False Miscarriage—I Was Misdiagnosed and Still Pregnant

I'd been diagnosed with a miscarriage—yet here I was, two weeks later, finding out that I was 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 professional said.

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

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State of Shock

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 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, or a dilation and curettage procedure in which tissue is removed from the uterus, per Johns Hopkins Medicine, 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. 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 someone who can experience that and not miscarry.

In fact, according to Medline Plus, some people have vaginal bleeding during their first 20 weeks of pregnancy. Though if you have heavy bleeding, bleeding with pain or cramping, dizziness and bleeding, or pain in your belly or pelvis, you should see your healthcare professional right away.

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.

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.

"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 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 uterus, leading to initial hCG (hCG is a hormone produced in the body during pregnancy, according to Medline Plus) 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.

If It Looks Like a Miscarriage…

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

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.

Why the Bleeding?

Now a big fan of second opinions, I also 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. "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," said Dr. Blumenthal.

I also asked about the ultrasound I saw—the one that looked like a blighted ovum. Per StatPearls, 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 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."

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

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

While there aren't exact numbers, per an ACOG practice bulletin published in 2018, early pregnancy loss occurs in approximately 10% of known pregnancies. Additionally, per the bulletin, if a gestational sac was empty at an initial ultrasond, and then was empty on a repeat scan at least seven days later, this was associated with the loss of the pregnancy.

M for Miracle

I lived through a miscarriage, one M-word, and I thought I knew everything there was to know about it. It turns 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.

This is a personal account of a misdiagnosed miscarriage. All thoughts, experiences, and language usage are those of the individual contributor.

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