When to secure a definitive diagnosis for a miscarriage.
May 29, 2013 | 50,00 EUR | answered by Dr. med. Ralf Berg
Hello, dear gynecologist,
I will now try to present the facts as unsentimentally as possible:
- 41 years old, healthy, 1 child 3 years old (no complications), no miscarriages
- 06.05. Pregnancy test done by myself, positive
- 07.05. Gynecologist confirmed pregnancy after urine test, nothing visible on ultrasound yet
- last KNOWN period 12.03.
- afterwards, there was another one, which should have been relatively regular, unfortunately not exactly traceable, estimated between 07.04. and 10.04.
- actual conception time completely unclear to us, as we did not have unprotected intercourse at the theoretical ovulation time
- 13.05. Ultrasound empty gestational sac 0.67 cm, HCG 3,600
- 22.05. Ultrasound empty gestational sac 1.3 cm, HCG over 10,000
- 27.05. Ultrasound empty gestational sac 1.5 cm, HCG 19,109
- no complaints or bleeding (belly has grown)
And now to my question / questions:
Does this necessarily have to be a blighted ovum or missed abortion, or is there still a possibility of a corner sitter or "late bloomer" etc.?
Does it need to be evacuated now or should we wait?
I would be very grateful for a quick and understandable remote assessment, because unlike these cool words, we are currently experiencing a terribly emotional situation...
Heike BT
Hello Heike,
I already answered the question on May 29th, but somehow this answer did not arrive.
I can imagine that things are getting emotionally heated for you. I hope that after my answers / second opinion, the emotional waves will calm down a bit.
1. The corner-dweller.../ Late bloomer
With today's ultrasound technology and resolution, it is actually not possible to overlook a intact embryo in any corners. If you have scanned 3 times vaginally and possibly also additionally from the abdomen and have not seen anything except an empty gestational sac, then it is almost certain that you have a blighted ovum.
You also mentioned that there was actually no fertilization. Even if it is assumed that (for whatever reason) the egg started dividing without fertilization, where would the second set of chromosomes come from in order for an embryo to develop?
The most likely scenario is that even with protected intercourse (e.g. with a condom), accidents can happen. It is a fact that not every fertilization leads to a successful pregnancy, especially in younger women and even more so in older age.
Based on the course of the ultrasound findings and blood tests, nothing else can be assumed other than a blighted ovum.
2. Regarding the timing of the abrasion, opinions may differ. Gynecologists see the increasing risk of bleeding and perforation and therefore advocate for a prompt abrasion. On the other hand, the opinion is that an non-intact pregnancy spontaneously aborts in 95% of cases anyway. Given your impressive HCG levels, this may take some time.
Therefore, in your case, I would also tend to perform the abrasion in 5-10 days. To clarify: HCG hormones are mainly produced by the ovary and not by the fetus. Initially, high HCG levels can be present even in the absence of an embryo.
With best regards,
Dr. R. Berg
