If you’ve heard the heartbeat once, it can be terrifying to walk away from an appointment where your doctor couldn’t find it. Worse, you’ll probably have to wait at least a week before they try looking for it again. It leaves most moms wondering: can the fetal heartbeat disappear and, more importantly, reappear?
The good news is, yes, it absolutely can, and we’ll explain why. Unfortunately, though, not all cases will have a happy ending, and we’ll explain those too.
What Could Cause a Fetal Heartbeat to Disappear?
While scary, it’s common to come away from a routine checkup without hearing the heartbeat. In most cases, it’s caused by a simple error or an awkward position.
Dopplers are a great way to check in on your baby between ultrasounds and usually give you some peace of mind. However, finding your tiny baby early on takes some skill, and your doctor can miss the heartbeat. This happens to women every day, and they’ll typically pick it up at the next appointment.
Your Baby Has Moved
One of the major drawbacks of a doppler is that the user can’t see what’s going on inside your uterus. In the early stages of pregnancy, when your baby has lots of room, they might move into an awkward position and evade the doppler. In some cases, moms could swear their baby would actively squirm away from it!
Your Dates Are Wrong
Pinpointing conception and, therefore, exactly how far along you are can be tricky. But, in the world of fetal heartbeats, a week can make a huge difference. Don’t panic if your sonographer can’t find a heartbeat at your 8-week scan. You might only be 7 weeks, after all.
You Have an Anterior Placenta
Sometimes the placenta can grow at the front of your uterus. This is usually no problem, but it will get in the way of a doppler finding your baby’s heartbeat.
You Have a Tilted Uterus
If you have a tilted uterus, you are not alone. Around 20% of women have a uterus that tips towards their spine. It’s no big deal, but it will make picking up your baby’s heartbeat harder.
You Are Plus-Sized
If you’re plus-sized, there’s more tissue between the ultrasound transducer and your baby. This can make it harder for your sonographer to find the heartbeat. If this is causing problems, ask for a transvaginal ultrasound instead.
Unfortunately, a missing heartbeat can occasionally indicate a serious problem. In these cases, the heartbeat will sadly not reappear:
Chromosomal abnormalities are responsible for between 50 and 60 % of miscarriages. They occur when the sperm or egg cell carries faulty chromosomes. This prevents the baby from developing properly and can result in a miscarriage.
Sometimes the cause is genetic, and you might want to investigate further. But most often, the problem was a random glitch in cell division that’s unlikely to recur.
Problems With Blood Supply
Some blood clotting and autoimmune disorders can cause an issue with blood flow to the placenta. If the supply to the baby falls too low, their heart will stop beating.
Infections like rubella, cytomegalovirus, bacterial vaginosis, and several STDs can cause a miscarriage.
Issue With the Umbilical Cord
Occasionally, the umbilical cord can become knotted or compressed. This will restrict the baby’s blood supply and will result in the loss of the pregnancy.
Progesterone is the hormone required to sustain an early pregnancy. If levels drop too low, a spontaneous miscarriage can occur. Fortunately, it’s possible to supplement progesterone to prevent it from happening again.
Can a Fetal Heartbeat Come Back?
If the heartbeat disappeared due to an error or the awkward position of your baby, placenta, or uterus, it could reappear at a follow-up scan.
If, however, the heartbeat is gone due to an issue with the cord, blood supply, infection, hormones, or chromosomal abnormalities, it won’t return. In these cases, the pregnancy will, sadly, result in a miscarriage or stillbirth.
How Can a Doctor Miss a Fetal Heartbeat?
Most doctors will use one of the following four methods to listen to your baby’s heartbeat. Some are more accurate than others, especially early on.
|How it Works||When It Works||Accuracy|
|Fetal Doppler||A small ultrasound probe is held against your belly. It detects movement and translates it into sound.||8 weeks +||When used by a professional, a doppler is very accurate. However, it’s possible to miss the heartbeat if: Your baby is in a weird position.You have a tilted uterus.You have an anterior placenta.|
|Abdominal Ultrasound||A transducer that emits high-frequency sound waves is moved over your bump. The sound waves bounce off your baby, return to the device, and are converted into images.||6 ½- 7 weeks +||Abdominal ultrasounds are accurate, but mistakes can be made in early pregnancy. This is a particular issue if your dates are slightly out. It’s also less accurate if you are plus-sized because it’s harder to get a clear image.|
|Transvaginal Ultrasound||An ultrasound probe is inserted into your vagina.||5 ½ weeks +||Transvaginal ultrasounds provide clearer images than abdominal ones. This is because the sound waves don’t have as many layers of tissue to travel through. They are the most accurate way to check on your baby.|
|Stethoscope||When your baby is large enough, a doctor can use a stethoscope to listen to the heartbeat.||18-20 weeks +||When used by a professional, a stethoscope is a great, zero-risk way to listen to the heartbeat after 18 weeks. However, it’s typically less accurate than a doppler.|
What to Do if the Fetal Heartbeat Disappears
1. Find Support
It can be scary, heartbreaking, and stressful to hear that your doctor can’t find your baby’s heartbeat. It’s also not usually possible, or helpful, to schedule an immediate follow-up appointment. This is because, if your baby is too small, it makes sense to delay trying to hear the heartbeat again for a week or so.
This will leave you with an agonizing wait. Leaning on a partner, friend, or family member for a listening ear, distraction, or a little extra care can be helpful.
2. Get a Second Opinion
A fetal heartbeat cannot restart. However, many women are given the bad news due to error and later discover the heartbeat was there all along. Schedule an appointment with a different doctor to confirm.
3. Opt for a Transvaginal Ultrasound
Doppler’s can easily miss the heartbeat due to a positioning issue. You can’t be sure the heartbeat is gone without an ultrasound, ideally a vaginal one.
4. Medical Management
If you’ve waited a week or two and a second ultrasound still can’t detect a heartbeat, tragically, it won’t return.
In this case, you can wait to miscarry naturally or undergo a D&C procedure (dilation and curettage). This is the surgical removal of pregnancy tissue from your uterus. If you undergo the procedure, you will receive a final ultrasound to confirm the loss.
26 % of pregnancies end in miscarriage. So if it has happened to you, you’re not alone. You may find it helpful to access online support groups like March of Dimes or The Miscarriage Association.