Friday, April 25, 2014

Misdiagnosed Miscarriage? The UK Has Changed their Guidelines. Your Doctor Needs to Take Note.

Several years ago, I followed with great interested the reports of misdiagnosed miscarriages in Ireland.  Over the years, I've talked with women in Ireland who have felt pressured to end their pregnancies too early.  After several women ended up finding their babies, the press took note and a health scandal was all the buzz. 

Now, truthfully, doctors in Ireland weren't any worse than doctors in England or the U.S. or Australia or any of the other countries from which I hear from women quite frequently.  But, misdiagnosed miscarriages did make the news and, in a country that seriously frowns on abortions, this was big news.

Here is an example of one news story: 
Babies may have died after miscarriage misdiagnoses

I, along with many other women, have eagerly waited to see what changes the medical community would make in response to this scandal.  I decided to see what changes have been made and found these newer guidelines from December 2012:
Royal College of Obstetricians and Gynaecologists  CG154 Ectopic pregnancy and miscarriage: full guideline(downloadable as a pdf).     
I can think of so many posts I could make on these guidelines.  For today, I'd like to concentrate on one flow chart in particular and focus on empty-looking gestational sacs.
(click on image to view larger)


Two things stand out here.

First, unless the gestational sac is measuring 25mm or more, doctors should wait seven more days for a follow-up ultrasound. 

Second, if the gestational sac is indeed measuring 25mm or greater, one of two options is recommended.

A)  Perform a scan seven or more days later before verifying
B)  Seek a second opinion.

These guidelines are from 2012 but we on the Misdiagnosed Miscarriage site have been suggesting these options to women for a number of years.

I truly believe that if all doctors followed these guidelines, most viable pregnancies would never be misdiagnosed.  We still have misdiagnosed miscarriages due to bleeding and suspected ectopic pregnancies but the vast majority are due to empty sacs. 

So, what can you do if your doctor is giving you no hope due to an empty-looking sac?

First, print out this chart.  Go to the link and get the full-sized chart.  Take it to your doctor.  Your doctor may not know about the misdiagnosed miscarriage scandal in Ireland.  Standards are changing.  Don't wait for your country to have its own scandal.  Take charge of your pregnancy and discuss these guidelines with your physician.  These standards will absolutely save many viable pregnancies.

As always, if you are going through a miscarriage scare, (((HUGS)))




           

20 comments:

  1. Hi my last menses was on 23 May, on 10 July vscan saw an empty sac measuring 19.4mm. I have been having morning sickness. My hcg was measured 32457. On 20 July, another V scan was done ges sac still empty measuring 24.6mm and My hcg lvl is 64257. Was told to scan again on 27 jul. I had a chemical pregnancy in Feb. Waited 3 months b4 trying again. Yet I Am now faced with this.

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  2. I think your next ultrasound should give you your answer. (((hugs))) because I know how hard it is to wait and not know what is happening.

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  4. Hi, I am sharing my current story in hopes of some kind of reassurance.

    I went to my first transvaginal scan at 8 weeks. It took the doctor 10 secs to tell me I had a blighted ovum. No blood taken, no questions asked, nothing. She immediately prescribed me some pills to take and have an abortion. After that, she took a blood sample. The next day I called to get my blood results, in which the first thing she asked when I called was if I had taken the pills she prescribed. I told her NO. And I'm calling to get my blood results as I want a second opinion. She gave me my results.. my hcg levels were 73,000, that's it. No other results. I called a different doctor, and scheduled an appointment 4 days later. This new doctor is the sweetest doctor! She performed another transvaginal scan which showed my gestational sac of 6 weeks, but empty. No fetal pole.. My hcg levels are 62,000 with a 13.1 progesterone and Gestational sac of 17.5 mm. According to my LDP I should be 9 weeks. She recomended another scan in a week. I have NOT bled or are cramping at all. But my pregnancy signs have been diminishing. My boobs don't hurt anymore and I haven't been that hungry. I blame it on the depression and stress I'm going through. I want to keep my hopes up, since I'm not bleeding...yet... any hope??

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  5. Your best bet is to see if the gestational sac is growing. If is and there are no complications, your doctor should wait until it is more than 25mm to diagnose a blighted ovum. (((hugs)))

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  6. Hello I am Surrogate who got an embryo transfer back in Nov 10 2015, I should be 12 weeks as today but I went this Tuesday for a regular ultrasound and Dr couldn't find a heart beat so he sent me to another imaging place which they did the regular ultrasound and than transvaginal and still no heart beat. My fertility Dr ordered a D&C but being that I'm not bleeding or in pain my Obgyn wants to do another scan this coming up Tuesday just to double check. Now I'm hoping there's a miracle

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    1. I think another ultrasound before the D&C is a really good idea. Please, keep us updated.

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  7. What is your opinion if the gest sac is over 25mm?

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    1. Speak with your doctor. If the gestational sac is still growing and there are no complications, you could wait another week. I know I would have. My sac was 28.5mm before we saw my baby but, even if we had not, I would have preferred a natural miscarriage. Generally after 10 weeks or so, a D&C is often necessary. (((hugs)))

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  8. Hi, im quite worried i have irregular menses my lmp 18th jan went to doc on march 6th coz saw bfp. She did ultrasound couldnt find anything. Did 1st blood test 746hcg level. Second hcg result on monday.no pregnancy symptoms at all. Had sore nipples now nothing. Is it gonna be ectopic?

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  9. Hi, im quite worried i have irregular menses my lmp 18th jan went to doc on march 6th coz saw bfp. She did ultrasound couldnt find anything. Did 1st blood test 746hcg level. Second hcg result on monday.no pregnancy symptoms at all. Had sore nipples now nothing. Is it gonna be ectopic?

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    1. This is much too early to diagnose but, if they suspect an ectopic, they should definitely have done another ultrasound. Please, keep us updated.

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  10. Good Morning. I am going through a miscarriage scare right now. I went to the Dr on May 11, 2016. They cannot find a heartbeat, no fetal pole... my HCG levels tested at 47,000. At first he said he saw two sacks, but couldn't find anything in them. Then sent me to the hospital for transvaginal and they only saw one sack with nothing in it and no heartbeat. I am supposed to be between 7-9 weeks pregnant. We don't know because I don't know when my last period was. I have been diagnosed several times with a tiled uterus. The doctor recommended a DNC. I am confused, why would he recommend this right away? I told him I am not ready for that. I don't know what to do. I still feel pregnant, no spotting, no blood, tender breasts, 10 lbs weight gain and nausea. Any recommendations?

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  11. I am 20 weeks shy of one day to be 21 weeks. I went in for my anotomy scan which I did a blood test and already know I'm having a boy. He has been perfect and healthy me and him. I went in this morning and was told after about 5 minutes of the ultra sound there's no heart beat. My baby is dead. They didn't even go in for a second look or anything just said nope sorry he's gone. I went home and lost it. My husband lost it my family was just devastated. Well I kept feeling movement and him doing his normal thing of poking his booty out and small kicks here and there. I drank a cup of coffee and some fruit and I started feeling things. My PA is my mothers best friend and neighbor so she snuck her doppler home and brought it over tonight and we picked up my heart beat at 85-90 and then found another ranging from 130-213 kept fluctuating between 150-190 for a good 30 seconds. We would lose it then re find it again. It's always on different sides and generally by my belly button or under my belly button. If he is really gone why is the Doppler picking up movement and turning and a heart beat. I even took a video of the heart beat that was not mine mine was a lot slower. I do know they had 3 cases like this where it was a false reading and the baby really was not gone. Their machines were not correct. Has this ever happened to anyone else. I'm laying here in bed just praying and sobbing to God please give me a miracle give me some hope and peace of mind that maybe somehow they were wrong and my Elijah is okay. I'm not bleeding I'm not cramping I feel like I normally do everyday. I go back tomorrow for another ultra sound by my moms friend because even she swears she heard him and heard a lot of movement. I need advice, help something that will make me feel better. I feel so scared and lost and idk what to do. The doctor even said by looking at my ultra sound how perfectly healthy he is and perfect size and the ultra sound was just perfect he was covering his face with his arm. His head measured perfect the only thing they could even think happened was just recently as in this morning he was wrapped around the cord. I just don't understand why I'm feeling movement and a doppler is picking up all this.

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  12. Pls help I am 9 weeks pregnant and did an u/s my gestational sac has grown but no heart beat or foetus detected doctor has recommended an abortion says it cud be a blighted ovum but refused. I still have hope.

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    1. Hello Tanya. I am so sorry you are going through this scare. Can you get a second opinion? Are there any complications? If not, do you know if the sac is more than 25mm? If it is growing but still smaller and there are no complications, find out if you can get another ultrasound a week out. Please, keep me updated. Saying a prayer for you.

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  13. Hi! My last day of my period was 25th Feb. however I felt the implantation on the 16th March. I felt it sharp and know it so well because we didn't have intercourse before for about two weeks and after for at least 3 weeks. I had my pregnancy test on 2nd April which was positive.

    I just came home from a dating scan and the doctor suggested to do a vaginal scan since it looks so small, estimating I am under 6 weeks.

    She suggested to talk to my midwife about the results and potentially do a hormone test.

    Tomorrow morning I will be talking to my midwife and will find out how big the sac actually is.

    Any other suggestions to ask, do, etc?

    Thank you so much!!

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    1. If there are not any complications, an ultrasound a week out from the last will tell you if the sac is growing. If the sac is growing and it is not yet 25mm, it may be too soon to diagnose. (((hugs)))

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  14. Update: I have spoken to my midwife. The gestational sac is currently empty at 19mm. I will get a blood test done on Monday to get the number of my pregnancy hormones. In two weeks I will go for a follow up scan and will have done a second blood test done prior (pregnancy hormones).

    We also spoke about my general pregnancy blood test (1st blood test) and everything is absolutely normal, good levels.

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  15. Two weeks is a long time to wait. You really should have your answer after a week. I do hope you get better news. (((hugs)))

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