QuestionQUESTION: Hello,
On Aug.25, I had a positive pregnancy test. I was 4.5 weeks at the time (1 week late for my period - LMP July 23). That same day, I had brown spotting, only to have bleeding (like a period) the following evening. I went for blood work on Monday morning (Aug.27) - the hcg level was 17 - they told me I was miscarrying. A week later, on Sept.2, I had another hcg blood test, which showed a level of 59 - the doctor said at that point, if I had a viable pregnancy, my level should have been in the thousands. He said that it may have been slightly higher than the previous week because I may have caught the first level on it's way up, and the second level on it's way down. Does this sound possible? I had a pelvic & transvaginal ultrasound on Sept.4, which showed that all was clear (no sign of sac or embryo). It was assumed that I had passed all my tissue. However, I am still spotting (today is Sept. 14). I had one day of no bleeding at all (Sept 5), so I assumed my miscarriage was over. I had sex that night. The following day I started spotting again. It's all been either pinky-red, or dark brown red blood. I had blood work done again yesterday (the 13th), and my levels came back at 254! My doctor seems convinced that I became pregnant from that one time we had sex on the 5th. Is it possible to have an hcg level of 254 after only 1.5 weeks of having sex? I'm not so sure I'm pregnant - I'm worried there's something wrong, especially since I'm still spotting. Please help!
Lisa
ANSWER: Dear Lisa,
OK - on 9/2 the hCG was 59. In a healthy pregnancy, the hCG level really would have been expected to be at least 1000 mIU/ml (at 5 weeks, 6 days).
Now, an hCG level on 9/13 of 254 would be consistent with the normal levels of a healthy pregnancy about 2 weeks after conception. So I can see why your doctor is using the rationale and coming to the conclusion that he is.
I would actually anticipate that your doctor will do a 48 hour hCG level to make sure that your hCG level is now rising (doubling) appropriately - meaning if your levels were 259 on 9/13, they should double by 9/15-16. We expect hCG levels to double every 48-72 hours early on in a healthy pregnancy. This will be important information for you and your doctor. Another ultrasound in a few weeks should also confirm a viable pregnancy contained within the uterus.
Remember - if this is a new pregnancy and conception did occur on 9/5, you would actually be considered about 3 weeks, 4 days today because pregnancy dating is based on LMP. The assumption is made that the 1st day is the LMP would be about 2 weeks prior to the conception date.
I hope this information has helped you and answered your question. I wish you well.
Brenda
---------- FOLLOW-UP ----------
QUESTION: Hi,
Thanks so much for your response.
Here is what has happened since the last note I sent:
I did have my HcG levels checked 48 hours after the 254 level - it came back at 212 (on Sept.15), which meant I wasn't pregnant, and my levels are finally starting to go down. I went for another test 4 days later (on Sept.19), which came back at 171. During this entire time, I was still spotting. I finally stopped spotting 4 days ago (Sept.20), but then I start bleeding again this morning. It is like having my period. Could this be my period, or am I still bleeding from my miscarriage? It has been exactly 4 weeks since I started bleeding with the miscarriage. Do my HcG levels have to be less than 5 for menses to start? Also, is there a certain amount of time that I am required not to bleed before it is true menses?
Thanks so much! I just want this to be over with!
Lisa
AnswerDear Lisa,
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.
Less often, your bleeding tapers off quickly, but with some spotting. You think it is over. Perhaps a week or even two will pass, and you begin to wait for your period. Then suddenly, it begins again. Strong cramping, heavy bleeding, and pain. You hope it is just your period, but it is not. (You must not bleed at all for about 20 days for it to be a real period, otherwise you have not gone through the hormone chain properly.) Usually within a few days, it does stop, and you are just spotting again. Here is what likely happened - some tissue was missed during your D&C or natural miscarriage. A bit of placenta clung to the wall of the uterus. It continued to draw a little blood, and the body continued to create very small amounts of pregnancy hormone. Eventually the body realized no baby was there and turned loose of this last bit of tissue. The miscarriage process begins again. Only now will your levels drop to zero and a new cycle begin. You cannot expect a normal period any sooner than 4 weeks from this, and up to 7 weeks could still be normal. Your total wait time from original miscarriage to first period can creep up to 9-10 weeks and still be normal.
You should continue to have your hCG levels monitored to make sure they are dropping steadily and coming back down to zero. Since your level was still over 100 at 4 weeks after the initial miscarriage, you likely will pass heavier blood and tissue with this last episode and then it will be done. If not, and you do continue spotting afterwards, a medication called Cytotec might be ordered by your doctor to help the body in cramping to push out any remaining tissue.
I hope this information has helped you and answered your question. Be well.
Brenda
