Pregnant but No Ultrasound Confirmation: Your Symptoms

Menstruation has been absent for a long time, and pregnancy has been confirmed, but no fetal heartbeat can be detected?

Hello, doctor.
I would like to ask about my last menstrual period, which was on 10/5/08.
Since then, I have confirmed my pregnancy at two clinics, but the ultrasound did not detect anything.
After confirming my pregnancy at one clinic, the doctor asked me to return for a follow-up ultrasound in a week, but it still did not show anything.
He then asked me to take another pregnancy test, which was still positive, although the line seemed to be faint.
During this time, I have been experiencing breast tenderness, especially in the nipples, but the discomfort is not constant.
However, the breast pain persists when pressed, varying in intensity.
Since the clinic still did not detect anything, the doctor referred me to the hospital to check for possible embryo resorption or ectopic pregnancy.
He prescribed pain relief medication for me.
When I went to the hospital, I informed the doctor that I was pregnant but that nothing was detected on the ultrasound, so he performed the scan himself, but still found nothing.
He did not ask me to retest but suspected an ectopic pregnancy.
After discussing my situation with the doctor, he ordered two HCG blood tests to check.
I inquired about how long it takes for symptoms of ectopic pregnancy to appear, and the doctor said it could be 6-8 weeks.
He mentioned that my situation indicated I was six weeks pregnant.
I am confused as to why the diagnosis on the form was amenorrhea and why he did not perform a transvaginal ultrasound to confirm the presence of an embryo.
Additionally, after the ultrasound, he did not inform me whether my uterus had thickened, only stating that nothing was visible.
During this time, I have not experienced any bleeding or abdominal pain, aside from previous episodes of heartburn and breast discomfort.
I believe my ovulation period was from August 21 to August 29, and I suspect I conceived around August 28.

Shizi, 20~29 year old female. Ask Date: 2016/09/24

Dr. Lü Lizheng reply Obstetrics and Gynecology

If the ultrasound does not show anything, it may indicate an ectopic pregnancy, or the embryo may still be too small (indicating a later conception), or the embryo may be degenerating.
Typically, physicians will assess the changes in HCG levels to determine which of these three scenarios is occurring.
If the HCG levels are rising rapidly, it is more likely to be a normal embryo that is just smaller due to later conception; after a week, the embryo should be large enough to be visible on ultrasound.
If the HCG levels are declining rapidly, it is more likely that the embryo is degenerating; after a week, if the embryo has not grown, it will still not be visible on ultrasound.
If the HCG levels are stable, slightly increasing, or slightly decreasing, there is a high suspicion of an ectopic pregnancy; after a week, if the embryo has not implanted in the uterus, it will still not be visible on ultrasound.
However, sometimes an ectopic pregnancy can show a mass in the area of the fallopian tube, and internal bleeding may also be observed.
In a normal pregnancy, a standard abdominal ultrasound can typically detect the embryo after six weeks of gestation; a transvaginal ultrasound can detect it a bit earlier, around five weeks of gestation.
If, based on the menstrual cycle or conception date, it is estimated that the pregnancy is already five to six weeks along but the ultrasound still does not show anything, there is a high suspicion of either an ectopic pregnancy or embryo degeneration.

Reply Date: 2016/09/24

More Info

It sounds like you are experiencing a challenging situation regarding your early pregnancy and the lack of ultrasound confirmation. Based on your description, you have had positive pregnancy tests but have not yet been able to visualize an embryo or gestational sac via ultrasound. This can understandably cause anxiety and confusion.

In early pregnancy, particularly around 6 weeks gestation, it is common for an ultrasound to not yet show a fetal pole or gestational sac, especially if the pregnancy is very early. The gestational sac is typically visible around 4.5 to 5 weeks, while the fetal pole can usually be seen around 6 weeks. If you are indeed around 6 weeks pregnant, it is possible that the ultrasound may not yet show these structures, particularly if your ovulation and conception dates are not precisely known.

The symptoms you are experiencing, such as breast tenderness, nausea, and gastrointestinal discomfort, are common early pregnancy symptoms. Breast tenderness, especially in the nipples, can be attributed to hormonal changes occurring in your body as it adjusts to pregnancy. Nausea and gastrointestinal issues, including heartburn, are also frequently reported during early pregnancy due to hormonal fluctuations and changes in digestion.

Regarding the concern for an ectopic pregnancy, it is important to monitor for symptoms such as severe abdominal pain, shoulder pain, or vaginal bleeding. Ectopic pregnancies typically present with these symptoms around 6 to 8 weeks of gestation, but not all women will experience them. If you are not experiencing any of these symptoms, it is a positive sign, but it is still crucial to follow up with your healthcare provider.

The fact that your healthcare provider has ordered beta-hCG blood tests is a standard procedure to assess the viability of the pregnancy. In a normal early pregnancy, beta-hCG levels should rise significantly (typically doubling every 48-72 hours). If your levels are rising appropriately, it can indicate a healthy pregnancy, even if the ultrasound does not yet show a gestational sac or fetal pole.

As for your concerns about the diagnosis of amenorrhea (missed period), this is often used in the context of pregnancy to indicate that you have not had a menstrual period due to the pregnancy. The absence of a period is a common sign of pregnancy, and your healthcare provider may have used this terminology to describe your current situation.

If you have not had any bleeding or severe pain, and your beta-hCG levels are rising, it is likely that you are experiencing a normal early pregnancy. However, if the ultrasound continues to show no signs of a gestational sac or fetal pole in the coming weeks, your healthcare provider may consider further evaluation to rule out conditions such as an ectopic pregnancy or a non-viable pregnancy.

In summary, while it can be distressing to not see confirmation of your pregnancy via ultrasound, it is not uncommon in early pregnancy. Continue to communicate openly with your healthcare provider, follow their recommendations for monitoring your beta-hCG levels, and report any new or worsening symptoms. It is essential to have regular follow-ups to ensure the health and viability of your pregnancy.

Similar Q&A

Pregnant but No Baby on Ultrasound: Understanding the Concerns

Hello, Doctor! I would like to ask about my situation. Last week, I went to the obstetrics and gynecology department for an examination. The urine test showed two lines, but one line was faint. The doctor told me that I was pregnant and advised me to have an ultrasound this week....

Dr. Dong Yuhong reply Obstetrics and Gynecology
Hello: I have seen your questions and would like to explain the following points for your understanding. 1: A pregnancy test showing two lines indicates a positive result for pregnancy. 2: If you go for an ultrasound a week later and see a pregnancy within the uterus, the doctor ...

Understanding Vaginal Ultrasound: Can It Confirm Pregnancy Absence?

If a transvaginal ultrasound has been performed and no signs of pregnancy are observed, can it be confirmed that there is no pregnancy? The doctor mentioned that menstruation is delayed by more than two weeks due to delayed ovulation, and there is some thickening of the endometri...

Dr. Huang Yiwen reply Obstetrics and Gynecology
Hello Ms. Ada: Sometimes a urine test shows pregnancy, but an ultrasound does not detect anything. This could be due to delayed ovulation, as the embryo may be too small to be seen. If menstruation is more than two weeks late but the urine test is negative, indicating no pregnanc...

Understanding Pregnancy Concerns: Missed Period and Ultrasound Results

Hello doctor, my girlfriend hasn't had her period for a month. On April 5th, she used a pregnancy test twice, which showed one strong line and one faint line. Later, on April 6th, she went to the obstetrics and gynecology department, where an ultrasound and urine test reveal...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, please take another pregnancy test. If the result is negative, there is no need to worry. Wishing you good health.

Understanding Early Pregnancy Ultrasound: No Heartbeat at 6 Weeks 5 Days

Hello, doctor. I would like to ask about my current pregnancy status. I am 6 weeks and 5 days pregnant. Today, I went for a follow-up ultrasound, but we couldn't detect the baby's heartbeat. The doctor mentioned that under normal circumstances, we should be able to see ...

Dr. Huang Jianzhong reply Obstetrics and Gynecology
I am currently 6 weeks and 5 days pregnant. Today, I went for a follow-up appointment for an ultrasound, but we couldn't detect the baby's heartbeat. The doctor mentioned that normally we should be able to see it at this stage and suggested that if we don't see it ...