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No Fetal Heartbeat on Early Ultrasound. Is There Hope?

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Updated November 24, 2008

Ultrasound

Seeing the baby's heartbeat on an early pregnancy ultrasound can be reassuring, but seeing no fetal heartbeat does not always mean miscarriage.

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Question: No Fetal Heartbeat on Early Ultrasound. Is There Hope?

Seeing the baby's heartbeat on an early pregnancy ultrasound is one of the surest indicators that a pregnancy is proceeding as it should; in general, the risk of miscarriage is much lower once the pregnancy has reached this point. But what does it mean if you go in for an ultrasound, and there's no fetal heartbeat? Is it a miscarriage?

Answer:

The answer is: maybe. If you are not yet six or seven weeks pregnant, it is normal to not see a heartbeat on an ultrasound. Using a transvaginal ultrasound, the developing baby's heartbeat should be clearly visible by the time a woman is seven weeks pregnant. Abdominal ultrasound is considerably less sensitive and it can take longer for the heartbeat to become visible on an abdominal ultrasound. So if you are only four or five weeks pregnant, you should definitely not worry about not seeing a heartbeat on the ultrasound.

If you are past seven weeks pregnant, seeing no heartbeat might be a sign of miscarriage -- but it may not be definite. In early pregnancy, being off by a few days with your estimated last menstrual period -- or having an irregular ovulation pattern -- can make a difference in whether or not you should see a heartbeat on the ultrasound. For example, if you did not ovulate exactly two weeks after your menstrual period started, there is a chance you are not really "seven weeks pregnant" in gestational age even if it has been seven weeks since your last menstrual period. In this situation, unless your doctor has other evidence to make a firm diagnosis, you will probably be asked to wait a week and come in for another ultrasound.

Sometimes a lack of a fetal heartbeat does definitely indicate miscarriage, however. These situations would include:

  • Having previously seen the heartbeat but finding no heartbeat on a subsequent ultrasound
  • Seeing no heartbeat and having falling hCG levels
  • Having a followup ultrasound after a week and detecting no change
  • Having other ultrasound measurements that indicate a heartbeat should definitely be present

Having to wait for word on whether you're miscarrying is understandably difficult and may be one of the hardest weeks of your life, but it is definitely better to be absolutely sure before getting a diagnosis -- especially if there is discussion of having a D & C, a commonly recommended treatment for miscarriage.

Similarly, if your doctor is recommending a D & C after one ultrasound and you are not 100% sure that it is the right choice, you should discuss the matter with your doctor and possibly ask for a followup ultrasound. You need to feel at peace with your decision one way or the other, and you do not want to be second guessing your choices years from now.

Source:

American Pregnancy Association, "Concerns Regarding Early Fetal Development." American Pregnancy Association Oct 2008. Accessed 15 Nov 2008.

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  4. Symptoms & Diagnosis
  5. Diagnosing Pregnancy Loss
  6. Ultrasounds
  7. No Fetal Heartbeat - Miscarriage No Fetal Heartbeat on Early Pregnancy Ultrasound

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