Exactly What Does No Gestational Sac on my small Ultrasound Mean


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4 Weeks Pregnant | Early Ultrasound and Ectopic Pregnancy Scare?

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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.

  • Hello I’m in 4 week, just went for ultrasound but too early to see a little baby. I’m really anxious at the moment. Which supplement did you take around this early stage? Lots of love ❣️

  • Same happen to me.. ive done ultrasound today, doctor didnt see anything make me depress after i watch your video make a bit of relief im hoping the baby will be visible after 1 week ����

  • Hi..
    I’m scared as hell.
    After my miscarriage which was 5 years ago, finally I conceived.
    I had my ultrasound today n my doctor says I’m 4 weeks n 6 days.
    We jus saw a sac only.
    I thought I’m 7 weeks. But my doc confirmed I’m 4w6d.
    I’m sooo scared I dont wanna loss this one. Having my appointment in next 2 weeks hope a miracle happens….

  • Hi everyone.. i just had ultravaginal earlier because im bleeding but it stops and it came back. my ob gyne said that im in early pregnancy i am bleeding but may cervix is closed and there is no sac.. is it really possible that i am pregnant? I tried pregancy test 5 times and its positive after i bleed i tried again and its positive.. i am super stress right now i hope you can give me some advice from your experience

  • Hope everything goes well. I am surprised they did an ultrasound so early! You must have just missed your period! 4 weeks is really only 2 weeks after have sex and getting pregnant and 6 weeks would just be 2 weeks late. Don’t worry. The embryo at that stage is only about the size of a sesame seed. SUPER tiny and hard to see even with a sonagram. I think sometimes the sonagrams give us more fear and anxiety than we need. Good luck on your pregnancy.

  • I’m going through this right now… it so funny how my dates are not adding up to what I thought I was.. I go tomorrow for my hcg blood test again…. I can’t wait

  • Hello im 6weeks and 3days pregnant by now but they only see a very very small gestational sac☹️ I hope by next month I’ll see my baby

  • I’m going to my first sonogram tomorrow hoping everything is ok I have been cramping (hear it Normal) but I’m praying I’m not overthinking

  • I went to the Emergency room last night for cramps (already knowing I’m pregnant but not knowing how far along I am my first ob appointment is about 20 days from the day I went to the ER) they did an ultra sound and told me they couldn’t see anything and I started freaking out they were telling me it is normal I was getting scared how could that possibly be normal?! ; I’m having cramps and now they can’t see my baby?! Turns out I’m only 4 weeks today, after watching your video I’ve decided to keep my first ob appointment date even though it’s a ways away so I can actually have something to see. Thank you so much for you video.

  • I thought I was 7/8weeks but my hcg is 150. The drs did a ultrasound and didn’t see much. They say maybe I’m 4/5weeks. And they can’t rule out ectopic pregnancy, so I’m stressed. But no bad cramps or anything bleeding besides spotting.:( I get tested in a couple days to see if my levels go up.

  • wow same like me. on the 23rd oct, i was having like the worst cramping ever. and i thought im going to get my period. then i went to emergency and found out that im positive. i was shocked and ofcourse happy. but they admitted me to ward and scanned me and saw nothing like gestational sac and whatsoever. so they made a decision to take my blood hcg which is in 48hrs. and thank god its doubling from 757-1568. first they thought im going to get the ectopic pregnancy. when the blood result came out, they said its a good sign. but still cant see anything. so i need to wait for a week. after a week, they scan me, finally gestational sac is there and no yolk sac yet. early pregnancy.

  • I had ruptured tubal at 5 week 3 days last year,i dont had any symptoms to say that it was ectopic…and i never had early pregnancy scan as i wanted to wait at 6weeks….

    Now that i have one tube, i did my early scan at 4 weeks,but of course you cant see thing,so we wait 5weeks scan next week..we are praying this time will be a normal and healthy pregnancy��

  • I had my appointment at 4weeks last Thursday ( I think I’m 4weeks). And she said she didn’t see anything. I got crazy scared about the situation but she did a HCG test and I was just 250 and it turned out I’m super early. Will wait until next week to check again and your story gave me hope and I’m praying for the best!

  • Omg thank you for posting this and congratulations on your birth! My Bf and I went to the hospital last week and they told me I miss carried and to follow up with the Dr. within 1-3 days it took me about a week to get an appointment setup and they were setting me up to remove “whatever was left” of the pregnancy because my hCG levels were too low at the hospital a 600ml. Took my blood and today they were at a 6,000ml and we seen a yolk sack and we had to reevaluate when we conceived. Very hectic and stressful week! Omg so scary! Have hope and faith and DONT GO TO A HOSPITAL FOR ULTRASOUNDS!

  • I thought I saw 2 sacs with 2 babies honestly. Trans vaginal would’ve been a lot better! I wouldn’t worry! At your doctor they wouldn’t of even gone abdominal yet as it’s still early for that plus you say you’re plus size so that could also play a big roll in the abdominal! Don’t sorry I’m sure everything is fine since you haven’t bled and your tests are very dark❤️

  • I don’t see anything. But unless your extremely thin you will not see anything on a Us unless it’s vaginal. I’d be upset they even took you back and your money. I’m sorry. I understand and would be alarmed too. When’s your next doc visit?

  • hi do you experience vaginal bleeding for along time,like just 2-3weeks?. i have the case like you,im also concetn about i have a ectopic pregnancy.. my doctor said that im possibly having that case.

  • Girl.. how did you get an ultra-sound at 4 weeks (2 weeks post conception)?

    Im 6 weeks (4 weeks post conception) and im being told i have to wait till im what like 9-10 weeks.. thats crazy and messed up. Im FREAKING OUT.. I WANT TO KNOW WHATS GOING ON INSIDE ME.. OMG.. I WANT MY HCG levels and i want to know if baby is in the right place.. god i hope so..

    My home pregnancy test get darker and darker.. every 2 days i test but i wont anymore cause its nerve recking. Is that a good sign though? A line that gets darker? Any advice is so helpful.

    Also sorry enough about me, your story is very helpful.. glad everything worked out ok..

  • Was the tech very experienced? Depending on how experienced they are maybe they didn’t look hard enough? I’m just glad that your ultrasound is tomorrow so you know one way or another. I hope that you get good news and they are able to explain what happened and what’s going on. I’m always shocked at the quality of care at military hospitals. Should be the best care!

  • I’m 3 weeks and some days and they scheduled me for prenatal visit ASAP because at emergency room my blood pressure was high and they did an ultrasound and saw a lil sac and my baby is in the right spot.The nurse practitioner scared me after I told her I had some bleeding so that’s how I got my ultra sound but everything is so far so good.I’m glad everything went well.

  • omggg.. we have the same situation.. i have a also a free fluid on my abdomen.. and iam feeling scared.. my p.t was positive i got utz yesterday and no baby was found on my uterus only the free fluid..������

  • Thankyou for explaining the free fluid, I had the exact same issue and when they were explaining free fluid it was confusing �� and I couldn’t find any info on it anywhere, it’s because most women go 6+ weeks plus so they’ve already past that stage

  • Hello. Thanks for sharing.. before three days i have positive hpt.. bht doctor said that there is only a dot in ultrasound.. and may be its too early. Can u tell me am pregnant?? I already missed my periods and 8 days late

  • Hi I saw ur video coz I am experiencing thesame right now,im hoping that its just too early to see the baby. �� may I just ask if you also experience severe cramping during ur 1st tri?

  • I’m going threw the same thing. But my Hcg levels were 1,800 when I had my first ultrasound and seen a tiny pregnancy sack. but the doctor told me it could be ectopic or just be a normal pregnancy. That’s why she wanted to do more blood work. I thought I was 7/8 weeks pregnant but turns out I was only 4 weeks. So my doctor wanted me to take another test for my hcg 2 days later and they told me that the hcg levels went up a lot to 4,680. I had some spotting but very very light for 2 days and it stopped. And so I was about a week and half since my first ultrasound and my doctor wanted me to get another hcg test done again and my levels went up to 40000 which it supposed to be at 6 weeks which I am now. Today I have another ultrasound so wish me luck.

  • I agree with the other comments regarding checking transvaginally. However, an 8 week fetus can be seen abdominally if the bladder is full, patient is not extremely overweight, and the uterus is tilted towards the bladder (anteverted uterus). Hope t all goes well for you. I’m an OB/GYN sonographer and do these exams all the time on all sorts of patients. We always check abdominally first and then vaginally when the fetus is under 10 weeks. I also make make videos on sonography, check them out. I may have a video that interests you.

  • Hi Gurl, I had this same exact news today and I’m freaking out. What was the reason why your were less weeks than expected? Did you ovulate late? How are you doing now? Please let me know. Thanks!!!

  • we really have the same situation.. you really gave me hopes. im too worried bcoz this is my 2nd pregnancy ive lost my baby 8months at my tummy. thats why i felt scared to my 2nd now. they couldn’t find any sac and baby. and had alot of fluids and my ob thinks i have ectopic thats why i still need to wait more weeks to check again maybe im still too early..

  • Literally just experienced the same thing yesterday, just without the free fluid. Def gave me a sense of relief to hear that Im not alone! The Doctor told me the same thing that I could either be really early or ectopic or a miscarriage. Praying that my levels go up and we see baby on the next ultrasound!

  • Thank you to everyone for your continued love and support as we start this new chapter in our lives! Are you pregnant as well? What type of early pregnancy symptoms did you have?

  • I went to the er because I was confused. I had an ultrasound 2 separate sacs. One empty sac was 5 weeks. The other sac is 6 weeks. Heart beat 120mph. Twins run in my family. My blood was drawn. I have received no call. My blood is rh negative. I’ve been scheduling ultrasound appointments I am now 9 weeks and I just want to know how its going. I keep getting blood drawn and no one is answering or calling me back. I am scared but I am hoping for the best. I’ve been researching all night and I was researching again before. The only thing I heard back in an appointment is that I had a miscarriage but nothing passed through. I’ve only had pink little dot spots and nothing else. But that’s why I had went to the er I thought it was my period. So now I’m just giving it to god to help me during this journey. My first pregnancy and I am 20 years of age. I’m trying to see the positive outlook on this. I have regular symptoms as of nausea tiredness dizziness I get light headed getting up fast or running to the bathroom. Please if you ever read this comment please help me pray ��. I have no support from family or anyone. I am latino descent and my baby is half moreno. I am a single parent, my significant other left me when I told him I was pregnant. Help me pray I get through this. ❤❤

  • With my little Emsley there was nothing there at 5 weeks 5 days, but next week a baby and sac measuring exactly correctly with a HB. My doctor literally pulled up my last ultrasound like what the heck �� Turns out I have a tilted uterus and it makes everything hard to see early on. I blame the twins lol.

  • Thanks for sharing I current going through this scare rt now two different doctors saying different things one say I was 5 weeks 2 daystbe other say 4 weeks and it’s to early to see anything on ultra

  • I’m pregnant got by scanning today same thing doc said gestational and no yolk sac and then doc told sorry it’s failed pregnancy as gestational sac is 7mm

  • trans is better specially for us plus size beauties cant see til 14 weeks. I yhought I saw baby but she should of done trans right then n there