When Will You See the Heartbeat? First Ultrasound Explained

If you just found out that you're pregnant, you are probably looking forward to your first ultrasound. It's pretty amazing. But if you don't know what to look for, it might end up looking like a screen full of static. Right here is your baby. Let's see it! So today I want to walk you through exactly what a first trimester ultrasound involves, what your medical provider is looking for, and what those early images actually mean so that you can be excited about what you're looking at. I see it now! And I'm also going to go over the part that most videos skip, which is what to do emotionally when the results aren't as clear as you hoped. And if you're on your cell phone, turn it sideways because you're going to be seeing a lot of cute ultrasounds here. By the way, my name is Diana. I'm a physician assistant specialized in women's health and gynecology. Now I have been in the room for more early pregnancy ultrasounds than I can count. And I've also been on the other side of that screen four times so I know what this feels like from both directions. So let's get into it. First, the procedure itself, because this is the part that catches most women off guard. Because when you picture a pregnancy ultrasound, you probably picture gel on your belly, a probe rolling around, and grainy images on a screen. That is an abdominal ultrasound. And you will have abdominal ultrasounds eventually. But at six weeks, and often at 10 weeks, your provider is going to use what's called a transvaginal ultrasound instead. And here is why. In early pregnancy, your uterus is still really low in your pelvis and the embryo is tiny. We're talking a few millimeters. And an abdominal probe pressed against your tummy just cannot get a clear enough image at this stage. There's too much distance and there's too much tissue in the way. But a transvaginal probe goes inside the vagina, just a few inches, and sits much closer to the uterus. And you are going to get way clearer images. Now what does that actually feel like? So the probe is very slim, roughly the diameter of two fingers. And it's covered with a sterile covering and gel. So your provider will gently insert it inside your vagina. And it shouldn't be painful. But it can feel mildly uncomfortable, especially if your uterus is tilted, which a lot of women have and don't even know about it. So if you feel actual pain, make sure to say something, because your medical provider can make adjustments to make it not hurt as much. But for some women, it's totally painless. Okay, so now what is your provider actually looking for? So let's start with the six-week ultrasound. The six-week scan has one main job, which is to confirm that the pregnancy is where it's supposed to be, that it's developing, and also how to figure out exactly how far along you are. So the first thing that they are looking for is what's called a gestational sac. It shows up on the ultrasound as a dark, oval circle. It's fluid-filled. And on ultrasound, fluid looks black. So you'll see this dark, oval shape. And that's normal. That's what you want to see. Now, where we see the gestational sac is really important. We want to see it inside the uterus. This is called an intrauterine pregnancy, or inside the uterus. And that helps us rule out what's called an ectopic pregnancy, which is where the embryo has implanted somewhere outside of the uterus, usually the full-open tube. An ectopic pregnancy is a medical emergency. So catching it on ultrasound is really, really important. Now, inside the gestational sac, we look for the yolk sac. It looks like a tiny, white ring on the screen. Now, the yolk sac is what is nourishing the embryo in these early weeks before the placenta takes over. So seeing the yolk sac inside the gestational sac confirms that this is a real intrauterine pregnancy, not just a fluid collection that could be confused for one. The next thing, and this is probably the most exciting part for you, is the fetal pole. So this is the first visible form of the embryo itself. It's a tiny, slightly curved, white structure right next to the yolk, like an adorable little jelly bean. And at six weeks, it might only be about one to two millimeters long. Your provider is going to measure it from end to end, and that measurement is called the crown rump length, or CRL. And here's what's really interesting. That measurement is actually more accurate for dating your pregnancy than the date of your last period, which is why your due date sometimes changes after your first ultrasound. That's not bad news. It just means that the measurement gave a more precise picture of how far along you are. And then there's the heartbeat. Okay, now I want to slow down here because this is the moment that most women are holding their breath for. And it's also where a lot of unnecessary panic might start. At around six weeks, your provider is looking for what we call cardiac activity, which is a rhythmic flickering motion in the embryo that tells us that the heart is beginning to beat. On screen, it looks like a tiny flutter. And honestly, seeing it for the first time is a moment that you never forget. If there is that flicker of a heartbeat, your provider can use the ultrasound to convert that flicker you see into a sound which you can hear, which is this sound. There's really nothing else like that. Now, at six weeks, the heart rate starts relatively slow, somewhere around 90 to 100 beats per minute. And then over the next few weeks, that heart rate will climb to around 140 to 170 beats per minute. Now, that being said, if you don't see the heartbeat at six weeks, that doesn't automatically mean that something is wrong. Because six weeks and zero days is the very earliest that you can detect a heartbeat on ultrasound. The embryo really is only a few millimeters long. So whether you can see the heart flicker depends on things like the exact gestational age, the position of the embryo, the equipment being used, and even the person that's doing the ultrasound. So if there is no cardiac activity, which is, remember, that little flutter, it's okay. The recommendation is to wait and then repeat the ultrasound in another seven to 10 days before drawing any conclusions. Because you might just be a little earlier in the pregnancy than you thought. So that is the six-week scan. Now I want to walk you through what's different at, say, a 10-week scan. Because those four extra weeks will give you so much more to see on ultrasound. Now, as a side note, your first ultrasound might not happen at six weeks. And it might not happen at 10 weeks. It could be at eight weeks or maybe 13 weeks. That's all fine. The measurements are going to be a little different. But I hope this will just help you to be able to understand what you are looking at. So by 10 weeks, your baby's growth is staggering. In just one month, they have transitioned from a tiny two-millimeter embryo to a 30-millimeter fetus. That means that your baby is at least 15 times longer and 40 to 50 times heavier than they were at week six. On the fruit scale, that means that they will have grown from something the size of a sweet pea to the size of a strawberry. And fun fact, at 10 weeks, your baby officially stops being called an embryo. It is now technically called a fetus. But that's not just medical jargon. It's a baby at six weeks. It's a baby at 10 weeks. And now on ultrasound at 10 weeks, compared to that little jelly bean at six weeks, the baby really starts to look like a baby. You can see a defined head and body. They have little limb buds, which are the early beginnings of arms and legs. And the baby might actually move during the scan, which can genuinely catch you off guard in the best way possible. Now, it's too early to feel those movements, but you can definitely see them on ultrasound. Now, the heartbeat is much clearer and easier to see. And it's usually beating around 140 to 170 beats per minute. They will also evaluate the placenta. They'll look at where it's developing and also how close it is to the cervix. Now, this can change a lot as the uterus grows. So early information is just the starting point. Your provider will be looking at the baby's growth as well. So they'll re-measure the crown rump length, which is, again, remember the top of the baby's head to the baby's bottom. Just to confirm that the baby is growing at the expected rate. They're also going to take a look at the uterus and the ovaries. And they'll be checking for anything that needs attention, like an ovarian cyst, which is actually pretty common in early pregnancy. And usually nothing to worry about, but definitely worth monitoring. Now, one more thing on the 10-week scan. Depending on your provider, this may also be when first trimester screening options come up. They can do blood tests for chromosomal conditions. And this is completely optional. If you are close to 11 weeks, they could potentially schedule you for what's called the nuchal translucency scan, which is an ultrasound that screens for chromosomal and genetic conditions, like Down syndrome. Now, that's a whole separate video, but just know that it might come up at this appointment so that you're not caught off guard. Now, before I give you the questions to ask, and I will give you those questions to ask in a minute, I want to do something a little different first. If you are heading into any one of these appointments and you realize that you want to feel even more prepared, not just about the ultrasound, but about labor, about birth decisions, and what to actually expect, I build a course called Own My Birth specifically for that. It's everything that you need to know about pregnancy, about nutrition, about exercise, about diet, about how to prepare for the delivery. But it's also the pain relief, the breathing, the birth preferences, and most importantly, a framework for making decisions in real time in the labor room when it actually matters. So the link is in the video description. Come and learn about labor, about decision-making with me. All right, now let's talk about the questions to ask while you are at your ultrasound. A lot of women leave without asking anything because when they get into that ultrasound room, their mind goes blank. And then they spend the rest of the day spiraling about what they saw. So at the six-week ultrasound, you can ask, is the pregnancy inside the uterus? Is it in the right place? Even if everything looks good, ask anyway so that you hear that confirmation out loud. Next, you can ask, can you see the heartbeat? And if not, what does that mean for the next steps? The second part, what does that mean for the next steps, is important because it makes your provider explain rather than just say, well, we're just going to rescan. And then that leaves you filling in the blanks with worst-case scenarios. Another question that you can ask is, what is a crown rump length? And does that match my dates? This prepares you for a possible due date change instead of being surprised by it. Although if you were having a 12-week ultrasound, for example, we're probably not going to change your due date based on the measurements if we already got measurements at a six or seven-week ultrasound. Another question that you could ask is, is there anything you're watching or want to follow up on? This is open-ended because it gives your provider space to flag something without you having to know the exact right question. One other question that you might want to consider is, what screening options do I have coming up and when do I need to decide? Because first trimester screening has timing constraints. It's better to know right now what your options are. So write those questions down. Seriously, write them down because when you are in that ultrasound room, you're going to forget those questions. I would forget those questions. So write them down and then write down their answers as well. Now let's talk about the emotional side because nobody actually prepares you for this part. When you're watching that screen and you're waiting to see something, not knowing what you're looking at, hoping that your provider is about to say something reassuring, it can be one of the most emotionally raw moments of early pregnancy. And it doesn't always go how you imagined. Sometimes you see a heartbeat and burst into tears and then sometimes you don't see one yet and that leaves you terrified. Sometimes you see one and feel strangely numb and then feel guilty about not bursting into tears with excitement. And then sometimes providers find something uncertain and then schedule a follow-up and then you spend the next two weeks in a fog of anxiety. And all of that is normal. All of those emotions are normal. But here's what I want you to know. Early pregnancy ultrasounds, especially the ones at six weeks, are often just the beginning of a process and they're not going to give you an exact conclusion. The results aren't always black and white at this stage. Sometimes the answer is, you know what, everything looks great right now and then sometimes it's, hey, we're going to need some more information. We're going to need to do a follow-up ultrasound. And sometimes, and I say this with as much care as I can, sometimes it's not the answer that you were hoping for. So whatever you see on that screen, ask your provider to walk you through exactly what they saw and what the next step is and then write that down. If possible, try to bring somebody with you. And if you leave with more questions than answers, that's a completely reasonable response to an inherently uncertain situation. Early pregnancy is a lot, so give yourself some grace. Let's bring that all back. So a transvaginal ultrasound is used in early pregnancy because the uterus is low and the embryo is too small to see from the outside. At six weeks, we're looking to just confirm that the pregnancy is inside the uterus. We're looking for a gestational sac, a yolk sac, and a fetal pole, as well as measuring the crown rump length and checking for cardiactivity. If you don't have a heartbeat at six weeks, that doesn't automatically mean something is wrong. It might just be too early. So repeating the ultrasound in one to two weeks is the right move when the findings are uncertain. At 10 weeks, you can start to see a defined tendon body. You can see limb buds, a clear heartbeat, and growth confirmation, and also the placental position. This may also be when screening options come up. So I hope that helped. If you like this video, save it before your first appointment and then pull it up in the waiting room. And also share this with anybody who's pregnant and hasn't had their first scan yet because this is exactly what most women wish they'd known going in. But if this is your first time to my channel, I have actually done a pregnancy series. I will walk you through pregnancy week by week. And on each video, I will talk about baby development, what to expect at your OB appointment, common pregnancy symptoms and how to help with them, and then so much more. So I am going to link to that playlist right here. Click on that. Find the week that you're at. Maybe watch a few earlier weeks just to get you caught up. So click on that right there and I will see you over there.