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Pregnancy ultrasound images can be one of the most exciting milestones for an expecting parent. Most ultrasound screenings take place in the second trimester, but a 6-week ultrasound may be appropriate for some pregnant people - learn why, what to prepare for and next steps after an early ultrasound in the first trimester.

Are you pregnant and anticipating an early pregnancy ultrasound? There are a few reasons a prenatal health care plan might include imaging at about 6 weeks of pregnancy - read on for some of those reasons, what to expect at the screening, and other tips for early pregnancy health care and planning.

• Reasons for a 6 week ultrasound
• Ultrasound standards
• Early pregnancy scans
• Early ultrasound concerns
• Transvaginal and abdominal ultrasounds
• Early heartbeat detection
• Preparing for your 6 week ultrasound
• Hydration and comfort
• Expectations
• Early screening and pregnancy loss
• What happens next?

Reasons for a 6 week ultrasound

The early stages of pregnancy have unique features, and ultrasounds are commonly used to date a pregnancy and confirm details of early fetal development. This is usually done after the first trimester, at about 12 weeks or later, after a conception has been confirmed by pregnancy test, but there are some reasons you night have an early ultrasound at about 6 weeks or at another time in your pregnancy.

Ultrasound standards

Ultrasounds are used to look inside of someone’s body using high-frequency sound waves. The sound waves bounce back to the ultrasound transducer from inside the body, and that echo is measured to calculate the size, shape and location of soft and hard tissues. As described by the American College of Obstetricians and Gynecologists and the National Institutes of Health , this technology is generally considered safe with appropriate use, as it “does not produce ionizing radiation like that produced by x-rays. Still, ultrasound is capable of producing some biological effects in the body under specific settings and conditions.”  Unregulated or recreational ultrasounds that are provided outside of your prenatal health care setting are not recommended and could come with unknown risks, as safety data is based on correct use of FDA-approved medical-grade machines.

For most pregnancies, recommended use is one abdominal ultrasound between the first trimester and about 22 weeks gestation - after this point ultrasound imaging becomes increasingly less accurate for size and age estimations, but may still be helpful for other assessments of your baby.

Pregnancies do develop at slightly different rates, and estimated due dates are often miscalculated, so exactly when you have an ultrasound, and what you can see in the image scan, may vary - most ultrasound procedures fall into three categories for pregnant people:

1. Standard Ultrasound Exams

‍These are most common, usually occurring between 12-20 weeks, and assess physical developments as well as screen for any signs of concern. Typical markers that will be measured in a standard exam include:

• Number of fetuses, in case of multiple pregnancy
• Estimated size and weight of a fetus
• Fetal position, movement, and anatomical details
• Observation of fetal breathing and heart rate
• Amount of amniotic fluid
• Placenta location in the uterus

2. Limited Ultrasound Exams

‍These are used to answer a specific question in someone’s care or experience, such as assessing a baby’s position during labor if a provider cannot do so manually.

3. Specialized Ultrasound Exams

‍These exams may use special equipment, such as 3-D imaging or Doppler sonography, and are used if there is any suspicion of a problem based on other tests, health history and risk factors.

Early Pregnancy Scans

Ultrasounds that take place earlier in pregnancy can be used to answer some of the same questions as above. Having a 6 week ultrasound does not mean that there is anything wrong with you or your baby, but your provider may order one if you have had any higher-risk pregnancies or health conditions in the past, or if anything about your health status or symptoms suggest that early screening would be beneficial to your care - if you ask, they should be able to give you their reasons.

Early ultrasounds are not always accurate - if a pregnancy has been misdated, it might be too early to see details, so try to be patient if you don’t get the image you were hoping for and have to return for a second screening. Features your provider can assess at 6 weeks include:

• A developing fetus just a quarter-inch long, about the size of a sweet pea!
• Early development of the beginning of limbs and body shape
• A visible heartbeat (only detected in a small portion of 6-week scans as many are scheduled a little too early)
• A balloon-like yolk sac, which nourishes the fetus until about 12 weeks - its size and shape help your provider assess the early health of your pregnancy
• The location and number of embryos - confirming if you are carrying multiple pregnancies, and where your pregnancy is located in your uterus, can help your medical team to plan for any special treatment.
  

Early ultrasound concerns

You may have questions about your 6 week ultrasound, any risks, and the questions your prenatal health care provider is trying to answer with this early pregnancy screening  - and you deserve answers! Read on knowing that you always have the right to ask questions, understand your options, and take time for collaborative informed decisions with your prenatal health care provider.

Transvaginal and abdominal ultrasounds

Generally, ultrasounds are performed externally, and the part of the machine called a transducer is placed over slippery gel on the skin of your lower abdomen and pelvis. There, the transducer sends out energy in the form of sound waves, and that energy bounces back from inside your body as echoes that the computer uses to create images - this is much like the way bats use sonar to see in the dark!

Standard ultrasounds are external, but if you have an ultrasound in your estimated 6-week range, your care provider will likely plan to use a transvaginal ultrasound. This is the same type of technology as described above, but instead of an external exam, the transducer is shaped like a wand or probe, usually about the size of a tampon. The transducer is placed about 2-3 inches inside of the vagina to get a more detailed image of developments in the uterus and surrounding areas, and covered with gel and a condom.

While the safety for these types of imaging technologies is considered the same, it is worth noting that a transvaginal or endovaginal ultrasound is invasive and may be uncomfortable. It should not cause significant pain and if it does, or if you need to ask to stop the exam, it is completely okay to do so. Depending on your preference, you might ask for the ultrasound technician to walk you through the procedure so that you know what is happening next and can support your comfort with deep breaths and relaxing your pelvic muscles as much as possible.

Early heartbeat detection

As mentioned above, your 6 week ultrasound will likely include an assessment of your pregnancy’s development, including a fetal heartbeat. It is difficult to date pregnancies with 100% accuracy, and more often than not, 6 weeks is too early to detect a heartbeat, so do not be discouraged if you or your ultrasound technician cannot see details of the heartbeat. If that is the case, or if it is difficult to measure anatomical development in general, you will very likely be asked to come back in two weeks. 

The variability of these early screenings and the likelihood of missed information is one of the reasons most people are not offered an ultrasound until later on in pregnancy. If you do have an early imaging screen and need to return for another appointment, it can be a period of emotional anticipation (positive or negative), so know that this is a normal waiting period, and it’s better to get an accurate re-screen  than to return too early to confirm helpful information. 

Preparing for your 6 week ultrasound

Your early pregnancy ultrasound screening may sound simple enough, but there are a few things you can do beforehand to support your comfort and confidence at your prenatal appointment. Physical and mental preparation is helpful in almost any healthcare setting, and at Seven Starling, we believe a little planning goes a long way. Read on for 6-week ultrasound tips or check out more pregnancy and birth planning resources here.

Hydration and Comfort

Whether you are planning for a standard ultrasound or early endovaginal ultrasound, your comfort will help the process go by more easily and effectively. We recommend:

• Asking your care provider about a full bladder. Some ultrasound screens benefit from a full bladder and so it may make sense to drink a glass of water about 25-45 minutes before your appointment. This may help a technician to find a good image - in early pregnancy, everything is so small and deep in the pelvis that a slightly full bladder can help make things more visible.
• Wear loose, comfortable clothing- you will likely need to remove all or part of your undergarments, but likely keep your top on. 
• A warm layer - clinics are often chilly, especially if you are partially undressed for the 15-30 minutes that an ultrasound might last.
  

Expectations

One of the major determinants of satisfaction in prenatal care is whether the reality of someone’s experience matches their expectations - this is one of the reasons childbirth education and pregnancy support can be so beneficial. To avoid feeling disappointed or unnecessarily worried while anticipating your 6-week appointment, here are some realistic expectations:

• You will be asked to partially undress, and the exam can take anywhere from a few minutes to half an hour or so, depending on the purpose of the screening.
• You may not be able to see as much information about your pregnancy’s status as you had hoped, as conception dates are often miscalculated.
• If you do see or learn information about your pregnancy, it may bring up strong emotions - or it may not - either experience is valid!
• Whether or not you receive a printout will vary with the facility.
• Your ultrasound technician may not share any information, or only very limited information. Depending on where you live and how your prenatal health care is set up, the ultrasound technician will usually send the examination results to your physician or midwife, who will then discuss the results with you.
• If a yolk sac is not visible or a heartbeat is not identified, you will most likely be asked to return in two weeks, depending on your estimated gestational age and other health factors. This can be emotionally stressful, and it may be helpful to know that this kind of repeat visit is common.
• If you or your care provider have concerns about miscarriage or other pregnancy complications, it may require some time and a combination of imaging and bloodwork to confirm the status of your pregnancy.
  

Early screening and pregnancy loss

Expectations around fertility, miscarriage, pregnancy loss and health are incredibly personal, and vary between families and cultures. It’s important to know that early pregnancy loss is almost always unpreventable - meaning it is not the pregnant parent’s fault, and it happens in healthy people who go on to have successful pregnancies and healthy babies. 

While this information does not make someone’s pain, grief or sadness at a pregnancy loss less real, we hope it is empowering to consider that a miscarriage this early on is usually due to something about the pregnancy that was unsustainable or would have caused severe risk to mother or baby had it continued. This is just one reason early prenatal care is so essential to the long-term health of birthing people and their families.

What happens next?

An early ultrasound in pregnancy is one step in determining the best route of care, and usually it is the first step in prenatal care that will continue through the first trimester and beyond. We hope this overview helps you to feel prepared and gives you the context and language to ask questions and make collaborative decisions with your medical care provider.

After your 6-week ultrasound appointment, the prenatal care that follows will be determined by your insurance provider, the type of maternity care provider you work with, your pregnancy and birth goals, and your health history. You also have options to start preparing and caring for yourself and this pregnancy by hiring a doula or signing up for some childbirth and infant care classes. 

Selected Sources

• ‍Ultrasound. National Institute of Biomedical Imaging and Bioengineering. www.nibib.nih.gov. Accessed April 2021.‍
• Ultrasound Exams. The American College of Obstetricians and Gynecologists. www.acog.org. Accessed April 2021.‍
• Transvaginal Ultrasounds. U.S. Library of Medicine. www.medlineplus.gov. Accessed April 2021.