OpenHealth Q&A

Concerns During 9 Weeks of Pregnancy: Irregular Gestational Sac and SCH

As a 36-year-old woman who is currently in my ninth week of pregnancy, I've been through an array of ultrasounds that have led to some puzzling findings. Although the measurements for crown-rump length (CRL) and fetal heart rate (FHR) are progressing well, the shape of my gestational sac has prompted confusion among the two radiologists I've consulted. It seems like the gestational sac appears to divide into two when the imaging wand is shifted, yet it’s unmistakably just a single sac. For context, last September, I experienced a missed miscarriage at seven weeks, which necessitated a manual vacuum aspiration (MVA) followed by a hysteroscopy with morcellator for retained products of conception (RPOC). Throughout this pregnancy, I have been monitoring my progress through weekly ultrasounds with two distinct radiologists: - **At 6 weeks:** The first radiologist speculated the possibility of detecting two heartbeats within one gestational sac, although only one embryo was confirmed. She pointed out the two heartbeats but emphasized the need for further observation before concluding anything about a twin pregnancy. Shortly after, I experienced 24 hours of spotting alongside a drop in my hCG levels. - **At 7 weeks:** The second radiologist confidently identified a single embryo accompanied by one heartbeat that was developing appropriately. She also noted a small subchorionic hemorrhage (SCH), approximately 5% in size. - **At 8 weeks:** The same radiologist observed continued growth, and the SCH had disappeared entirely. Despite good signs, the gestational sac remained irregular. She expressed confusion but reassured me that this might be related to the previous medical procedures after my miscarriage last year. - **At 9 weeks:** Radiologist #1 confirmed adequate growth and a healthy heart rate (23 mm CRL, 184 FHR). However, she quickly adopted a serious tone, suggesting that the irregular gestational sac may actually indicate a significantly large subchorionic hemorrhage. I brought up the possibility of vanishing twin syndrome to both radiologists, but they both felt it was unlikely. The general agreement is that we must wait and observe the situation further. However, I find myself eager to understand what is happening, even if there’s little I can do. I welcome any insights or thoughts on this matter.

Answers (1)

3/20/2025, 1:20:43 AM

OpenHealth AI

It's understandable to feel anxious about your pregnancy, especially with the complex findings from your ultrasounds. While your baby's growth parameters look positive, the irregular shape of the gestational sac and the history of your previous miscarriage bring added concern. Here are the main points regarding your situation:

1. Gestational Sac Irregularity: The irregular appearance of the gestational sac may be a result of factors related to your prior procedures or could indicate a compromise such as a larger subchorionic hemorrhage. Both radiologists agreed on the need for continued observation.

2. Subchorionic Hemorrhage (SCH): In the context of pregnancy, small SCHs are relatively common and often resolve without intervention, particularly if you've seen improvement, as in your case where the SCH disappeared by the eighth week. However, ongoing monitoring is essential.

3. Previous Pregnancy History: Your previous missed miscarriage adds an understandable layer of concern. Knowing your history, it's normal to feel apprehensive, but maintaining a positive outlook based on current vital signs and measurements can be helpful.

Next Steps:

1. Continued Observation: Adhere to the plan of weekly ultrasounds or follow-up visits. Regular check-ups will help monitor the growth and ensure everything is progressing well.

2. Self-Care: Focus on stress-reducing techniques such as gentle yoga, mindfulness, or relaxation exercises. Good mental health is crucial during this time.

3. Symptom Monitoring: Be vigilant about any new symptoms, such as increased spotting or cramping, and document them. This information can be useful during your next ultrasound.

4. Stay Informed: While it's tempting to seek extensive information, consider focusing on the advice given by your healthcare providers. If you have specific questions or concerns arise, write them down and bring them up during your visits.

5. Emotional Support: If you are feeling anxious, consider talking to a supportive friend or professional specializing in pregnancy-related counseling.

Remember that each pregnancy is unique, and there’s a chance for positive outcomes given the current signs of a progressing pregnancy. Take care of yourself, and don't hesitate to reach out for support whenever you need it.