Ultrasound Shows Slow Fetal Heart Rate in First Trimester

Risk of Miscarriage With Slow Fetal Heartbeat

Pregnant Woman Having An Ultrasound
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During the first trimester, the baby's heart rate should start somewhere around 100 beats per minute (bpm) around 6 weeks gestation (the time of first detection), peak at 9 weeks (sometimes even reaching levels as high as 180 beats per minute) and then gradually decrease as the fetus approaches term.

Ultrasound Showed a Slow Fetal Heart Rate in First Trimester. Will I Miscarry?

When the heart rate is slower than expected, the physician may note that there's some cause for concern and recommend a followup ultrasound to check the baby's development.

A slow heart rate is a cause for concern because studies show higher odds of miscarriage when the baby has a heart rate of fewer than 100 beats per minute at 6.2 weeks of pregnancy or less than 120 beats per minute at 6.3 to 7 weeks.

If your ultrasound revealed that your baby had a slow heart rate, you are probably scared and concerned, especially if you have been searching for information on what this might mean. You may feel frustrated that you have to wait a week for a followup. But unfortunately, there is no way to tell what is happening without that wait. Sometimes the baby's heart rate will normalize, and then the pregnancy will continue without further complications. But sadly sometimes the outcome goes the other way. There is nothing you or your physician can do to affect the ultimate outcome. When pregnancies miscarry after detecting a slow fetal heart rate, the reason is often chromosomal abnormalities that were present at conception.

What Is the Value of Ultrasound During Pregnancy?

During pregnancy, ultrasound is used for many reasons including the following:

  • dating (figuring out the age of the fetus)
  • aneuploidy (chromosome) assessment
  • cervical length assessment
  • determination of fetal well-being (biophysical profile)
  • anatomical assessment

    During 13 to 18 weeks of gestation, the age of the fetus can be determined using ultrasound. Different measurements are used to estimate the baby's age including the following:

    The accuracy of dating is plus or minus 7 days. In other words, the baby's age is estimated within about a week. At 24 weeks, this accuracy decreases and ultrasound is best used to assess fetal weight and growth.

    Using ultrasound, fetal heart tones can be heard at about 10 weeks' gestation. It takes between 18 and 20 weeks to hear the baby's heartbeat using fetoscope.

    Ultrasound is the gold standard, or the best way, to determine whether the fetus is alive. Sadly, if a fetus is present but no heartbeat is detected, then the fetus has died.

    What Happens If It's Unclear Whether There's a Heartbeat Exhibited During Ultrasound?

    Sometimes during the first trimester of pregnancy, it's unclear whether there's a heartbeat. In these cases, further tests need to be performed to figure out whether the baby is alive.

    These tests include serial beta hCG levels, a type of pregnancy hormone.

    Fetal Demise During Late Pregnancy

    During late pregnancy, the first sign of fetal demise is usually lack of movement. When the baby isn't moving, ultrasound can be used to detect fetal heart tones and uncover a reason for the lack of fetal movement.


    Bernstein HB, VanBuren G. Chapter 6. Normal Pregnancy and Prenatal Care. In: DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e. New York, NY: McGraw-Hill; 2013. Accessed March 04, 2016.

    Doubilet, P. M. and C. B. Benson. "Embryonic heart rate in the early first trimester: what rate is normal?" Journal of Ultrasound in Medicine 1995. Vol 14, Issue 6 431-434.

    Doubilet, P.M., C.B. Benson and J.S. Chow, "Long-term prognosis of pregnancies complicated by slow embryonic heart rates in the early first trimester." Journal of Ultrasound in Medicine 1999. Vol 18, Issue 8 537-54.

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