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 How to deal with the confusing problem of not seeing the baby on ultrasound while your hcg blood test say you're pregnant, how to avoid delay diagnosis of baby? how to protect yourself from misdiagnosis at early pregnancy?

firstly, you must know why pregnant do sono early?
The purpose of the scan is:

• to confirm that there is a heartbeat
• to assess the baby’s size and growth
• to estimate the delivery date and
• to check whether there is one baby, or twins or more.

What is the best routine ultrasound scan of pregnancy?
There are two ways of doing an ultrasound scan for pregnancy:

1. Trans-vaginal (internal) scan: where a probe is safely placed in the vagina, accurate and clearer early picture. useful before 11 weeks for earlier detection, and after 12 weeks if a trans-abdominal scan doesn’t give a clear enough sono picture.
2. Trans-abdominal scan: useful from 11-12 weeks and at the routine booking-in scan, at early pregnancy it's less clear than an internal scan and that could delay diagnosis. the woman doing the scan spreads a special gel on the lower abdomen specifically below your belly button and above the line of pubic hair, the doctor then moves the scanner over the gel, sometimes pressing down, until the womb (uterus) and pregnancy can be seen.

Is ultrasound scan do work to detect pregnancy without the hcg blood test?
No, both are used to detect and confirm the progress of pregnancy, although the hcg test results may come up with the earlier sign of pregnancy as closer as 7 days after ovulation and successive implantation which is much more than ultrasound scan do, at 6 weeks of gestation hcg level is well detectable but sonogram is a bit unclear until the week 8, however hcg results only can't confirm a viable pregnancy until a sac and heartbeat can be clearly detected on the sonar screen.
what to expect from the heartbeat results?
As long as there is a heartbeat, the risk of miscarriage decreases as the gestational weeks go by.
You will asked to repeat the scan and beta subunit hcg if:

• There’s a heartbeat, but I’m still bleeding? Then check your beta subunit hormone, FSH, LH, E2, and Prog. levels and repeat ultrasound after few days, if ok, then progesterone medication may be suitable.
• if the pregnancy is too small for the heartbeat to be visible, or there may be nothing much to see at all and it’s not clear what is happening, then retest and rescan after 1-2 weeks for the results to be clearer.

7 weeks and no image on sono, no heartbeat, no sac, low hcg levels, what to expect?
Your doctor thinks you might have an ectopic pregnancy or silent miscarriage, take blood tests and/or a laparoscopy.
Remember that: An ectopic pregnancy is a medical term for a pregnancy that is developing outside the uterus, usually develop in one of the Fallopian tubes or inside the abdomen.
Hydatidiform Mole/molar pregnancy: where the cells of the placenta grow very quickly while the baby can’t develop. difficult to be diagnosed on scan so you might find out only after the miscarriage.
let us take this pregnancy quiz to discover why pregnancy hormone is normal but the baby not showing in Ultrasound scan?
Suggested causes and solutions:

• Recalculate your ovulation days and gestational age.
• Repeat HCG blood test after a week and rescan ultrasound, have you got a strong baby heartbeat and a sac on the monitor? have your bhcg count raised?
• In the early pregnancy at 6 weeks gestation, the developing embryo show on monitor is very small because the baby is only 5-9mm long or may be smaller in many cases,  to get a better image of the baby on sonar at early pregnancy ask your doctor to use transvaginal ultrasound, Asking your doctor to scan your vagnia with vaginal probe to see any smaller mass is not difficult and not hurting, nevertheless, is more accurate to detect the baby than the abdominal probe.
• Sudden unplanned miscarriage may be suspected if you had bleeding, the best indicator of abortion is the vaginal bleeding not spotting, although ultrasound scan may show dies baby some weeks earlier than visual bleeding and any pain. The medical term for this is “missed” or “delayed” miscarriage. This can come as a considerable shock and need a difficult medical decision by your doctor.
• If dates are correct and no bleeding then check if there is irregular past periods or interrupted menstrual period due to hormonal imbalance, take blood tests for progesterone, LH, FSH, TSH and E2, if all are within expected ranges then it’s ok.

Examples:

1. hcg levels 1600 and no image on sono? if HCG hormone count is normal, no bleeding from vagina, but still no heart beat or image seen on ultrasound, you may be diagnosed earlier or you have abnormal pregnancy, waiting 10 days on average is the ideal solution.
2. Bhcg levels 15000 and no image on sono? it is a risk of ectopic pregnancy, use vaginal ultrasound and retest the beta hcg.

The hcg levels chart for viable pregnancy at 6 weeks from LMP (gestational age) :

• 3 weeks LMP: 5 – 50 mIU/ml.
• 4 weeks LMP: 5 – 426 mIU/ml.
• 5 weeks LMP: 18 – 7,340 mIU/ml.
• 6 weeks LMP: 1,080 – 56,500 mIU/ml.
• 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml.
• 9 – 12 weeks LMP: 25,700 – 288,000 mIU/ml.
• 13 – 16 weeks LMP: 13,300 – 254,000 mIU/ml.

Read the full interpretation of: hcg chart, hcg for twins, and am I pregnant or late period?

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