QuestionHello Brenda - today I am 31 days (4 weeks, 3 days) pregnant. (last period 12/17). My Hcg Levels have slowly risen - they were 9000 on 1/8/07, 13000 on 1/10/07 and 24000 on 1/15/07. My progesterone has risen as well - 8.5, to 13.0, to 16.8. My temperature dipped a few times, but seems now to be steadily over my coverline.
Now, I have had two sets of two ultrasounds on 1/12/07 and 1/16/07 (pelvic and trans) and neither one showed ANYTHING. No sac, no ectopic, no NOTHING. I asked 2 Dr.'s on Just Answer and both said this is definitely not an intrauteral pregnancy, because my HcG is too high and they should see a sac by now. The Ultrasound Dr. seems convinced that its just far too early in my pregnancy to see anything, but the ObGyn (and all others) say my HcG levels are far too high for NOTHING to be seen by ultrasound, and is convinced its probably ectopic. I am so confused and scared. I am now convinced this pregnancy is doomed. I have had a previous ectopic, so my chances are high. I am just scared as to WHEN they will finally be able to find something in my tube. I am afraid it will rupture before I get answers. My next ultrasound is not until next Monday - and I am terrified of what comes next.
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Hi Brenda,
I am sorry to keep asking so many questions, but I feel like you are kind of a life line.... and the only person who gives me a little hope! I went to the ultrasound today, and the Dr. said "he sees no evidence of a pregnancy whatsoever". He said if I am 3 weeks 4 days along, he really doesn't expect to see anything yet. In fact, he was quite surprised the the ObGyn even bothered sending me for an ultrasound this early in the game, and he kind of brushed me off. He said my levels are definitely off, but its too soon to tell why. I feel like no one will help me. I am so confused and upset, I am ready to go to the ER to get blood levels again, because my Dr.'s office was closed and they didnt order me another one. If, in your opinion, they did not see any signs whatsoever of me being pregnant, does that mean its just not going to progress and its not a viable pregnancy? How is it possible that my HcG levels are so high, but nothing is showing up? Is it possible this is a molar pregnancy? What should my next step be? Should I switch doctors? My last period on 12/17 was normal, even longer than usual, with bright red blood in the beginning, fading to brownish. No pain, nothing out of the ordinary. Is it possible I actually miscarried at that point? -------------------------------------------
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I had my second blood test after 48 hours. Thankfully, the Prometrium did help, my progesterone went from 8.5 to 13.0. However, my Hcg level did not double, it only went from 9000 to 13000. The nurse indicated that this was a bad sign - that my pregnancy might not be viable because my HcG did not double like she likes to see. She said something might be abnormal. I have an ultrasound tomorrow, but I feel like I am going crazy with worry. Do these levels seem really bad?
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My last period began on 12/17/2006. Yesterday (1/8/07) I got a positive pregnancy stick test, so got a blood test. It showed my HcG as 9000, but my progesterone as 8.5. The doctor put me on Prometrium. Is there any chance for this pregnancy, or is 8.5 just far too low for a viable chance? I am so scared.
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Dear Kate:
Correction in Caps: (Noted as I re-read answer later and wanted to correct! Ectopics typically have low hCGs, molars are abnormally high - a tired brain on my part.) Also, please let me know how this goes for you! :-)
Dear Kate,
OK - first, your hCG would not be increasing if you had miscarried on 12/17. Second, I'm in agreement with the ultrasound tech. Just to make sure I have my facts exactly straight (because I am NOT an expert in ultrasounds), I've done a little more research. From what I've found, the gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured by about five and a half weeks. A visible heartbeat could be seen and detectable by pulsed doppler ultrasound by about 6 weeks and is usually clearly depictable by 7 weeks.
So, my question is...is your doctor listening to you regarding your LMP?? NOW... my only concern is this - with that high of an hCG level and no uterine evidence of pregnancy, I have to be slightly concerned about the possibility of an MOLAR pregnancy. So please be aware of any bleeding that may occur. However, because your LMP was 12/17 and that dates you at 3 weeks, 6 days just today, I just cannot understand the quickness to jump to a dire conclusion here. I feel like I'm missing some huge piece of information to connect the dots.
You absolutely have the right to seek a 2nd opinion before giving up on this pregnancy if you feel you are not being heard. If you do, make sure the FIRST thing you report to that doctor is that your LMP was 12/17 and that it was a regular, normal period. Also, if you have any idea as to when you conceived (some do, some don't - depending on sex lives) make sure you pass that on also. It will be helpful to write down what medical interventions have been done so far and dates (hCG and progesterone levels, Prometrium started, ultrasound, etc,..) He/she can get your records later if you decide to switch, but it will be helpful to have that information written down for a reference. Talk to family/good friends that you trust for a reference for an OB.
I hope I've helped. Don't worry about asking questions - that's what I'm here for! :-)
Brenda
AnswerDear Kate,
I wish I could alleviate some of your anxiety. The problem is that I really agree with more than one of the opinions that you've gotten. First - I do think that the U/S doctor has a point about it being a bit too early in the pregnancy to have full-out panic yet. On the other hand, with the hCG of 24,000, you would expect a developed enough sac to see SOMEthing SOMEwhere - especially with a trans-vaginal ultrasound.
Having an ectopic previously does put you at a slightly higher risk for another ectopic. As I noted before, ectopics typically have hCG levels lower than we'd expect with a healthy pregnancy. Yours are within normal range BUT they are rising slower than we'd like (not doubling every 48-72 hours), so that would also fit the profile. So - be aware of these ectopic symptoms:
-Abdominal or pelvic pain, usually 6 to 8 weeks after a missed period. Pain may get worse with movement or straining. It may occur sharply on one side at first and then spread throughout the pelvic region.
-Vaginal bleeding that may be light or heavy.
-Pain with intercourse or during a pelvic exam.
-Dizziness, lightheadedness, or fainting
-Signs of shock (restlessness, rapid pulse and breathing, cool, clammy skin)
-Shoulder pain caused by bleeding into the abdomen under the diaphragm. The bleeding irritates the diaphragm and is experienced as shoulder pain.
If you are aware of the symptoms, you should not be as scared of a rupture before a confirmed diagnosis can be made. Unfortunately, all you can do is wait this out. Next Monday you will be at 5 weeks LMP. They should be able to see something at that point, especially with T-V U/S. At least then you will have answers - one way or another.
I'm sure you feel overwhelmed but I hope you can TRY to take each day one day at a time until then. Keep me posted.
Brenda
