Exactly What Does No Gestational Sac on my small Ultrasound Mean


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If a gestational sac is not seen on an early pregnancy transvaginal ultrasound by around 5 weeks gestational age, there are several things that could be occurring. If a gestational sac is not visible, it could mean that: It is too early in the pregnancy. The.

If one cannot identify a yolk sac at a mean gestational sac diameter of 16-24 mm, this is suspicious for, though not diagnostic of a failed early pregnancy. Seeing no yolk sac on an ultrasound at this stage of pregnancy could simply mean the fetus’s gestational age may have been miscalculated. This can happen if you made an error in remembering when your last period was or if you have irregular menstrual cycles. Not Seeing Gestational Sac on Ultrasound. If it has been five weeks since your last menstrual period but your hCG level has not been measured, there is a possibility that seeing no gestational sac simply means that you ovulated late and your pregnancy has not yet reached 5 weeks gestational age. Your physician may order a follow-up ultrasound in a few days or a week.

Ultrasound showed empty uterus besides ovarian cyst and thick lining. My doc said both are common in early pregnancy but that you can usually see a gestational sac by 5 weeks. Tested positive 9/18, got 2-3 weeks result on test 9/20, and tested positive again today.

I either 1) am too early to see gestational sac, 2) am miscarrying (again), or 3) it could be ectopic. An Error in Timing In very early pregnancy, especially during a first ultrasound, a smaller-than-expected gestational sac could simply mean that the pregnancy is earlier along than you expected based on the date of your last menstrual period. In some cases, a gestational sac is not seen at all.

The most common reason for this is inaccurate dates or it is simply too soon. If a gestational sac is not seen on a follow-up scan, or if your hCG levels indicate one should be seen, it can be a sign of a miscarriage or ectopic pregnancy. Especially if a woman had early pregnancy bleeding or other miscarriage symptoms leading up to the ultrasound, a finding of no gestational sac may mean that she had a very early miscarriage (chemical pregnancy) or that the pregnancy tissue has already left the uterus.

The gestational sac is the structure surrounding the fetus early in pregnancy and its shape early in pregnancy (usually before 8-10 weeks) is important. Ideally, the gestational sac should be round. But other shapes can also be normal, and there is no sure way of predicting what it means. An empty gestational sac is a cavity within a uterus that forms to house a pregnancy but the embryo has stopped growing. This means that a fertilized egg was capable of implanting within the uterine wall to signal a pregnancy, but the embryo does not continue to develop and the pregnancy fails to progress.

It is an early form of miscarriage.

List of related literature:

Yolk sac abnormalities The absence of a yolk sac on transvaginal ultrasound, when the gestational sac diameter is 8 mm or more, is a sign of failed pregnancy.

“Differential Diagnosis in Abdominal Ultrasound, 3/e” by Bisset
from Differential Diagnosis in Abdominal Ultrasound, 3/e
by Bisset
Elsevier India, 2008

Normal intrauterine pregnancy—gestational sac with yolk sac: Transvaginal ultrasound.

“Diagnostic Imaging for the Emergency Physician E-Book” by Joshua Broder
from Diagnostic Imaging for the Emergency Physician E-Book
by Joshua Broder
Elsevier Health Sciences, 2011

• Mean gestational sac diameter of at least 25 mm and no embryo.

“Manual of Obstetrics E-book” by Daftary, SUDIP Chakravarti, Muralidhar Pai, Prahalad Kushtagi
from Manual of Obstetrics E-book
by Daftary, SUDIP Chakravarti, et. al.
Elsevier Health Sciences, 2015

Absent yolk sac or embryo on TVS when the gestational sacis 25 mm suggests an empty sac miscarriage (also referred to as a blighted ovum).13 Other sonographic signs of poor prognosis for continued pregnancy exist, but they are generally beyond the scope of emergency ultrasound.

“Textbook of Adult Emergency Medicine E-Book” by Peter Cameron, Mark Little, Biswadev Mitra, Conor Deasy
from Textbook of Adult Emergency Medicine E-Book
by Peter Cameron, Mark Little, et. al.
Elsevier Health Sciences, 2019

Empty uterus (i.e., no yolk sac or fetal pole; a pseudosac in uterus may appear similar to a gestational sac).

“Ferri's Clinical Advisor 2019 E-Book: 5 Books in 1” by Fred F. Ferri
from Ferri’s Clinical Advisor 2019 E-Book: 5 Books in 1
by Fred F. Ferri
Elsevier Health Sciences, 2018

With ultrasound examination alone, a normal gestational sac can often be distinguished from an abnormal sac doomed to miscarriage, even before the embryo is visible.

“Pfenninger and Fowler's Procedures for Primary Care E-Book” by Grant C. Fowler
from Pfenninger and Fowler’s Procedures for Primary Care E-Book
by Grant C. Fowler
Elsevier Health Sciences, 2019

A distorted or large yolk sac is associated with pregnancy loss.

“Comprehensive Gynecology” by Gretchen M. Lentz, David M. Gershenson
from Comprehensive Gynecology
by Gretchen M. Lentz, David M. Gershenson
Elsevier Mosby, 2012

• A sac of 20 mm MGSD on transvaginal scan lacking a yolk sac or an embryo is a failed pregnancy.

“Clinical Ultrasound, 2-Volume Set E-Book: Expert Consult: Online and Print” by Paul L Allan, Grant M. Baxter, Michael J. Weston
from Clinical Ultrasound, 2-Volume Set E-Book: Expert Consult: Online and Print
by Paul L Allan, Grant M. Baxter, Michael J. Weston
Elsevier Health Sciences, 2011

A distorted or large yolk sac, greater than 7 mm, has been associated with pregnancy loss.

“Comprehensive Gynecology E-Book” by Rogerio A. Lobo, David M Gershenson, Gretchen M Lentz, Fidel A Valea
from Comprehensive Gynecology E-Book
by Rogerio A. Lobo, David M Gershenson, et. al.
Elsevier Health Sciences, 2016

If an empty gestational sac is seen within the uterus, it may represent a very early intrauterine pregnancy, particularly if the diameter of the sac is 10 to 20 mm.

“Essentials of Radiology E-Book” by Fred A. Mettler
from Essentials of Radiology E-Book
by Fred A. Mettler
Elsevier Health Sciences, 2018

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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  • Awesome video!!! I just found out I’m pregnant with #2 after a chemical pregnancy! Check out my journey here https://youtu.be/f2lwbMutyDM

  • Hey Sam! Nice video. M going through something similar. It’s 6 weeks and there is a gestational sac..but no foetal pole..m very upset.. what shall I do? Next 10 days another scan there..

  • I also going throught this right now. Per my doctor im in my 5weeks 2days. I just had my ultrasound 2days ago but sonologist said they cant see the baby and i have also free fluid in my right ovary.

    And what make me sad more is she saw a Csyt in my right ovary. I was so devasted that im so lost while having ultrasound.

    Im having a bad cramps for the past 2 weeks. That made me took a pregnancy test (4x all positive) and see a doctor. But so sad that they cant see my baby.

    And now im questioning myself if im really pregnant or that cyst are causing my cramps.

  • My UPT is positive yesterday after an IUI and im having the similar abdominal pain with free fluid in my abdomen. They suggest to repeat scan again in 1 week time

  • I also went to doctor at 4+2 and they didnt see nothing at the uterus but told me that everything is ok. A few days after i need surgery because is an ectopic pregnancy and lost my right tube. Maybe you were worried with no reason but the doctors are very professional in your case.

  • I am going through exactly this!! Blood test confirmed pregnancy at a HCG of 170. Started bleeding and went for a sonogram at 4 weeks. Dr immediately said either a miscarriage or ectopic pregnancy because he can’t see anything. Went for follow up blood work and count went up to 390 in 24 hours. Going for more bloodwork in 2 days and new sonogram at 6 weeks. I was balling my eyes out cause of my dr having absolutely no hope even before seeing the new bloodwork. Staying positive until we go for new sonogram. What a scary few days!

  • This video really helped me. Because it was so similar to my situation. I was feeling cramps, chills and lower back pain. I was told to go to ER by the urgent care clinic I went to. They did an ultra sound and found no gestational sac. I’m only about 3-4weeks. With an hcg of 1,900. I have to do the waiting game and go back to have my levels checked in 2 day. I’m so stressed and sad. So this video helped calm me a little. Thank you!

  • Currently going through a similar thing, my doctors DO NOT know what is going on I am freaking out, but I pray I get blessed like you did! ��

  • Love your video but the background music too loud�� ��. I’m going through the same situation with the sonogram. Thanks for the video����

  • I went to the doctor today and im 7 weeks 5 days. I also had the same situation. 9mm sac but no baby. Doctor said to test my hcg through blood and said to come in 10 days. Im a little upset but have a hope. I also have sore breasts dizziness.