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Q. TVS shows empty gestational sac with no pain or bleeding. Do I need medical help to expel it?

Answered by
Dr. Ridhi Narang
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 10, 2020

Hello doctor,

I am a 42-year-old female with no known health conditions. I recently became pregnant (spontaneous conception). I approximate that I conceived on 19th June. I had a transvaginal ultrasound done on 23rd that only revealed an empty gestational sac measuring 6 weeks and 4 days. I was advised to stop vaginal progesterone. Till date, I still feel pregnant and have no pain, no bleeding, and no cramping.

I have a retroverted uterus and I have read about women that have had issues locating yolk sac, fetal pole, and embryo due to this anatomical variance. Can this really happen even while using transvaginal ultrasound?

Urine HCG is positive.

My HCG serum levels are:

6/30 - 79.

7/2 - 172.

7/6 - 638.

7/10 - 2504.

7/13 - 4815.

7/21 - 24,007.

My main question is, whether I should have any hope or call gynecologist for medication to expedite the passage of this nonviable pregnancy? For now, I am on Sertraline 50 mg and Aspirin 81 mg.

Dr. Ridhi Narang

Obstetrics And Gynaecology


Welcome to

I would advise you to repeat your scan after one week as your beta HCG has been progressively increasing. If you still have just the sac and no pain or bleeding, you can go for medical management to terminate. Then it will be a missed abortion.

TVS (transvaginal scan) has good sensitivity in detecting the sac and location so do not worry.

Investigations to be done:

TVS after a week.

Differential diagnosis:

Missed abortion. Delayed conception.

Treatment plan:

Repeat the scan after one week. You can continue your progesterone support until then.

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Thank you doctor,

Today my HCG level is 27,277 and my last one on 21st of this month is 24,007.

Given those numbers, I thought they would call and recommend medication to expel the pregnancy but the doctor wants a repeat HCG in a week because they are still rising. Should not the HCG be doubling still or does it taper off around week 8? I am confused. What are the chances this is viable? From what I have read, it seems to be a blighted ovum.

Dr. Ridhi Narang

Obstetrics And Gynaecology


Welcome back to

Yes, the beta HCG should have been more by now. There are more chances of the pregnancy being a missed or blighted ovum. There is no harm in waiting for one more week. The rate of expulsion is good when pregnancy is around six weeks or more. There are more chances of spontaneous expulsion too at that time.

With induced abortions, there are more chances of retained products. Your doctor have asked you to repeat next week just to rule out if there are any chances of delayed conception or to wait for spontaneous expulsion. One more week wait has no harm.

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