8w6d Scan - Heard heartbeat but couldn't see embryo

[ireadyermind]

Hey, all. I'm hoping you ladies will have some insight for me, or maybe shared experiences. Thanks in advance.

A little backstory: at 6 weeks 2 days I was scanned by my infertility clinic, where we saw the little embryo and heard a healthy heartbeat of 119bpm. The clinic then released me to my regular OB.

Fast forward to yesterday, I went in for my scan at my OB's office. She used the vaginal probe and immediately found a healthy heartbeat (she would not tell me the bpm), but could only barely see the embryo and could not find its fetal pole for measuring purposes.

The OB tried guessing at the CRL a few times, but always came up with measurements that were too far behind, like 7w4d, when I was 8w6d. All we could see on the screen was a foggy, vague embryo shape - though strangely the yolk sac was crystal clear.

After several minutes she gave up, and I was told that if I wanted to see the embryo, I could make an appt with the specialty ultrasound dept, which has higher quality machines - but also demands out of pocket payments. After contacting the ultrasound department, I learned that there are no available appointments until Nov 30th!

So now I'm a little nervous.

Should I worry about my little bean not growing properly? Or is the healthy heart rate a better indicator of fetal viability than the CRL is? I've Googled this topic to death, and all I can ever find is info pertaining to embryos WITHOUT a heartbeat, and that's definitely not my problem.

I'm hoping you ladies will have some input on the matter, because I could really use some reassurance. Thanks again!

 

[MindUtopia]

That sounds strange to me. I'm wondering if perhaps the OB doing the scan wasn't very experienced and didn't know what they were looking for. I've had an 8 week ultrasound (abdominal and vaginal) and on the vaginal one, it was crystal clear. I could see a little baby with hands and legs and I could even see the indents where the eye sockets were. This was on a standard ultrasound machine, nothing fancy. I've also had one done previously with a pregnancy that wasn't viable at 8 weeks when baby measured only 5 weeks and even still was clear to see and she could get CRL measurements. There should be no reason she shouldn't be able to get a decent image vaginally at 8 weeks (unless the pregnancy was ectopic and wasn't actually in the uterus, which I assume has been ruled out if they can see a yolk sac there). I would push to go back for another appt with your OB and ask for a different person to do it, make the argument that you can't get an appt with the other place. Do you have another regular u/s scheduled sometime soon? I expect they would want to see you at 12 weeks anyway, but maybe you can argue for it sooner. A healthy heartbeat is a good sign, but I would personally be worried that she was picking up your heartbeat if she couldn't even manage to find baby very well. I'd be concerned she didn't really know what she was doing.

 

[Talia12]

I agree with pp. Sounds like a problem either with the machine or with the technician. Did you hear the heartbeat yourself? If so, was it definitely baby's? If you're sure on that then I'd be reassured that it was potentially just a problem with the machine, but I can't understand why the tech wouldn't flag that up. Definitely ask for another scan. Whatever the purpose of that scan was, they didn't fulfil it, so if you needed one before then you still need one now, if that makes sense.

 

[minties]

Here the people who do ultrasounds are trained technicians, and if they have a hard time seeing something or figuring something out, they bring in a more senior/experienced staff member into the room. I don't know anything about what an obstetrician does, but imagine it is more along the lines of a doctor crossed with a midwife? So I don't expect them to be a master of sonography.

 

[ireadyermind]

Thanks, ladies.

The ultrasound was not done by a tech, it was done by my OB herself. The image was way off to the side of the screen, and she didn't even move the wand much. We could see the flickering heartbeat just barely, but as I mentioned, she couldn't find the fetal pole.

I did hear the heartbeat myself, and I'm certain it was the baby's. I compared my own heartbeat to it as we listened to make sure.

She did say it was a very old machine, too. I have to wonder why they keep it around, in that case! Women needing dating scans can't get accurate dates on dinosaur aged ultrasound machines!

I've had several calls back and forth with the specialty ultrasound dept, and it sounds like they can squeeze me into the schedule tomorrow instead of making me wait until Nov 30th.

Also - minties: you're correct, an obstetrician is sort of like a cross between a midwife and a gynecologist. They handle all prenatal care, gynecological care, AND labor and delivery.

 

[Talia12]

Really glad you're getting a scan so soon. I hope you get good news. It's definitely promising that you heard baby's heartbeat - got to have been something wrong with the screen, it doesn't make sense that there was a heartbeat there but nothing visible. Update us if you can!

 

[ReadynWaiting]

I came across sites a few years ago that talked about OBs purchasing U/S equipment to have in their office but aren't trained fully on them. It makes a huge difference in machine quality and tech ability. I'm glad to hear you can get in tomorrow.

 

[ricschick]

I'm glad you have an appointment I'm sure all is fine! Xx

 

[veganmum2be]

That sounds odd! I've heard OB's sometimes aren't the best at doing the scans, the techs are.
Glad you have another scan!

 

[minties]

Wow - Jack of all trades, master of none type thing? I have never met a gyno in my life, isn't it weird how we do things so differently from country to country.

If there is a heartbeat, there must be a baby. I will be following!

 

[ireadyermind]

Thanks for all your words of encouragement, ladies. It looks like the OB really didn't know what she was doing, because my little bub is doing just fine! Measuring at exactly 9w1d and a heart rate of 176bpm.

I'm so relieved!

 

[ricschick]

Oh that's great!!!

 

[Talia12]

Ahh so relieved for you!

 

[ReadynWaiting]

Great news!

 

[veganmum2be]

Great news!

 

[Bevziibubble]

That's great news! You must be so relieved

 

[Bumpontherun]

That's great news...but- this is private health care that you are paying for right? If the OB can't work the scanner she shouldn't be offering the service and should be employing a technician to do that part of your care. How do you know the rest of the care she is offering isn't suboptimal. If it were me I would switch to a different doctor.

I'm in the uk where care is totally different but I find her behaviour quite unprofessional.

 

[ireadyermind]

That's great news...but- this is private health care that you are paying for right? If the OB can't work the scanner she shouldn't be offering the service and should be employing a technician to do that part of your care. How do you know the rest of the care she is offering isn't suboptimal. If it were me I would switch to a different doctor.

I'm in the uk where care is totally different but I find her behaviour quite unprofessional.

There's so much more they've already screwed up since the start of this pregnancy, including misdiagnosing an ectopic pregnancy despite there being absolutely no reason to suspect one. My HCG levels were excellent, I had no pain or bleeding, etc. but the OB couldn't find my embryo at 6 weeks and dubbed it ectopic right off the bat. She called their emergency folks and told them I was having pain and bleeding, and that I needed an emergency diagnostic ultrasound. I ended up paying for a private scan and they had no trouble finding my little bean and its heartbeat right away.

Unfortunately the insurance plan we currently have only allows us to use doctors within a network, and the nearest network ob office is where I am being cared for now. This company is more like a retail business than a healthcare company. They run their offices like assembly lines, getting patients in and out as quickly as possible, with the least amount of effort they can manage. The OBs do not have ultrasound techs in their office, and all their machines are ancient and low resolution, because it's cheaper than paying for good machines and the hourly wages of dedicated ultrasound techs.

They have all kinds of ridiculous rules - for example, even though I have a history of low estrogen & progesterone, and previous miscarriages, my OB was not ALLOWED to prescribe me supplements because she doesn't work in the infertility department. I had to go pay out of pocket for a 3rd party to examine my bloodwork/records and prescribe hormone supplements so I could prevent another loss.

They're similar to retail in that there are limited locations where you can access services, and if the nearest location doesn't offer something you need, oh well. Drive 1 hour or more to get treatment, or do without.

It's like needing to go shopping at walmart or tesco. You might have one down the street from your home, but imagine if what you needed was a new car, and Tesco or walmart were your only options for shopping. Since they don't carry cars for sale - too bad for you!

Or let's say your nearest location DOES sell cars, and you go in and ask the only person on the sales floor that you can find to sell you a car. And the salesperson says, "Well I can see you need a car, and are indeed qualified, and I am also qualified to sell them, but I can't sell you one. I am only allowed to sell sandwiches this week. Would you like a sandwich?"

That's this company. I hate it.

But we can't change insurance until November, and the new plan won't go into effect until January 2018, so for now I'm stuck! And I keep having to get second opinions on EVERYTHING. I do not need this kind of stress.

 

[Talia12]

That is so crappy. Thank god for the nhs here.
At least your new insurance plan thing will be in place before the baby's due!

 

[Bumpontherun]

That sounds awful. Poor you- pregnancy is a stressful time without having to put up with that. I guess the positive side is that your baby is thriving so fingers crossed everything goes smoothly and you have to see her as little as possible!