7 weeks pregnant with gestational sac but no embryo

Patient: Hi doc. Just want your ideas. I’m supposed to be 7wks pregnant according to LMP. I had my my 1st ultrasound during my 6wks, the doc found nothing except the sac. Then had mild abdomen pain and i went direct to ER and they did transabdominal scan and they said they saw the sac and fetal pole. So when i came back to my ob doc yesterday, they did ultrasound, and they said they saw only gest sac. According to her again, my hcg level doesn’t increase that much means that from 20000 increase to only 22000. Which she said is not normal. she will schedule again ultrasound for me next week and will decide whether i need d&c after that which i scare the most. My question also where is the fetal pole that the ER doc saw. Please help me.

Doctor: Thank you for your query.Generally the gestational sac will have a fetal pole which is a thickening of the sac margin and appears white on the scan. It is visible when vaginal ultrasound scan is done at 6 weeks and at 8 weeks when an abdominal scan is done. Probably your obs/gyn doctor may mean that she only saw a gestational sac with fetal pole but there was no fetal heart in it therefore she mentioned that there was only a sac. 5-7 days follow-up scan should show a fetal heart which means the pregnancy is continuing otherwise it is a missed pregnancy. The hormone levels called as βhCG should increase in doubling pattern which means the pregnancy is healthy. From what you say, the chances of a viable pregnancy look meek. Wondering if any hormonal support like estrogen, progesterone or hCG were supplemented to support the gestation to increase the chances of continuing the pregnancy.