Early Pregnancy Loss: Common Questions and Concerns

Question: Suspected miscarriage due to an unhealthy embryo?

I usually have irregular menstrual cycles, sometimes my period comes every 40 to 55 days.
My last menstrual period was from July 13 to July 17.
On the evening of September 5, I experienced severe abdominal pain (it was more intense than menstrual cramps).
On September 6, I took a home pregnancy test and got a faint positive result (indicating two lines).
I then went to Clinic A, where the doctor said there was a high probability of pregnancy.
An ultrasound was performed, but nothing was visible.
After experiencing more severe abdominal pain, I visited Clinic B on September 10, where I had a blood test.
The doctor at Clinic B also confirmed that I was pregnant.
On September 11-12, I accidentally fell and experienced two days of brown spotting, which was minimal and required only a panty liner, but my abdomen continued to hurt significantly.
On September 13, the blood test results confirmed pregnancy, but the doctor estimated it was about three weeks along, suggesting that the embryo was not viable and had likely passed, as nothing was visible on the ultrasound.
I asked if it could be an ectopic pregnancy, and he said it had likely passed.

Q1: Is it possible that I am three weeks pregnant? (It feels like it has been longer than three weeks.)
Q2: Is there a possibility of an ectopic pregnancy in this case? If so, why was nothing visible on the ultrasound?
Q3: I did not experience heavy bleeding, only severe abdominal pain and brown spotting, but the blood test indicated pregnancy.
Is it possible for a non-viable embryo to pass naturally without heavy bleeding?
Q4: Does a miscarriage always involve bleeding?
Q5: What could be the reason for not being able to see anything on the ultrasound? Shouldn't an ectopic pregnancy be visible as well?

Niming, 10~19 year old female. Ask Date: 2018/09/13

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I usually have irregular menstrual cycles, sometimes it takes 40 to 55 days for my period to come.
My last menstrual period was from July 13 to July 17.
On the evening of September 5, I experienced severe abdominal pain (it was more intense than menstrual cramps).
On September 6, I took a home pregnancy test and got a faint positive result (indicating two lines).
I then went to Clinic A, where the doctor said there was a high probability of pregnancy, but the ultrasound did not show anything.
I continued to have severe abdominal pain and on September 10, I visited Clinic B for obstetrics and gynecology, where I had blood drawn.
The doctor at Clinic B also confirmed pregnancy.
On September 11-12, I accidentally fell and experienced two days of brown spotting, which was minimal and required a panty liner, but I continued to have significant abdominal pain.
On September 13, the blood test results confirmed pregnancy, but the doctor said it was about three weeks along, although it seemed like the embryo was not viable and had likely passed, as nothing was visible on the ultrasound.
I asked if it could be an ectopic pregnancy, and he said it had likely passed.
Q1: Is it possible that I am three weeks pregnant? (It feels like it has been more than three weeks.)
A: You are likely not three weeks pregnant; it is at least four weeks.
Q2: Is it possible that this is an ectopic pregnancy? Why was nothing visible on the ultrasound?
A: An ectopic pregnancy can be too small to be detected.
Q3: I did not experience heavy bleeding, only severe abdominal pain and brown spotting, but the blood test showed pregnancy.
Is it possible for the embryo to be nonviable and pass naturally?
A: The information is incomplete.
Q4: Does a miscarriage always involve bleeding?
A: Yes.
Q5: What could be the reason for not seeing anything on the ultrasound? Shouldn't an ectopic pregnancy be visible?
A: An ectopic pregnancy can be too small to be detected.

Reply Date: 2018/09/13

More Info

Understanding early pregnancy loss can be a complex and emotional journey, especially when faced with symptoms like abdominal pain, bleeding, and uncertainty about the viability of the pregnancy. Based on your description, let's address your questions and concerns in detail.

Q1: Is it possible that I was pregnant for three weeks?
The timeline of pregnancy is often calculated from the first day of your last menstrual period (LMP). If your last period was from July 13 to July 17, and you experienced symptoms of pregnancy around September 6, it is likely that you were indeed around three weeks pregnant at that time. However, given your irregular menstrual cycle, it is possible that you may have ovulated later than expected, which could mean that you were further along than three weeks when you experienced symptoms.

Q2: Could this be an ectopic pregnancy? Why was it not visible on the ultrasound?
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, often in a fallopian tube. While ectopic pregnancies can sometimes be detected via ultrasound, they may not always be visible, especially in very early stages. If the pregnancy hormone (hCG) levels are rising but no gestational sac is seen in the uterus, it raises the suspicion of an ectopic pregnancy or a very early miscarriage. However, since your doctor indicated that the pregnancy was likely lost, it suggests that the embryo may not have developed properly.

Q3: Is it possible to have a pregnancy with strong abdominal pain and only experience brown spotting?
Yes, it is possible to experience significant abdominal pain and brown spotting during a miscarriage. Brown blood typically indicates older blood, which can be a sign of implantation bleeding or the beginning of a miscarriage. The presence of pain, especially if it is severe, can indicate that the body is going through the process of expelling the pregnancy tissue.

Q4: Does a miscarriage always involve bleeding?
While most miscarriages do involve some degree of bleeding, it is not always the case. Some women may experience a miscarriage without significant bleeding, particularly if it occurs very early in the pregnancy. The symptoms can vary widely from one individual to another.

Q5: What could be the reasons for not seeing anything on the ultrasound?
There are several reasons why an ultrasound might not show a developing pregnancy. If the pregnancy is very early, it may be too soon for the ultrasound to detect any signs of a gestational sac or embryo. Additionally, if there is a miscarriage occurring, the ultrasound may not show anything if the body is in the process of expelling the pregnancy. In cases of ectopic pregnancy, if the embryo is not located in the uterus, it may also not be visible on a standard ultrasound.

In summary, early pregnancy loss can be accompanied by a range of symptoms, including abdominal pain and bleeding. It is crucial to follow up with your healthcare provider for further evaluation, especially if you continue to experience pain or unusual symptoms. They may recommend additional blood tests to monitor hCG levels or follow-up ultrasounds to ensure that everything is resolving appropriately. Remember, it's essential to take care of your emotional well-being during this time, as experiencing a loss can be very challenging. Seeking support from healthcare professionals, counselors, or support groups can be beneficial.

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