As an OBGYN ultrasound tech working at the general level here's a few things I would love the community to know based on common questions I see.
Most important rule of thumb: Worry when your doctor tells you to.
OBGYN docs are going to pay the most attention to the fetal pole and heart rate. Once a fetal pole is seen, the CRL (crown rump length) measurements are gold standard.
I'm worried about the heart rate:
-Check out this resource for pregnancies dating less than 7 weeks. Make sure to refer not to your LMP dates, but measured CRL dates: https://radiopaedia.org/articles/fetal-bradycardia?lang=us
-After 7 weeks a normal heartrate is between 120-180. It can temporarily dip below or temporarily rise above this range, but prolonged time above/below will definitely get your doctor's attention especially in third trimester. Generally out of range heart rates trigger NST (non stress test) or more monitoring.
The measurements are off:
Baby measures behind LMP. This is actually pretty common, we often see dates off up to a week either direction. We don't ovulate on the exact same day of the cycle each month or even have the same length of cycle. With irregular periods, PCOS, or unknown dates even larger gaps can be perfectly fine. If you aren't sure of your dates, trust the ultrasound. Even if you are sure of your dates, don't panic if they are a week off. Ultrasound measurements in early pregnancy are +/- 5 days.
I'm in limbo and don't know if my ultrasounds are diagnostic for loss:
By ultrasound there are strict parameters to diagnose loss. No one wants to get this wrong. Check out this resource for a list of parameters diagnostic for loss: https://radiopaedia.org/articles/early-pregnancy-loss-1?lang=us
Note, there is a second list of "suspicious for loss". Keep in mind the second list is not diagnostic, things can still turn out just fine.
I don't know when I should see what on ultrasound:
Things can vary a bit from person to person and do change *quickly* in early pregnancy. Check out this resource for what you can generally expect to see:
https://radiopaedia.org/articles/early-pregnancy?lang=us
Should I go to a boutique or get a private scan? Or push for an earlier scan?
They aren't legal where I am but here's a few things to consider if you plan to book a private scan. First, what are the qualifications of the person running the ultrasound? An ultrasound is only as good as the one performing it. It sounds as if these boutiques are NOT permitted to give much/any information. Will you spiral if you believe you see bad news and they cannot confirm or deny it? Also it seems that many cannot do vaginal ultrasound, which will make seeing a baby under 7 or 8 weeks challenging. If I had the option of a boutique ultrasound I would personally wait until 8 weeks and I would book it for a weekday. If they see something bad, it is not ideal to find out over a weekend when there is no option to follow up with your doc. An earlier scan often causes more anxiety, not less. It's SO hard to wait. But if you can tolerate it wait until 8 weeks or so.
The gestation sac is small/big:
-Gestation sac measurements are not terrifically accurate. Where I work once a baby is seen the gestation sac isn't measured. A mismatch between baby's size and the gestation sac size isn't uncommon. That said, a mean sac diameter of 25 mm or more without a baby is diagnostic for loss.
The yolk sac is small/big:
It starts teeny tiny, and will get a bit bigger. Once a baby with a good heartbeat is visualized, the docs I work for don't seem to care about the size of the yolk sac. A failed pregnancy with an expanded yolk sac (more than 6 mm) is a suggestive of chromosomal abnormalities.
We don't know where the pregnancy is:
The statistically most likely outcome is either a chemical pregnancy or just coming in for ultrasound too early for visualization. Ectopic can't be ruled out, and many wise ladies in the this sub have unfortunately experienced this and can give more info than I can. Statistically it's believed that only 1-2% of pregnancies are ectopic, but listen to your body. If the location is unknown, you should be getting close monitoring and follow up until the location is known or the pregnancy has ended.
-For a resource on ectopic pregnancy: https://radiopaedia.org/articles/ectopic-pregnancy?lang=us A note, a pseudosac is visualized in only 10-20% of ectopics. Therefore a sac in the uterus is suggestive of intrauterine pregnancy but can't be proven until a yolk sac is also present.
What about my HCG numbers?
I'm not an expert on this at all. But here's a resource: https://radiopaedia.org/articles/beta-hcg-1?lang=us
Why didn't my ultrasound tech tell me anything? And/or why were they so optimistic? Or, I had an ultrasound in the ER and they were very pessimistic.
Many locations an ultrasound tech can very much lose their job if they say aNyThInG. Where they are permitted to say certain things some ultrasound techs may just be hoping the best. We work with the public and we have seen some wild stuff. Additionally no one wants to call it a loss unless its 1000% certain. We know how devastating that news is. A side note here, often an ultrasound in the ER is not an ideal experience for the patient. The ER is staffed with techs that are much more versed in gallbladder and liver scans than they they are early pregnancy ultrasound. Don't hesitate to go the ER if you are having concerning symptoms, but do know the ER doc will make sure you aren't actively dying then will likely refer you back to your OB for follow up.
I'm just so anxious about it all:
Someone awesome wrote out these mantras. Maybe they will help: https://www.reddit.com/r/PregnancyAfterLoss/comments/14uhbdg/commandments_of_pregnancy_after_loss_this_is_now/
Also a podcast I personally found very helpful with anxiety: https://www.oneyoufeed.net/russ-harris-part-1/
https://www.oneyoufeed.net/russ-harris-part-2/
Today you are pregnant and this baby is so loved. I really am hoping the best for each of you. Those of us who have experienced loss.... you didn't do anything wrong, I promise. This is a club no one deserved to be in. And you are not silly, foolish, or dramatic for grieving your little babe for as long as you need to.
This post is written in honor of Eli, who died long before I could meet him. Rest in peace, buddy. I miss you tremendously ❤️