What to Expect From Your 5-Week Ultrasound

Every pregnant person has different ultrasound needs, and every provider has different preferences. I live in France, and for each of my two low-risk pregnancies, my doctor performed an ultrasound at every prenatal appointment. I also got a level-2 anatomy ultrasound once per trimester. Every time I saw my babies’ little bodies and heard their little heartbeats, I felt reassured and excited.

In the US, the American College of Obstetricians and Gynecologists (ACOG) officially recommends at least one ultrasound during pregnancy: the mid-pregnancy ultrasound, at 18 to 22 weeks, unless there are complications that need to be monitored. But many practitioners perform more than one scan for their patients.

An ultrasound at 5 weeks isn’t the norm—there’s a good chance you may not even know you’re pregnant yet—but it does happen in special circumstances. Here’s why your provider might recommend a 5 week ultrasound.

Do You Get an Ultrasound at 5 Weeks?

A 5-week ultrasound isn’t a standard part of prenatal care and is “relatively uncommon,” says Catherine Caponero, DO, an ob-gyn at Cleveland Clinic. That’s because at 5 weeks pregnant, baby’s still too small to see much on a scan.

Although you’re only required to get one ultrasound during pregnancy, some practitioners perform first-trimester scans for all patients—often at around 8 weeks—to check for a heartbeat and estimate the due date.

Why You Might Get a 5-Week Ultrasound

Your doctor might recommend a 5-week ultrasound in “very specific circumstances,” says Caponero, including to follow up on abnormal bloodwork, severe pain, significant bleeding or if they’re concerned you may be at risk of an ectopic pregnancy or life-threatening miscarriage. “Some fertility doctors will perform ultrasound this early because they’re tracking Mom’s progress,” says Kimberly Khabeer, a sonographer at Temple University Hospital in Philadelphia.

What Happens at the 5-Week Ultrasound?

This early on, you can expect a transvaginal ultrasound: Your technician will place lubricant on an ultrasound wand, which they then insert into the vagina. (It might be a bit uncomfortable, but it shouldn’t be painful!) Ultrasounds typically take a few minutes, but it can take longer depending on what your practitioner needs to check. Good news: You don’t need to prepare in any way for a 5-week ultrasound.

What Can You See at the 5-Week Ultrasound?

During a 5-week ultrasound, the sonographer will check for signs of pregnancy inside and outside of the uterus. You might see a very small gestational sac—a fluid-filled structure around the embryo—which resembles a dark-colored spot inside of the uterus. Inside the gestational sac, you might also spot a yolk sac, which nourishes the embryo until the placenta takes over around the end of your first trimester, says Caponero. “The yolk sac looks like a round or pear-shaped white circle with a black center on ultrasound,” she says.

Your practitioner usually won’t be able to see an embryo. They may also check the area around your ovaries and fallopian tubes for signs of an ectopic pregnancy, which is when a pregnancy implants outside of the uterus.

Don’t be alarmed if there’s no heartbeat—in fact, this is completely normal for a 5-week ultrasound, says Khabeer.

5-week ultrasound pictures

It’s true that you won’t be able to discern much on a 5-week ultrasound picture, but here’s what it might look like:

What if you see nothing at the 5-week ultrasound?

If you see nothing at your 5-week ultrasound, it’s not necessarily a problem. “Sometimes we can’t see anything,” says Khabeer. “It’s very possible to have a positive pregnancy test with no gestational sac visible on ultrasound at 5 weeks,” says Caponero. This may happen for several reasons, including that the pregnancy isn’t far enough along to be visible on scans. Other potential reasons include a chemical pregnancy (a pregnancy loss that happens before 5 weeks), a miscarriage or an ectopic pregnancy.

Next Steps After the 5-Week Ultrasound

Because your doctor likely won’t see an embryo, they’ll usually schedule another ultrasound about 14 days later. “Just seeing a gestational sac isn’t enough. You need to see a fetal pole with cardiac activity to say it’s a viable pregnancy,” says Khabeer. This next ultrasound will also be able to confirm your estimated due date. “While it can be very hard to wait, it’s so important for expectant parents to have a clear answer instead of uncertain possibilities,” says Caponero.

At your next ultrasound, your practitioner should be able to detect an embryo with a heartbeat. If not, they may prescribe bloodwork to figure out the best time to repeat imaging, or to offer testing or treatment, Caponero says.

To Sum It Up

It’s unusual to get a 5-week ultrasound, because it’s simply too early to see much. You might get one if you have unusual symptoms like heavy bleeding and your practitioner wants to check for ectopic pregnancy or another serious condition. Basically, it’s a little extra peace of mind for your pregnancy journey—and that’s always welcome.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.