My First Ultrasound

So I finally got an ultrasound today. I was incredibly excited to learn that the pregnancy was in my uterus this time but am still a little worried that they still didn’t see a yolk sac or a heartbeat. I’m sure it’s just that I’m too early to see it but I can’t help but be anxious. The ultrasound tech was really positive and I left feeling really good about it, but then I read the dr’s report online and became a little more discouraged. Here’s the report:

 

CLINICAL HISTORY: 26-year-old pregnant woman (gravida 2, ectopic
1) with regular, 28 day cycles and confident menstrual dating
(last menstrual period: 1 June 2010, 7.1 weeks ago) whose study
is performed to confirm intrauterine gestation. No prior
comparison IHC Urban Central Region imaging during this
pregnancy. Maternal serum Beta-hCG value is reportedly about
4,147 mIU. The patient believes she ovulated "late", she expects
to be about five week size.

PROCEDURE: High resolution real time curved array 5.0 megahertz
contact harmonic imaging of the pelvis is performed through a
distended bladder in longitudinal and axial planes. After
obtaining informed consent and in a standard fashion
supplementary endovaginal curved array 8.0 megahertz imaging was
also performed. Our study included permanent storage of recorded
images. I discussed the findings with Dr. Hebert, attending
obstetrician. We obtained the following pertinent measurements:

Average Chorionic Sac Diameter: 1.4 cm, 6.1 weeks

FINDINGS: Midline anteverted uterus measuring 8.6 cm longitudinal
x 3.7 cm anteroposterior x 4.2 cm transverse. Myometrium is
homogeneous and normal in sonographic appearance and
symmetrically surrounds a solitary fundal extra endometrial
intrauterine chorionic sac with sharply defined smooth margins.
Within chorionic sac I define what appears to be a solitary
normal appearing yolk sac. I do not yet define embryonic pole or
cardiac activity during our bimodal study. No chorioamniotic
separation or extra chorionic blood. The surrounding decidual
reaction is homogeneous and normal in sonographic appearance.
Sonographic size 6.1 weeks, the patient expects about five week
size by ovulatory dating, menstrual dating 7.1 weeks. At this
early point in pregnancy I am unable to accurately predict
placental distribution, exclude previa or assess cervix. Amniotic
fluid volume within the chorionic sac is normal.

No free pelvic fluid. Normal posterior cul-de-sac. Adnexal
dimensions on the right are 4.0 x 2.7 x 2.2 cm; the left measures
2.1 x 2.9 x 1.5 cm. Ultrasound is not and cannot be tissue
specific but the sonographic appearance of each ovary is normal;
characterized by small peripheral sonolucencies, usually
follicular cysts (the largest is on the right and measures 16 x
13 x 20 mm, average: 1.6 cm, likely corpus luteum cyst of
pregnancy). Color flow Doppler evaluation confirms blood flow at
each ovary; torsion or ischemia are less likely.

IMPRESSION:

1. I document a solitary fundal intrauterine extra endometrial
likely chorionic sac with an apparent yolk sac. Sonographic
morphology is normal for early gestation, by standard criteria.
My identification of likely intra uterine chorionic sac makes
coexistent ectopic gestation less likely.
2. Sonographic size 6.1 weeks, expect about five week size
(according to the patient's estimate of ovulatory dating),
menstrual dating 7.1 weeks; reflecting relatively good agreement.
Our findings are discrepant with maternal serum beta-hCG values,
this is a troublesome finding for pregnancy continuation.
Additionally my inability to define embryo or cardiac activity
with a six-week sized gestational sac is of concern for pregnancy
failure. Please correlate with serial maternal serum quantitative
Beta-hCG values and, if indicated, consider followup imaging,
best if no sooner than ten days to two weeks from now.
3. 1.6 cm right adnexal apparent corpus luteum cyst of
pregnancy.
4. Please see above for additional details and discussion of
today's evaluation.

 

Long, I know but informative nonetheless. I’m hoping that I will get another ultrasound in another week or two and we finally get to see the baby on the screen and hear the heartbeat. Nothing would make me happier! Until then, it’s back to worry…