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Q. I am pregnant with good hCG, but there is no sac in sonography. Why?

Answered by
Dr. Zubayeralam
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 22, 2020 and last reviewed on: Aug 08, 2020

Hi doctor,

My last period was 45 days ago. Pregnancy test was a strong positive. My HCG count is 7290 and 8800 at a gap of five days. But in sonography, no sac was seen. Intervaginal sonography also showed no sign of sac. I have no signs of vaginal bleeding until now. Just facing light cramps in abdomen. Please suggest what could be the reason?



Welcome to

I can understand your concern. According to your statement, you have been suffering from amenorrhea and your last menstrual was 45 days ago. Your beta HCG count was 7290 and 8800 at a gap of five days but USG (ultrasound) of pregnancy profile or transvaginal sonography has shown no sign of sac.

If a gestational sac is not seen on transvaginal ultrasound by around six weeks gestational age, there are several things which can be happening such as the pregnancy is ectopic, or the pregnancy is a miscarriage, or it is too early in the pregnancy.

The ultrasound did not show a gestational sac that means the doctors are not sure whether it is ectopic pregnancy, miscarriage, or a very early but normal pregnancy due to incorrect timing. It is totally frustrating but sorry to say that you need to follow up. Ultrasound and repeat beta HCG levels after two to four weeks to exclude the causes for your present sufferings.

Thank you doctor,

Will not waiting for further two weeks might harm my body? Rupturing of some tube or other part might happen if I put it as wait and watch.



Welcome back to

Yes, you are right but your ultrasound report has also advised to undergo a repeat ultrasound after 7-10 days. So it depends on your decision.

A fetus in an ectopic pregnancy sometimes survives for several weeks. The structure containing the fetus usually ruptures after 6-12 weeks. An ectopic pregnancy may be located in a fallopian tube, an ovary, cervix, abdomen, etc. Laparoscopic examination can detect the exact location of ectopic pregnancy.

The later structure containing fetus ruptures, the worse the blood loss and the higher risk of death. If an ectopic pregnancy is treated before it ruptures, it can save the life of that woman. So consult with your current supervising gynecologist and do as needful according to her advice.

In case of any other query ask me.

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