helpful. I also want to update you on what's happening.

I went to the GP - not much value other than to reassure me the EPU were good at their jobs. So, we took the trip into London and had a private scan.

Result: est. 11 weeks pregnant, good size gestational sac & fetus for gestational age and good strong heartbeat. All seem well.

I went back to the EPU for a follow up scan, didn't tell them I had a private scan, and they decided not to do the scan "as it wasn't in my interests" but put more pressure on me to have a medical term. Suffice to say they will be recieving a complaint letter some-time soon.

Am now considering finding the money somehow for a private midwife & scans for antenatal care.

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