This question was answered on Thu 06, May 2010 05:54am by Dr J Singh

i went to get an ultra sound last monday becuase i am not sure of dates. in the ultra sound there was a 9mm gestational sac but no yolk sac or anything else to see. i was told to come back in 2 weeks to see if it could be a blighted ovum. what i want to k

    
Asked by chamika (Female; 24 ) on Thu 06, May 2010 12:58am

i went to get an ultra sound last monday becuase i am not sure of dates. in the ultra sound there was a 9mm gestational sac but no yolk sac or anything else to see. i was told to come back in 2 weeks to see if it could be a blighted ovum. what i want to know is - when i was pregnant with my son at 7 weeks and 2 days i had a gest sac of 6.7mm with a visable yolk sac so if im furthur along in my measurements (this time being 9mm) wouldnt that make me more than 7 weeks?

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Answer by Dr J Singh  on Thu 06, May 2010 05:54am:

Hello, Welcome to the forum. I can understand your concern the way things have turned up. It is true that the wait seems endless for the next ultrasound. As defined in Wikipedia, gestational sac(GS) is the only available intrauterine structure that can be used to determine if an intrauterine pregnancy (IUP) exists, until the embryo is identified. The gestational sac first appears at about 4 weeks gestational age, and grows at a rate of about 1 mm a day through the 9th week of pregnancy. As the sac is not usually round, an average of the length, width and depth is made. The acccuracy of dating using GS size is low and can be off by a whole week. In some women it can first appear at about 5 weeks gestation. At 4 weeks gestation, the length of gestational sac is between 3-6 mm and at 5 weeks gestation, it may be 6-12 mm. This can be +/- 1 week. A chorionic sac that is smaller than 5 mm at 5 weeks' gestation could be the first sign of abnormal gestational development. Since your gestational sac measures 9 mm, so it corresponds to 5 weeks gestational age. At 7 weeks gestation, the size of gestational sac varies from 14-25 mm. Last pregnancy you had a gestational sac with a visible yolk sac, so the crown rump length might have been taken to date a pregnancy. Much more important is the appearance of the yolk sac in the gestational sac. Like I told you before the accuracy of dating pregnancy by a gestational sac is low and one should refer to the appearance of yolk sac and fetal crown-rump length; wherever possible for dating a pregnancy. Because the yolk sac first becomes visible around 5.5 weeks of gestation, seeing no yolk sac on an ultrasound could simply mean that the pregnancy is not yet 5.5 weeks along. Your gestational sac corresponds to 5 weeks pregnancy and hence you have been asked to wait for 2 weeks before a repeat ultrasound is done. In a viable pregnancy, the yolk sac and possibly the fetal pole will always become visible on a followup ultrasound. A gestational sac larger than 13 mm that contains no yolk sac means the pregnancy is not viable, so when the sac is larger than this and there is no yolk sac, the doctor can diagnose miscarriage and a miscarriage that consists of no yolk sac would fall in the category of blighted ovum. Your doctor is taking the correct approach and hence I suggest you to follow up with him for ultrasounds. I hope it helps. Take care and please do keep us posted in case you have any additional doubts. Kind regards.

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Comments:

Comment by Dr.Kokil Mathur on Thu 06, May 2010 06:17am:
Hi! It is really commendable how Dr Anand has simplified the things for you. Yes, I agree with him completely. Your pregnancy is probably not more than 5 weeks +/- 3-4 days. Hence you have been asked to wait for 2 weeks for a repeat ultrasound. However if by LMP you have a longer duration even if you make a rough estimation since you do not remember the exact date, then chances of blighted ovum do exist. In this the gestational sac exists without the yolk sac because though the embryo implanted, the baby did not grow. If the pregnancy or gestational sac measures more than 20mm, and there is no yolk sac or embryo, then a diagnosis of blighted ovum will be made. Hence you have been asked to come back after 2 weeks. Since you are not very sure about your LMP, you will have to wait out these 2 weeks for a repeat ultrasound assessment. Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!

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