I recently went to ER at about 6.4 weeks pregnant due to cramping and light brown blood. The did an ultrasound found the fetus and heart rate at 99. They also felt the yolk sac was a little under developed. They diagnosed me with threatened miscarriage. Went back the next Tuesday(ER was Thursday) and they did an ultrasound and found only the yolk sac. I'm confused on how this happens? I didn't have any more bleeding or cramping. I do have a tilted uterus. I trusted the doctors diagnoses and recommendation for d&c and went through with it that day. I am now thinking clearly and want better answers. Could you help and explain?

Hello Sarah from the U.S. (Wisconsin),

I can only conjecture as the what occurred, not having been there to see the ultrasounds.  This should not be considered the absolute correct explanation for that reason.

There are two possible scenarios that I can imagine to explain the change.  One is that the fetus died in the interim between Thursday and Tuesday and so was not visible on the Tuesday ultrasound.  At 6.4 weeks gestational age, the fetus would be very small and barely visible.  A fetal heart motion would make visualization easier, so if it not there, the fetus would be harder to see.  So, one could presume that the fetus died and did decrease in size enough that the second ultrasound could not see it, which would explain why it was not seen.

The second possible explanation was that an inadequate ultrasound was done and so the fetus was not seen.  Sometimes the fetus can move against the wall of the gestational sac and be less visible, especially at that stage.  Again, a 6+ week fetus is very small and barely visible.  For that reason, I don't make decisions on viable at that stage.  I give it a little time to see if it grows or not.  Waiting until 7 weeks gestational age can make a big difference in term of size.  I also don't recommend D&C's as the first option because most people at 6 weeks will have a natural miscarriage that is more like a heavy period so that the invasive procedure is not required.

Now, as I've shown there could be conflicting advice between what I've said and what your doctor's said at the time.  This is just a differing opinion and not meant to be the gold standard of care.  Their decision and protocol, though differing from mine, is still an acceptable method.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


All Answers

Answers by Expert:

Ask Experts


Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

©2016 All rights reserved.