Miscarriage Misdiagnosed: Surprise, I'm still pregnant!

by Erica Kain

"What exactly is that?" I asked, propping up on my elbows on the examining table, scrutinizing the ultrasound monitor.

"That is a seven-week-old embryo with a heartbeat," my doctor said.

"No, wait, is it human?" I asked, gasping for air, staring at the flickering heartbeat pulsing through the little body.

I couldn't believe it. Two weeks before, I'd been diagnosed with a miscarriage-specifically, a chemical pregnancy. I'd raced to the doctor's office after experiencing heavy cramping and bleeding, and an ultrasound seemed to confirm my gut feeling that my pregnancy was ending. There wasn't an embryo where there should have been one. And yet, here I was, two weeks later, finding out that I was still pregnant.

I had spent the past two weeks saying goodbye to this pregnancy. My friends had taken me out and gotten me properly sauced. I purposely did everything a pregnant lady is not supposed to do-sucked down soft cheeses, exercised strenuously, and drowned my sorrow in wine and beer.

I'd even yearned for a D&C to end this "lost" pregnancy and clear the way for our next attempt at getting pregnant. Thank God I'd scheduled this second ultrasound before booking the surgery.

Because there was our embryo, with its tiny leg buds and that unmistakable heartbeat, alive and, apparently, human. It was simply a week "behind dates," i.e., conceived much later in my cycle than we thought. And my bleeding and cramping? It turns out that I'm one of the of women who can experience that and not miscarry.

My husband and I are in a state of shock at this turn of events. And although I feel cautious about celebrating this news until the embryo lives past 10 weeks, we can't help but feel excited and so incredibly lucky.

I hesitated to share this news publicly, because I am wary of sowing false hope for other women: Most miscarriages really are miscarriages. But I wish I'd known, as I fully embraced the grieving process after my miscarriage diagnosis two weeks ago, that this was a possibility.

How often does this kind of reversal occur?
That's what I asked Charles Lockwood, MD, the Chief of Obstetrics and Gynecology at Yale-New Haven Hospital.

"It's a pretty rare event," Dr. Lockwood told me, "but we do see it happen. Sperm can remain active and viable in a woman's reproductive tract for up to six days," so conception can be much later than a woman (and her doctor) anticipated.

Dr. Lockwood sees this most often with IVF or other forms of assisted reproductive technology. "Even when we think we know with incredible precision when the date of conception is, we can be three or four days off. Delays in women's ovulation and/or an embryo's implantation can occur. I have seen twins that are both growing at a perfectly normal rate but one of them has been nearly a week off."

So a fertilized egg can take several days to implant and begin growing in a woman's uterus, leading to initial hCG tests and ultrasound results that seem to indicate an embryo that is slow to develop and therefore likely to be miscarried. In fact, the embryo is simply behind schedule due to its later-than-expected implantation.

But usually, if it looks like a miscarriage, it is.

"The vast majority of times that we see blood pregnancy hormone (hCG) levels rising slowly, or a sac in the uterus that isn't doubling in size appropriately, it turns out to be a miscarriage," he says, "It doesn't end happily."

But, he cautions, "If there is no heavy vaginal bleeding, people shouldn't be in a hurry to end the pregnancy until they're confident it's not viable. What I tell my patients is, 'I'm not absolutely certain [this is a miscarriage]. I'm pessimistic, but I'd like you to come back in a week.' Then they are better prepared psychologically for what might happen."

I know I wouldn't have gone in for a D&C before verifying once more that the pregnancy wasn't viable, but it terrifies me how dead set I was on ending this pregnancy.

But why did I bleed so heavily?
Now a big fan of second opinions, I also talked to Paul Blumenthal, MD, the director of family planning services and research at the Stanford University School of Medicine, to learn about his experience with what he calls "erroneous diagnoses of missed abortions."

Why did I bleed so much, I asked Dr. Blumenthal. "The fact of a pregnancy establishing a foothold in the uterus causes bleeding," he told me. "And hormone levels fluctuate, leading the uterus to let go of some of its lining sometimes. Usually, in the case of bleeding, the pregnancy's continuation is tenuous. It's only possible to diagnose a missed abortion if you wait a few days after the bleeding" he said.

But what about that ultrasound I saw, the one that looked like a blighted ovum?

"This is a new conundrum people face," he said. "We don't want people to get upset by the [ultrasound] technology, because when we're looking at an early pregnancy, we can't be sure which side of the coin we're coming down on-a pregnancy or a missed abortion. That's why we've got to wait a few days and test again." (And, I might add, it's probably a good idea not to break out the Johnny Walker until those second test results are in.)

In the future it may be possible to measure hCG levels more precisely with at-home urine tests, says Dr. Blumenthal. So a woman who is not sure of her diagnosis might be able to test daily and watch if her levels are rising or falling.

I called up the the American College of Obstetricians and Gynecologists to see if they had any information on this phenomenon. But they could point me to no studies that count the number of times women ride this particularly crazy roller coaster of conception.

There's an online community of women like me
So I went to a completely unscientific source and found more than 250 stories posted online by women who have gathered at a site called Misdiagnosed Miscarriage. These are other women who have been told they are miscarrying, only to discover their embryo is viable.

The reasons for the misdiagnoses chronicled on the site vary, from a tilted uterus preventing an accurate ultrasound to "blighted ovum" diagnoses early in pregnancy, before a potentially late-developing embryo had a chance to appear.

Kay Cilenti founded the site in 2005, after she went through the experience, and subsequently heard similar stories. "Women need to know that they can ask questions of their doctors," she advises.

"They have the right to a second opinion if something feels off with the diagnosis or they feel they are being unnecessarily pushed toward ending the pregnancy quickly. Doctors who bring up the M-word early [in the first few weeks of pregnancy] drive me nuts."

I've lived through two M-words, so I thought I knew everything there was to know about it. It turns out out I was wrong, as was my doctor. Now that M-word for me is miracle.

Will it continue to survive? Will this new baby stop our hearts once again with more drama? For me, every additional day I get with the little being is like a gift. I've already mourned its passing, so this is now a bonus baby as far as I'm concerned.

Don't miss:
Erica's previous post: I Was Pregnant For a Week
The Facts About Miscarriage
Trying To Conceive and Making Friends Online