Today is Pregnancy and Infant Loss Remembrance Day, and with a new son and another on the way since last year, I still find myself thinking back to the baby I found out that I lost two years before with a bit of sadness in my heart. Although the pain isn’t fresh, it is still memorable, and I feel both for the many women who went through the same struggle with me, and the many, many more who have losses that I have never known.
Which is why a new study published yesterday in Science Daily has me absolutely livid.
Via Jezebel, a group of papers being published in the journal Ultrasound in Obstetrics and Gynecology claim that the method being used to diagnose miscarriages may not be as accurate as doctors have believed, and that in fact, many doctors may be misdiagnosing healthy pregnancies as miscarriages and having patients terminate pregnancies that haven’t actually failed at all. “This research shows that the current guidance on how to use ultrasound scans to detect a miscarriage may lead to a wrong diagnosis in some cases. Health professionals need clearer evidence-based guidance to prevent this happening,” says Professor Basky Thilaganathan, Editor-in-Chief of the journal.
According to the papers, because miscarriage is often diagnosed by a failure of the pregnancy to progress in measurement from one week to the next, by using faulty equipment there is a possibility that unreliable ultrasounds are being misread to look like there is no progression, when in fact there is actually growth. “The final study revealed that there is up to a 20% variation in the size of gestational sacs reported when different clinicians measure the same pregnancies. If the first measurement over-estimated the sac size and the second measurement some days later underestimated it, then it would be easy to incorrectly conclude that no growth had occurred.”
But there’s a separate issue with using that reasoning to declare a misdiagnosis of miscarriages. Most women who are thought to have had a missed miscarriage (ie: a pregnancy that is no longer progressing due to lack of development into an embryo, or the loss of a fetus that the body doesn’t recognize has died in utero) receive at least two ultrasounds, the standard week apart, if not longer. If there is no growth between that week, yes, it is assumed that there is a likely miscarriage, but not just because of size of sac, or unchanging size of fetal growth, but lack of other signs that the pregnancy is progressing, most importantly, a heart beat.
An empty sac at six weeks is not the best sign for a pregnancy, but still has hope. An empty sac that still has no fetal pole at seven weeks is a pretty sure sign of a blighted ovum – an unsuccessful pregnancy. A fetus that measures near 8 weeks but doesn’t show signs of a heartbeat is alarming, but could simply be measuring behind due to date. But a fetus that should be one week older at the next measuring and doesn’t show definite signs of growth and still shows no heartbeat is another sure sign of miscarriage, since a heartbeat should be seen in a fetus that far developed.
As for my own pregnancy, a second ultrasound wasn’t necessary to verify what we knew. I was supposed to be nearly 12 weeks pregnant, and the fetus both measured weeks behind and showed no heartbeat, either via abdominal ultrasound or transvaginal. There wasn’t a doubt in the world that it was a missed miscarriage that needed to be followed up on.
Many women who miscarry deal not just with grief, but an overwhelming sense that if they had done something differently, maybe they would not have lost that baby, even when it’s almost never true. To release a study especially right before Pregnancy and Infant Loss Remembrance Day, that would make women question if they would be holding that lost baby if they had just held on to hope is absolutely cruel.