Confused about scan at EPU - Please help!

[moneli]

Hello, sorry in advance for this being long and rambling, but I need some advice and clarification and am hoping someone out there might be able to give it...
I fell pregnant in Oct 09 but at the 20 week scan it was clear that the baby had a lethal condition. Heartbreakingly we opted for a termination at the beginning of February. I didn't stop bleeding and had to go back in for an ERPC at the end of March. I waited for one period before ttc again, as we very much want another baby. My period started on the 28th April (I'm VERY sure about this) and I fell pregnant during the next ovulation cycle. I have been very anxious about this pregnancy from the start, probably because of what happened above; I really didn't want to go through losing a baby again, but I was also concerned because I have had NO pregnancy symptoms. A bit of tiredness but no breast tenderness, no changes in appetite or taste. I have felt very different to the last two times. Yesterday I decided to to go the EPU to find out what was going on and the results have confused me and tbh got me even more concerned. Because I'm so sure of the dates of my last period, I thought I was 7w +5d. However, the sonographer said the embryo measured only 6 weeks. How can that be? That suggests I was ovulating and getting pregnant at the same time that I did a pregnancy test and got a BFP? Also, he said the heartrate was 'a bit slow' at 85bpm. He didn't seem massively concerned and said to come back in 10 days to measure changes but when I came home and googled (a dangerous thing to do, I know) all the results came back as '80% chance of embryonic demise if bpm less than 90'. So my very uninformed self diagnosis is that the embryo isn't thriving and the heart rate will continue to slow until it dies. Maybe I'm programmed to expect the worst after what happened last time but the signs aren't good, are they? Does anyone have any knowledge/experience of either fetal heart rates or where there is a discrepancy between menstrual dates and scan findings? I do have a follow up appointment but all this waiting sends me a bit mad I think.

Just bumping for you, I am sure you will get some experiences/advice here soon

Really sorry moneli to hear about your loss earlier this year. I'm afraid I don't know much about heart rate - but the fact that your little bean had one is definitely a good thing. The waiting is awful - I have my fingers crossed for you hope everything goes well.

moneli it is anxious waiting for scans etc, and although I am not an expert, could you not try and get a second scan - what is difficult in early scans is that they can be out, (there is a margin of error, and your scan is also dependent on the skill of the sonographer - ) and so you might find at your next scan that you are indeed 7 weeks ....
Sometimes it is worth going for a private scan, expensive, but can give you some peace of mind -
good luck, and i am sorry to hear about your last pregnancy and fingers crossed for this one ....

I haven't had experience of low heart rates, sorry. But dating at early scans can be far more unreliable than at scans post 10 weeks. I had a scan at 8+3 going by LMP and it dated me at 7+4, which I was fine with as I tend to ovulate late. But at my dating scan at 12 weeks, my dates changed and according to the more accurate later dating scan, I was actually 8+4 at the first scan. When the embryo is that small, an error of 1mm say in the measurement has far more of an impact on dates than at later scans and all scan measurements will have a margin of error.

Hang in there. The waiting is horrendous I know but unfortunately there's often no way round it.

hi moneli

I'm in a similar situation as you after an early scan last Friday when I thought I was 8 weeks. Due to my long cycle (32-36 days) the sonagrapher wasn't surprised not to see anything detailed on a normal ultrasound and had to do an internal scan. She then found the sac, saw a very small embryo measuring just 6 weeks and also said the heartbeat was slow - although also said that we shouldn't worry too much about that at this stage (I'm purposely not googling as I don't want to stress myself out anymore than I am already).

Initially she'd measured me at 5+4 (!) so was surprised to even find a heartbeat. I've got to back in 2 weeks when I am 8 weeks and the days are dragging. I'm trying hard not to worry about it as got the usual symptoms - sore boobs, tired, peeing lots etc and as it's my first I don't really have anything to compare it against.

The dating discrepancy at early scans is very common. That's why you don't get gvn an estimated due date till the 13w scan. The image on screen is magnified a lot. So if their measurement is even a fraction out, that equates to a lot in real terms. If something had already gone wrong then thete wouldn't be a hb at all. Just be positive and try to go for another scan soon, to try to clarify things further.

Thanks for all of your reassuring words. We're away next week on holiday (when I hope to be able to relax and try not to think about this too much) but have another scan booked on Mon 5th so hopefully I'll find out more then.

Dee36, I hope your next scan goes well too x

Moneli,

I have experience of this (several M/C over last 2 1/2 years), sadly you're research is accurate, but that does not mean no hope.

Often the first sign of problems (and with all but one of my own m/c), is a discrepancy between date of LMP (or ovulation if you were using testing sticks as this is more accurate than LMP), and the age of the embryo by size on scan. Slow heart rate is not good at all and along with a smaller than expected embryo usually means an abnormal embryo which sadly is dying and is just not going to make it. 80-90% won't make it, but they usually stop developing by the time a second scan is done. If the babies heart rate picks up, and is normal at the next scan, it still has a high m/c rate, but if it makes it to 12 weeks,then the risk is about the same as any other preg - but there is double the risk of serious problems (chromosomal or heart defect), with about 5% risk rather than about 2.4% for all babies.

While I've been in this situation twice and lost the baby, there is hope - I'm 21 1/2 weeks preg with a baby who had a heart rate of 100 at 7 weeks (should be about 140 at that stage and anything less than 120 at 7 weeks is a huge m/c risk), and I was told at the time that the baby was almost sure to fail. But heart rate was 130 a week later (still slow but increasing).
Had CVS at 13 weeks (normal), then heart check at 21 weeks (appeared normal), as there was the risk (with the slow initial heart rate) of structural heart problems.

85 is low, but not hopless. I wish you well and hope it works out ok.

Well. Good luck trying to relax after oldmum42's post. I'm sorry you have had such horrible luck, oldmum, but I have to completely disagree with the comment about embryos measuring small. I was put one week back with both of my healthy pregnancies. The important thing is what the following scan shows. If it is 2 weeks later, then the scan should show that the embryo has developed accordingly

There are literally hundreds of posts from prople on MN who were concerned that the embryo size was smaller than it should be. The problem is almost always due to a margin of human error when the scan is carried out.

Heartbeat is the more important factor. TBH I thought oldmum42's post was good. Too many people try to sugar-coat poor situations IMO and possibly give false hope.

Yes, hb is more than likely the important factor, but the comment about embryo size was not absolutely correct.
I agree that honesty can be helpful, but Ive been in this situation twice, and although i wanted and appreciated honest answers, thete are ways to say things in a more positive way
When i was in a similar situation, that reply would have been devastating to me. The op is already upset and anxious.

I'm not meaning to offend anyone. Apologies if that's how it seems

Thanks to everyone for their replies, I have found them all very useful. I guess I am gearing myself up for disappointment at the next scan, rightly or wrongly, (I did after all go to the EPU because of a sense that something was not right) but if I can be an exception to statistics I would be delighted.
Thanks again all x

vmcd,

It was not my intention to upset anyone, the OP already knew the statistics (and had read some of the same research papers I did, by the sounds of it).

Of course there can be errors with the U/S dating, but I was saying "smaller than expected embryo WITH a slower than expected heart rate FOR THAT SIZE of embryo". For each mm in size that the embryo measures, there is a specific "normal" heart rate, and m/c rate increases in a linear way as you drop below this rate (I've researched this topic extensively due to my own experiences).

When I post, I want to hear it all - the good and the bad, I'm not wanting false hope, although a little bit of real hope is good (which I thought I gave, by speaking about my current situation, were I was actually told by the MW that the fetus was almost certainly dying at 7 weeks, due to the heartrate, and to come back in a week to have another scan before they arranged a medical m/c!! but the baby is now 22 weeks and healthy, as far as they can tell).

I learnt a lot about the risks which may be the cause of the slow heart rate, so maybe I passed on too much of that, but honestly, in my case, I want to know EVERYTHING, good and bad, as this is the way I tend to deal with situations - I always want to know 100% of the infronation, as I feel this puts me in control (rather than the "experts" who only tell you what they want you to know!).

Maybe I'm guilty of assuming everyone actually wants to be told it straight, because I do.

Moneli, it was certainly not my intention to cause further worry.

Oldmum,
Thanks for the message. As I said I didn't mean to cause offence to anyone. But I know I was quite shocked when I first read yr post., so I was concerned about how the op would have felt, already being worried.
Yes I completely understand the point about a slow hb combined with a small embryo, but I'm not sure if yr original comment explained that it was the two issues combined that can indicate a problem, as the statement reads, "often one of the first sign of problems is a discrepancy between the date of LMP and the age of embryo by size."
That is what I had to disagree with. Esp given the fact that it is actually very common that an embryo is smaller than expected at early scans.
I hope it all works out brilliantly for you this time, I really can't imagine what you have gone through.

Moneli, I read a website yesterday which said the normal hr for a 6w embryo is in the range of 90 to sthg like 110. You are therefore very close to what is considered normal. The rate should gradually increase each day.

Yes, I was maybe less clear than I could have been but thought that my next sentence was the "explainer", mentioning both heart rate and size, but I could have worded it better. Certainly I am shocked to think I shocked you -not intended, for sure. Obviously I had my scientific ass head on yesterday.

I know and agree with what you say about it being very common for the embryo to measure smaller than expected by LMP at an early scan, BUT this is because there is a big variation in ovulation dates and using LMP to estimate ovulation/conception is fairly inacurate and being a week or so "wrong" is not unusual.

What's important though, is the rate of growth once you have had a scan - if you measure say, 6 weeks and 2 days, then 2 weeks later you should measure 8weeks and 2 days - "growth as expected" is a vary good indication of embryo health (yes, u/s can be slightly inacurate if not done well but it should not be more than + or - 3or4 days). The embryo grows at about 1.3mm per day at this stage (up to about 11weeks), when scan dates actually become less accurate as the older the fetus gets, the more individual his/her growth pattern.

Fetal heart rate should increase at around 3 to 4 beats a day from the time the heart starts beating until it reaches about 140 bpm, then the increase slows, and eventually the rate falls towards the end of pregnancy.

Some of what I read suggests that for an embryo with a slower than avarage rate, the rate of increase is important - so slow but increasing at the expected rate is a better sign than staying the same or only increasing slightly, and it may be that some hearts just start at a very slow rate but then increase at 3 beats a day so eventually reach "normal" but later than they should. This seems to be the case with my current Preg.

Moneli - the above is, I hope reasuring.

Hi both, thanks for your concerns and clarifications. I really didn't mind being told 'how it is' and am heartened by your good news oldmum42. I know I need to wait and see but I do feel this pregnancy won't work out. I went for an EPU because I was worried something was wrong, I don't feel pregnant; no symptoms at all. I also am sure of when I ovulated because not only are there physical signs that I recognise, but also my DH had an injury that shall we say, put him 'out of action' for the rest of the month. I know this embryo is 8 weeks old, but only measures 6 weeks and has a too low heart rate. Maybe I'll be another exception and everything will work out fine but I think my original post was to kind of say 'I've read this and that and I think this is happening, am I right'. And yes, unfortunately I am. I'll let you know how I get on at the scan x

sorry, one question for oldmum; you sound like you've done your research about this. Are these all indicators (slow growth/low heartrate) of a chromosomal disorder, the risk of which increases with maternal age? I'm 39. I'm guessing it's nothing I did/didn't do, and is not any other medical cause?

Moneli if it's of any help to you, I got pg straight after MC in February with no cycle in between so was very very nervous. I was certain of my dates given it was an MC and also of when I ovulated, had scan at 8 weeks +4, they dated me 7 weeks + 2. I was devastated and super super worried. However at the 12 week scan I was dated at 13 weeks. She said that if they are even out by a milimetre with the scan then that can mean you are out by a week etc.

Best of luck loads

Thanks HappyGirl and good luck with the rest of your pregnancy

Hi MONELI, I have read into this in a lot of depth, due to my own m/c history, (and as a science graduate I am probably a bit insensitive to the fact most people read in less depth and may be offended/upset by too much information, so I appologise again if my original post was too frank/negative, as was justifiably pointed out to me by vmcd28!).

To answer your question, my understanding is yes, slow growth/low heart rate (or indeed a very high heart rate) are indicators of Chromosomal disorders, and that these indicators suggest (but do NOT prove 100%) an embryo that is ill and failing. As your age increases, the risk of these problems increases (even by age 35 the risk is rising, and sharply after about 37).

I also found references to the idea that if the embryo is ill, either from a bug it/you have developed or from a problem with implantation, this may affect growth and heart rate for a time - and some will fail and some will recover and continue as normal.

Heart rate is supposed to start at about 80bpm at around 5weeks 3 days and increase 3 to 4 beats a day, but a few normal embryos may start with a very low heart beat, but then increase at the normal rate of 3 to 4 beats a day, and eventually they will catch up with the normal rate. Some embryos may start with a slow rate due to a problem with the developing heart. (in my case, having ruled out a chromosomal cause by having CVS, I then had a detailed heart check at 21 weeks, which was also ok).

The thing that seems to go wrong as you get older, is the separation of chromosomes in the ovum just as it is fertilised,this is less efficient, and non-disjunction happens more often - this means you get an extra copy of 1 or more of the 23 chromosomes (so you have 3 instead of 4). This can be a single trisomy such as T21 (down syndrome), or many or all of the chromosome can be repeated.
Most of these extra chromosome combinations are lethel and the baby can't develop past 6 weeks or so. With others, such as Down, Turner,Edward, patue (sp?), although some babies do survive and develop, most are, sadly, very badly affected and M/C later (usually 6-14 weeks), but they also have a higher rate of loss in late pregnancy and the first few weeks of life. Children and adults we see around us in society are actually the lucky few survivors of the bad genetic hand they were dealt.

My consultant told me that in older women (40+) almost all of the "excess" m/c rate compaired to younger women are "probably" caused by Non-disjunction of chromosomes. (the rest, maybe caused by immune and structual issuse that may develop as we get older).

IT IS NOTHING at all you have done (none of us can be blamed for getting older!).

But as I said, high dose folic acid is showing promise at reducing the risk, so may be worth discussing with your consultant.

For now though - you know the possibles, you need to see how your next scan goes, I know from experience it's possible for things to pick up and work out well, and I very much hope that's the case with you.

Thanks OldMum, really appreciate the time you have taken to tell me all this. I started spotting a bit yesterday and more today so think maybe a m/c is on its way. It's what I thought might happen and am pleased it happened sooner in this pregnancy than last time. Will definitely talk to my consultant about high folic acid dose for next time

Moneli,

I am very sorry to hear about your spotting, yes earlier is easier IME, but still an awful thing to go through.
If this is M/c starting, as you suspect, then I hope it goes as smoothly as these things can, and that you have plenty of support around you.

Will be thinking of you.