QuestionQUESTION: Hi there.
First off, I have PCOS and my husband and I have been trying to get pregnant for over a year now. My last period was 07.11.07.
I found out I was pregnant on 09.24.07 from taking a home pregnancy test. It was confirmed with a blood test the following day (09.25.07). I met with my OBGYN the same day of the blood test and she could not find any signs of a fetus. To make sure I did not have an ectopic pregnancy, I took another blood test the following day. She told me my hcg levels went from 62 to 122 which was normal and concluded I was only 2-3 weeks pregnant.
The following Sunday, on 09.30.07 I started spotting -- very light and no pains. I immediately contacted my OBGYN and she said it could be normal but to come in for a blood test. I, however, was out of town for business and did not return til Tuesday. So I took my blood test 10.03.07 the following day. The hcg levels had dropped to 91. She informed me I was having a miscarriage and there was nothing we could do at this point and that she expected me to bleed for awhile and probably have a period. It was a difficult time as it was our first pregnancy, but I continued to work.
I continued to spot for a week -- it would stop and start and was always light. And again no pains. Then on Monday, the bleeding got heavier. And the following night, 10.09.07, I started cramping. I believed this to be normal since I was told I was having a miscarriage. However the next night, 10.10.07, the cramping was extremely painful and the bleeding more intense. And I passed two clumps of what I later learned was tissue (no one had told me this was going to happen). I ended up going to the ER where I they gave me vicodin for the pain, performed a pelvic exam, and blood tests.
The doctor said my cervix was closed, he did not see any more tissue, and the blood was dark so it appeared old. However, he was surprised by the blood tests because my hcg levels were now at 292! They had actually risen. He advised me to contact my obgyn the following day.
On 10.11.07, I spoke to my dr. again and she told me she was shocked by the results as well. i let her know that after the night in the ER, the following morning, I did not bleed at all, but it started again in the afternoon. I am now back to spotting. she now says it could be an abnormal pregnancy (possibly ectopic after all) or the slightest chance of a normal pregnancy after all. She had me take blood tests again today and to repeat them on Sunday. She says she will call me Monday.
My question is, what will happen at this point? if the hcg level drops, should i ask for a D&C? And is it really possible to still be pregnant after all this? But if it is a miscarriage, how long will I continue to bleed? And when can we try again? And after spotting should I have taken to bed (one nurse said that's what I should have done)?
I would appreciate any insight you can provide as different ppl are telling me different things...it is a very painful emotional and physical time for me and my husband.. we want a child so badly.
thank you for taking the time to read this. god bless.
ANSWER: Dear Lynn,
*First*
Please accept my apologies for the delay in answering. Our cable (TV and internet) went out early Saturday and after several BOGUS stories, the tech came today and regretfully informed us we were mistakenly shut off for our NEIGHBOR's non-payment. So... as frustrated as all of you may be at having to wait longer for an answer, try being me with a husband without football all weekend for apparently no valid reason!!!
Now to your question...
Depending upon what your results are (well, now WERE - thank you to Charter Cable) on Sunday, that will determine whether this pregnancy is developing appropriately. Early on in pregnancy we expect hCG levels to double every 48-72 hours. So if your level doubles, or nearly doubles, then there is reason to be hopeful that the pregnancy may be progressing. If the levels do not even come close to doubling or drop, then we are less optimistic and a miscarriage is definitely a possibility.
If that ends up being the case, you will have the option of miscarrying naturally or having a D&C. There is no way of knowing when a miscarriage will actually occur. The hardest part of a natural miscarriage is often the waiting. Many women opt for a D&C for this very reason once they know there is no hope for the pregnancy.
Most often after a miscarriage or D&C your bleeding will taper off to spotting within 7-10 days, and maybe random spotting will continue for another week. Your hCG will drop steadily, usually hitting zero during the end of the spotting, or about 10 days after the miscarriage or D&C. Some women find they have mild pregnancy symptoms, or little ovulation cramps. Many many women think they could be pregnant, because strange things are happening and their period is "late" (although almost every post-miscarriage period is late.) These symptoms are due to the body's attempts to regulate its hormones again. It may kick into gear right away, and you will get a new period in 4-5 weeks, or it may struggle a bit, and the period will not come for up to 8 weeks.
The general recommendation is to wait through 2-3 normal menstrual cycles before getting pregnant again to allow for complete healing and for your hormones to get back to normal levels again. As far as bedrest to fend off a miscarriage this early in a pregnancy - it is simply not true. Most early miscarriages are due to chromosomal abnormalities and cannot be fixed or thwarted by staying in bed.
I hope this has helped you and answered your question. I wish you well and again, thank you for your patience.
Brenda
---------- FOLLOW-UP ----------
QUESTION: Brenda,
Thank you for getting back to me (it's okay for the delay, I'm having internet issues as well).
Here is the latest... I took blood tests on 10/10, 10/12, and 10/14 with the results being 283, 339, and 438. So they are going up but not doubling. I am still bleeding.. but it has not been heavy since Wed. night. It went back to spotting a couple days and now light bleeding again of darker blood (some clots). I had cramps this weekend but nothing yesterday or today.
My doctor emailed me and said that bec. the HCG levels initially dropped and are slowly increasing, that it highly suggests that I have an abnormal pregnancy (she says either ectopic or abnormal uterus). She recommended an injection of methotrexate to terminate the pregnancy.
My husband (bless his soul) has been doing all kinds of research and thinks that I may have a chance of a normal pregnancy (my doctor does not think so). He says he read that HCG numbers do not always double? And he says he read about a lady who had bleeding for 6 weeks and ended up in a normal pregnancy?
I don't want to get my hopes up but I don't want to give up either... I'm so torn. My question is, if there is any hope at all that this may be a normal pregnancy, should I ask to wait to see what the HCG levels do? Will it be harmful to me and/or affect our chances of getting pregnant again in the future if we wait to get an ultrasound on Nov 1 (originally scheduled dr. appt. for ultrasound when we first found out we were pregnant)?
I guess my concern is that my doctor doesn't really know for sure what's going on -- only that everything "highly suggests an abnormal pregnancy." My husband says if we wait for an ultrasound on Nov. 1 (which should put me around 7 weeks), we can know for sure.
Thank you again for your help.
AnswerDear Lynn,
Sometimes the hCG doesn't exactly double in that 48 hour period, BUT unfortunately they are not even doubling in a four day time period. That definitely does suggest that there is a problem of some sort with the pregnancy.
An hCG level that is lower than what would be expected is one reason to suspect an ectopic pregnancy. Low levels of progesterone may also indicate that a pregnancy is abnormal. An ectopic pregnancy often also includes the following symptoms:
-Sharp or stabbing pain that may come and go and vary in intensity. The pain may be in the pelvis, abdomen or even the shoulder and neck (due to blood from a ruptured ectopic pregnancy gathering up under the diaphragm).
-Vaginal bleeding, heavier or lighter than your normal period
-Gastrointestinal symptoms
-Weakness, dizziness, or fainting
An ectopic pregnancy can be a very serious condition and can be a medical emergency if it were to rupture. If you were approximately 3 weeks along on 9/25, you would now be about 6 weeks. I would highly suggest an ultrasound as soon as possible - not waiting until 11/1. If this is an ectopic, that needs to be determined right away in order to avoid the chance of a rupture which could permanently damage the Fallopian tube and affect future fertility. So you need to know ASAP whether this is an actual intrauterine pregnancy or an ectopic.
At 6 weeks gestation, the hCG level should be between 1,080-56,500 mIU/ml. So you can see why your doctor shows concern about, not only the level not doubling, but also the level not even being close to normal for this stage of pregnancy. Also at 6 weeks, a gestational sac, yolk sac, embryo, and usually heart activity can be visualized via trans-vaginal ultrasound.
This is why I feel it is very important for you to get a follow-up ultrasound as soon as possible. You will garner a tremendous amount of information and be able to make a more informed decision about how to proceed without risking your own health or future fertility by waiting another two weeks.
I hope this information has helped you and answered your question. Be well! I'll have a good thought for you.
Brenda
