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Monday, October 10, 2005

Miscarriage

Dr. Amy,

My daughter-in-law is pregnant and scheduled a doctor appointment with her OB/GYN. When they arrived, she was given an ultrasound, with the internal Doppler. According to her calculations, she was six weeks, but according to the doctor's calculations, they said she was eight weeks. The yolk sac was intact according to the doctor, however, no heartbeat was detected. The doctor stated to her and my son that they were to come back in two days and decide what they wanted to do, because she was sure there would be no change.

They were devastated to say the least, since she didn't explain any of her reasons as to what she was basis her information on. Since there was a discrepancy between the doctor's calculations and their calculations, is it possible that the reason they did not hear the heartbeat was because it was too small?

My daughter-in-law had a miscarriage a little over a year ago, but she was only three weeks along, and didn't even know she was pregnant. Since this doctor visit, she has had a little cramping and light spotting, but I think some of it is due to the stress by the doctor's suggestions that she have a D&C. They are scheduled to go back to the doctor this week, which according to their calculations, she will be 8 weeks. Just to reassure them, what should they be able to see and hear at 8 weeks? If they do not hear a heartbeat by internal Doppler at 8 weeks, does that mean there is a problem?

I am wanting them to seek a second opinion if this doctor is still insisting on a D&C. What do you think?

Concerned Grandma

Dear Concerned Grandma,

Before a D&C can be done, it must be proven that this is a miscarriage. Your daughter-in-law should insist on blood tests to check HCG (pregnancy hormone) levels. In a normal pregnancy, the HCG levels will double approximately every 48 hours. If the HCG levels are not rising appropriately, the pregnancy is not normal.

The discrepancy between your daughter-in-law's calculations and the doctor's calculations may be due to the fact that your daughter-in-law is counting from conception, while the doctor is counting from the first day of the last period (the standard measurement of pregnancy). You should be able to see the heartbeat between 7-8 weeks of pregnancy (5-6 weeks after conception).

Stress does not cause spotting or cramping, so it is possible that these are additional signs of miscarriage.

Sincerely,

Amy

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