Possible silent miscarriage

I am pregnant and have had two early scans. The first measured 10 x 8 x 10mm (MSD=9.4mm) and 10 days later I measured 16.7 x 16.5 x (MSD=14.6mm). I was told I had sub optimal growth as it should grow at 1mm/day and my chances of miscarriage are very high. There was also no fetal pole seen, only a gestation sac and yolk sac. Please help me so I can prepare myself to loose this baby. Could the doctor be wrong?

14 August 2019

Thank you for taking the time to write in to Ask the Expert.

The process of conceiving and maintaining a pregnancy is a complex time involving many changes to both your body and to that of the future baby.

Generally after conception it can take 6-12 days for the fertilised egg to implant in to the uterus wall lining.

Once implantation occurs it then takes a further 3 weeks or so for a yolk sac and embryo sac to become visible on ultrasound.

From about 5- 6 weeks a foetal pole can become visible on ultrasound examination.

Usually a heartbeat can be found on ultrasound by about 6-7 weeks gestation.

You say that you have had a few ultrasounds already – is this because you were being assisted with the pregnancy or had had some vaginal bleeding after receiving a positive pregnancy test result?

At the time of ultrasound measurements are taken in order to confirm pregnancy or to observe for growth or causes for bleeding.

If growth is reduced or the foetal pole is not present this could be as a result of conception dates being inaccurate or because of a ‘silent miscarriage’.

If it is felt that the dates are inaccurate further scans and blood tests may be done to observe the foetal development until normal pregnancy development is confirmed.

Miscarriages are common in early pregnancy and these are often caused by chromosomal irregularities or problems in the development of the baby in the initial stages of development. However, it is not always possible to give a cause for miscarriage.

Miscarriages often present with women experiencing vaginal bleeding and abdominal pain but sometimes can just present with the easing of initial pregnancy symptoms such as nausea and breast tenderness.

Usually further scans to assess for growth and blood tests to check your hormone levels will confirm whether your pregnancy is still viable or whether you have had a silent miscarriage.

Any results of scans and blood tests should be discussed with you by your gynaecologist/obstetrician.

If a miscarriage is diagnosed and you have not started bleeding or losing your baby, it may be necessary for you to have the egg sac and other products of conception medically or surgically removed.

Management of miscarriages according to NICE guidelines varies depending on the signs and symptoms presenting and also on the wishes of the client.

Miscarriages can be treated both medically and surgically.

Medical management of miscarriage

If there is bleeding present already then blood loss would be monitored and a pregnancy test repeated after a week – if the blood loss has increased and the pregnancy test is now negative then it is likely that miscarriage is completed.

Where there is no pain and bleeding present then administration of the medication Misoprostol (orally or vaginally) to encourage expulsion of the conception products is given, abdominal pain and bleeding monitored and then a pregnancy test is repeated after 3 weeks to check whether the client has miscarried.

Surgical management of miscarriage

Surgical routes for treating miscarriage involve the removal of products of conception vaginally under a local or general anaesthetic.

Next steps

Our advice to you if you have miscarried would be to allow your body time to recover prior to attempting to conceive again. We usually recommend about 6 months as this would allow your hormones to readjust and normal menses to recommence as per your norm.

Other recommendations that we would make is that you try to optimise your health by maintaining a healthy diet, good weight, reducing alcohol and smoking intake and to commence using folic acid. By implementing these changes it can help with you conceiving but also help with the development of the new baby.

We hope the above information is helpful. Your gynaecologist/obstetrician or GP should provide you with more information and guide you through the next steps and be able to give you information re support groups if needed.

Wishing you all the best,

Answered by the Health at Hand nurses  

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