Re: No heartbeat at 14w

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>I had a prenatal appointment with my obgyn today, at 14 weeks. He tried
>to pick the heartbeat using a doppler, but couldn't find it. He said I
>shouldn't worry, since it's a little early to hear.

It's very difficult to be an "armchair quarterback" when deciding whether or not another doctor is practicing the "right" way. Unless you are very overweight, one should be able to hear a fetal heartbeat using a doppler at 14 weeks. Fortunately, we have a couple of ultrasound machines in our office, so when this happens, we simply grab the machine and take a look. However, this makes the appointment take longer, which will not matter a bit to you (because you are understandably worried), but it will matter a lot to the ladies waiting impatiently in the waiting room. Perhaps your doctor does not have an ultrasound in the office, or has a policy of not providing this (usually free) service (insurance companies rarely pay for ultrasounds that are not preauthorized, and many will not pay for any ultrasound in pregnancy unless it's for a serious medical condition). Since an ultrasound machine can run between 30,000 and 300,000, it is not cheap to buy one of these. As HMO compensation drops, many doctors cannot afford to buy an ultrasound because they do not get reimbursed enough for each procedure to make it worthwhile. However, I think it's a poor practice to make a worried patient wait many weeks before the next appointment, and I'm surprised your doctor did not do or order an ultrasound.

I'll bet if you phoned the office and expressed your concern, one of the nurses (or the doctor) could work you in to check for the heartbeat again. If you need an ultrasound and your doctor does not have one, get it approved from your insurance company and have one done at the hospital or outpatient radiology center.

Best of luck. I'll keep my fingers crossed for you.

--
Ashley Hill
David Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, FL
http://home.mpinet.net/dahmd

The above is intended for general medical education,
and is not for specific medical advice.
I apologize, but I am unable to answer personal e-mail
due to time constraints.

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