What is the reason for not seeing fetal heartbeat on ultrasound at 45 days of pregnancy?

Patient's question:

Doctor,
I am a 32-year-old pregnant woman. During a B examination at 45 days of pregnancy, it was said that the fetal heartbeat was not detected. Is this an indication of a miscarriage, or is it due to the short duration of pregnancy?
Please provide an answer.

Doctor's answer:

Your normal pregnancy usually shows fetal pole and fetal heartbeat around the 50th to 60th day of gestation. Your case may be due to delayed ovulation leading to late fertilization, resulting in no fetal pole. You can go to the hospital for a follow-up check in 10 days to see if there is a fetal pole. If there is still none, you should consider the possibility of fetal demise. You can go to the hospital again in 10 days for a follow-up check to see if there is a fetal pole. Generally, ultrasound can detect fetal heartbeat after the 7th week of pregnancy. Doppler can detect it after the second month of pregnancy. A stethoscope can detect it after the fourth month of pregnancy.

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