First early US: what to expect?

[taramiss]

I am 35 and am currently pregnant for the fourth time. My first pregnancy was successful and resulted in my daughter’s birth in September 2022, my second was a mmc at 12 weeks this past September (confirmed monosomy x), my third was a mmc at 8 weeks this past January (cause unknown). For all of those pregnancies, I didn’t have my first ultrasound until about 7 or 8 weeks.

This time, my first scan is tomorrow at 5w 1d (24 dpo). My anxiety is through the roof. Can you guys help me prepare? I’ve seen some conflicting information. What SHOULD I see on my scan? What would be a red flag that this isn’t viable?

In case it helps, my betas are as follows:

16 dpo: 260

20 dpo: 1591

 

[josephjurg]

@taramiss So that early the only thing I would expect to see is a gestational sac. Maaaaybe a yolk sac but it certainly isn't a red flag if you don't see one.

 

[commissionerfd1]

@josephjurg At only 5+1 it also wouldn't necessarily be a red flag not to see the gestational sac. It can take up to 5.5 weeks for it to be visualized.

 

[taramiss]

@commissionerfd1 Thank you for this. That really helps to know in case there is absolutely nothing. I’ve felt impending doom all day just anxious about going and having it be absolutely nothing at all!

 

[romans82]

@commissionerfd1 I know you mean well, but she’s 24dpo or 5+3. Her last beta at 20dpo (96 hours prior) was already nearly 1600. Given the gestational age and beta cutoffs for certain pregnancy structures, she should 100% see a gestational sac in a healthy IUP at this point. It would 100% be a red flag to not see a GS when her beta would presumably be greater than 3000 at a gestational age of 5+3.

 

[nevable]

@taramiss Is there a reason they scheduled you for such an early ultrasound? I would say the chances of seeing something are pretty unlikely. Don’t stress if they can’t find much!

 

[taramiss]

@nevable I started seeing an RE for RPL after my second loss. I think it’s standard protocol at his clinic to watch his patients like a hawk. I also have a gene mutation that makes me more likely to develop blood clots during pregnancy, so I’m on an anticoagulant (lovenox). Maybe they want to check early to monitor if an SCH develops as a result of that? Not sure

 

[nevable]

@taramiss Ahh that makes sense. The early monitoring seems good but I wouldn’t stress about anything just yet good luck!

 

[josephjurg]

@nevable My REs standard protocol was first ultrasound once you hit 2k hcg, mine was also around 5w2d

 

[inquirer17]

@taramiss Not your question but just wanted to assure you that some of us are just hit with bad luck and it’s not reflective of your future chances.

I also have 1 LC and then had two losses related to random chance chromosomal defects. It’s my understanding that monosomy x is one of those random chance events that is not carrier related and is just bad luck.

I’m on my third pregnancy post LC now at almost 18w and so far this one has passed all the tests.

Good luck at your scan! As others mentioned, this early, it’s sort of 50/50 if you’ll see anything at all. So try to not to read into it too much if you don’t see anything.

 

[taramiss]

@inquirer17 I found this comment so reassuring and impactful. We have so much in common! Thank you so much for saying this. Congrats on your pregnancy! I hope I get to be where you are too. You give me hope

 

[labanswe]

@taramiss I'm not sure what exactly you'll be able to see that early except to confirm it's not chemical/ectopic? I was sent for an early scan at 6 weeks. We could only see the gestational sac and yolk sac corresponding to 5 weeks. There was no fetal pole yet so I'm supposed to go in again this weekend to see if it's viable.

I'm freaking out a bit because last time around too I was measuring behind, but only in second trimester and had a MMC. This time it's already behind though my doctor says it could be because I ovulated late.

So only two things were determined. That it was implanted correctly and I measure a week behind according to my LMP.

 

[taramiss]

@labanswe I’m sorry to hear about your previous loss. Fingers crossed for this one. I’ll be thinking of you!

 

[apologeticsguy]

@taramiss I’ve also had a pretty early ultrasound after a stillborn and 2 very early miscarriages. I started spotting at 6 weeks on the dot. There is a chance they will see nothing, there is a chance something will be there but no heartbeat yet (for most people that doesn’t start until 6 weeks). Don’t get too worked up over this one. It’s so early that nothing can be definitive. My HcG was significantly lower than yours (around 13/14 DPO I was only at 17). I am now 11w4d. I’ve had 4 ultrasounds all showing a healthy baby with a heart beat (although we were measuring behind at 6 weeks low progesterone and slow rising HcG). I’ve been rushed into Maternal Fetal Medicine so I have another ultrasound Tuesday for a viability scan, my first official prenatal appointment and I see a specialist at Maternal Fetal Medicine both on Thursday. My advice is not to fixate on numbers (I did and it drove me crazy), try not to get too worked up if you are measuring a bit off because it is extremely normal in the first trimester since the baby is so small, if nothing is seen that is also totally fine! You’re too early for anyone to know anything for sure so there are no flags at this point to say it isn’t viable. Things to watch out for in a few weeks would be an HcG lowering or not rising, a progesterone level 5 or below as that indicates miscarriage, or if at 7 weeks they still see nothing. It’s a limbo and it’s the worst part. Stay positive! Everyone is different and as you can see from my story just because your pregnancy is not the “norm” doesn’t mean it won’t work out! Good luck!

 

[taramiss]

@apologeticsguy First, I’m so sorry about your losses. That’s devastating. And your words of “don’t get too worked up over this one” made me feel like you somehow saw me over here in my state of extreme anxiety. Although it sucks that this happened to both of us, it’s nice to hear from people who actually understand this level of US fear. So being told to not get worked up by someone who has history of loss and understands this actually holds some weight and DOES calm me down. So thank you.

It’s so refreshing to hear about your baby and that strong heartbeat! I’ll be thinking about you on Tuesday and wish you best of luck for a healthy happy and uneventful pregnancy!

 

[apologeticsguy]

@taramiss Thank you so much I wish you all the best and all the success

 

[2531alpha999]

@taramiss You might see a very small sac at 5 weeks. Don't expect too much like fetal pole etc.

 

[taramiss]

@2531alpha999 Thank you! Gosh I hope I see a sac either way though. That would be much more reassuring!

 

[periosehperi]

@taramiss You should see a gestational sac, maybe a Yolk sac but not guaranteed

 

[romans82]

@taramiss So if I’m reading your post right, your scan will be at 24dpo, which is technically 5+3 (if you’re going by LMP as most OBs and apps do until a dating scan, it might put you a little earlier if you have shorter cycles). 14dpo is 4 weeks gestational age on the nose. And 96 hours before your scan your beta was close to 1600, so by the time of your scan, it will be >3000 if it rose appropriately. Given your gestational age and beta cutoffs for pregnancy structures, you will see a gestational sac if this is a healthy intrauterine pregnancy. That’s all you should 100% see at this point- everything else is icing on the cake! Congratulations!