False Miscarriage—I Was Misdiagnosed and Still Pregnant

"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 healthcare provider said.

I couldn't believe it. Two weeks before, I'd been diagnosed with a miscarriage—a loss of 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.

Yet, here I was, two weeks later, finding out that it was a false miscarriage and I was still pregnant.

How Did a Misdiagnosis Happen?

I had spent the past two weeks saying goodbye to this pregnancy. My friends had taken me out to distract me. I purposely did everything a pregnant person 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 dilation and curettage procedure—also called a D&C—in which tissue is removed from the uterus 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.

There was our embryo, with its tiny leg buds and that unmistakable heartbeat— alive. It was simply a week behind dates, so we conceived much later in my cycle than we thought. My bleeding and cramping? It turns out that I'm someone who can experience that and not miscarry.

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

I hesitated to share my news publicly because I was wary of sowing false hope for others: 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.

Why Would You Bleed During Pregnancy?

I spoke to Paul Blumenthal, MD, the director of family planning services and research at the Stanford University School of Medicine, to learn about Dr. Blumenthal's experience with what is known as "erroneous diagnoses of missed abortions."

I asked Dr. Blumenthal why I bled so much. "The fact of a pregnancy establishing a foothold in the uterus causes bleeding," said Dr. Blumenthal. "Hormone levels fluctuate, leading the uterus to let go of some of its linings 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."

Spotting—bleeding in small amounts every now and then—is normal early in a pregnancy. Other than hormone levels and the fertilized egg implanting in the uterus, common causes of bleeding in early pregnancy can include having sex and infections.

When Should You Seek Medical Help?

Even though bleeding is common and may not have a serious underlying cause, there are more serious causes of bleeding—like a miscarriage. If you have any of the following symptoms, you should see a healthcare provider right away:

• Heavy bleeding
• Bleeding with pain or cramping
• Dizziness and bleeding
• Pain in your stomach or pelvis

Do Misdiagnosed Miscarriages Happen?

That's what I asked Charles Lockwood, MD, executive vice president of the University of South Florida Health and USF Health Dean, USF Health Morsani College of Medicine.

Incorrectly Predicting Conception Date

"It's a pretty rare event," said Dr. Lockwood, "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 an individual (and their healthcare professional) anticipated.

Dr. Lockwood said they see 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 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."

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

Issues with Technology

I also asked about the ultrasound I saw—the one that looked like a blighted ovum. A blighted ovum is when a fertilized egg implants in the uterus, and the gestational sac begins to grow. However, there is no embryo within the sac.

"This is a new conundrum people face," said Dr. Blumenthal. "We don't want people to get upset by the [ultrasound] technology because, when we're looking at 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."

In the future, it may be possible to measure hCG levels more precisely with at-home urine tests, said Dr. Blumenthal. An individual who is unsure of their diagnosis might be able to test daily and watch if hCG levels are rising or falling.

How Likely Is It To Have a Misdiagnosed Miscarriage?

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," said Dr. Lockwood. "It doesn't end happily."

I called the American College of Obstetricians and Gynecologists (ACOG) to see if they had any information on this phenomenon. However, they couldn't point me to any studies that count the number of times pregnant individuals ride this particularly crazy roller coaster of conception.

While there aren't exact numbers, early pregnancy loss occurs in approximately 10% of known pregnancies. Additionally, if a gestational sac was empty at an initial ultrasound, and then was empty on a repeat scan at least seven days later, this was associated with the loss of the pregnancy.

What Should You Do?

Still, said Dr. Lockwood, "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 determined I was to end this pregnancy.

A Quick Review

Although uncommon, it is possible for a miscarriage to be misdiagnosed. This can occur if the conception date is actually earlier than predicted or if there are some difficulties with the ultrasound technology.

It's normal to experience light bleeding in early pregnancy. Spotting can mean that the egg is implanting into the uterus, or your hormone levels are fluctuating.

Bleeding can, however, be a sign of a miscarriage. If you are experiencing heavy bleeding along with pain, dizziness, or cramping—contact a healthcare provider.