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Q. Does a 55% increase in beta hCG in 48 hours interval indicate a healthy pregnancy?

Answered by
Dr. Sameer Kumar
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Nov 10, 2021

Hello doctor,

My wife had two serum beta hCG tests at a 48 hours interval, and the results were for 13936 mIU/mL and 21552 mIU/mL, respectively. Her last period was 15 days ago. In her previous periods, she had clots along with spotting.

Kindly help.

#

Hello,

Welcome to icliniq.com.

Thanks for the query.

You are in six weeks of gestation today. Beta hCG (human chorionic gonadotropin) levels show a rise of only 55%, which is below the expected range. So, it is likely a failing pregnancy. If the bleeding has not stopped with the Progesterone, it is termed as threatened miscarriage due to failing pregnancy.

But keeping in view the reference range of beta hCG for six to eight weeks as 15000 to 200000 mIU/mL, your values are still within the range, so I would suggest you do not rush into a decision. Kindly wait and continue medications for another week and then get a transvaginal ultrasound done for a final check-up.

It shows whether the fetal pole has arrived with a heartbeat or not. If not, it would confirm a chemically failed pregnancy at seven weeks. Moreover, a repeat beta hCG test after three days from today to compare and substantiate the present serial beta hCG test result for failing pregnancy.

We usually follow a conservative approach during the early stages of pregnancy of less than seven weeks and give an adequate chance for the embryo to fight for survival, hence the advice.

I hope I have cleared your doubts.

Take care.

Hi doctor,

Thank you for the clear answer, doctor.

I read that beta hCG above the range of 6000 is likely to come down around 96 hours. Will that apply here, doctor?

Thanks.

#

Hello,

Welcome back to icliniq.com.

I agree with your statement that a 35% rise is adequate, but it is meant for women who have undergone IVF (in vitro fertilization) or frozen embryo transfer within 72 to 96 hours. They can have 6000 mIU/mL of hCG levels.

Hence this is an average followed in early pregnancy of fewer than seven weeks, and ideally, hCG should increase twice in 48 hours.

And so, ultrasonography is still considered the preferred method to verify the presence of a viable intrauterine gestation. Kindly repeat the transvaginal ultrasound after a week.

Regards.

Thank you doctor,

Thank you for your clarification doctor and I am sorry for asking questions. I was very anxious. We are taking an ultrasound tomorrow and I have asked my wife to take another HCG test yesterday. The result came at 36,662 (70% increase in 5 days). The doubling time is 6.52 days and the increase over 2 days is 23.7%. The previous results are 13936, and 21552 (54.4% increase in 2 days). Please let me know your thoughts on this doctor.

#

Hi,

Welcome back to icliniq.com.

There is a rise in hCG levels in the last five days. But the rise is still inadequate as it should have been for 7 weeks plus one-day pregnancy. Tomorrow's ultrasound for dating scan shall be contributory and we should be able to see the yolk sac and the heartbeat if it is a viable pregnancy. There is no point speculating based on HCG levels whose values are not encouraging as per the period of gestation. The USG (ultrasonogram) would decide tomorrow if it is a delayed conception or anembryonic gestation or a chemical pregnancy. Please share the report. Regards.

Thank you doctor,

We have taken the ultrasound today and the doctor told us the gestational age is 5.3 weeks with a fetal heart scan. I have attached the photos. Please let me know your thoughts on this.

#

Hi,

Welcome back to icliniq.com.

The reports show a viable single intrauterine pregnancy with CRL (crown-rump length) of 5 weeks plus 3 days with the presence of fetal heart rate at 148 bpm. This indicates that this was a delayed conception and the bleed that she experienced was an implantation bleed. There is no presence of sub-chorionic hemorrhage The cervical length of 3.5 cm is adequate and os (opening in the center of cervix) is closed. So there are no chances of miscarriage. This is a viable pregnancy as evident by the fetal pole with a heart rate and not a failing or chemical pregnancy. Hence, I would reiterate that USG is still the best diagnostic means during early pregnancy after 7 weeks. So congratulations. She can be started on antenatal if you wish to continue the pregnancy now. Regards.

Thank you doctor,

How about the low hCG increase? Can she travel now normally through car or train and climbing stairs?

#

Hi,

Welcome back to icliniq.com.

The HCG rise was slow in the reference range for 6 weeks +. Hence a USG confirmation was mandatory. Nevertheless, it is good news that it is a viable pregnancy. I still would not suggest traveling keeping in view of the early pregnancy status. Travelling is advised ideally only after 14 weeks of gestation. But she should be started on antenatal. Regards.

Thank you doctor,

My wife's spotting has resumed today. I have attached the photo. She is taking Duphaston twice a day. I have another query. Now, her gestational age is 5.3 weeks as mentioned in the report. Does that mean, the baby has formed 2 weeks later than usual? I am a bit confused on that part. Could you say when the delivery is expected, doctor? Thank you.

#

Hi,

Welcome back to icliniq.com.

The baby was conceived late by 2 weeks and hence the gestational age as per CRL was 5 weeks plus three days in the scan. If you would see the scan report, the corrected EDD is mentioned as 24/ 4/ 2022, which is the ultrasonological estimated date of delivery. The first scan or the dating scan is taken as the correct measure of gestation and accordingly, the period of gestation is calculated, so keeping in view the corrected EDD, the baby is 5 weeks plus 5days as on date. The bleeding is evident but minimal.

I feel along with Duphaston 10 mg twice a day, she can be started on tablet Susten 300 SR (Progesterone), which can be taken one tablet at night each day an hour before sleep, till 12 weeks of gestation to support pregnancy. Such bleeds are seen when natural progesterone levels remain inadequate. You may share your doctor's prescription for review. Ideally, additional progesterone would be required and excess progesterone does not harm the baby, rather supports the pregnancy. Regards.

Thank you doctor,

We did another scan today and the doctor told me that there is no fetal growth and no heartbeat and it is a missed abortion. I was wondering whether it is possible for the fetal heartbeat to stop. The doctor told us that we need to do medically induced abortion.

#

Hi,

Welcome back to icliniq.com.

If the scan shows that the heartbeat has stopped then it is a missed abortion for sure. We had a skepticalty initially when we did the serial beta hCG levels, however, the heartbeat arrived but the bleeding occurred in the form of continuous spotting. It has been seen that heartbeat arrives and then stops in cases of pregnancies that are not deemed suitable for survival by nature. The cause can be congenital genetic abnormalities in the embryo or some chromosomal defect that is not compatible with life. The causes however are still unknown as fetal tissue at such early pregnancies has been inadequate for genetic studies (as retrieved post-abortion) though sperm defects have been attributed to the outcomes. In your case, now that it is a confirmed missed abortion. So the pregnancy has to be terminated by inducing medical abortion if the bleeding does not start naturally as spontaneous miscarriage. I am sorry for your loss. Regards.

Thank you doctor,

My wife went through medical abortion last Wednesday. She has been having bleeding and stomach pain since Wednesday. She had severe pain, which has slightly come down now to sudden pain now and then. She sent me a picture of her bleeding today, which I have attached. This looks more brown or blackish. Is this a cause for concern doctor? Thank you for your help.

#

Hi,

Welcome back to icliniq.com.

Thanks for the follow-up. The fact that the color is darkish brown with the presence of clots as well and the history of sudden onset increase in pain and bleeding indicates that there is a high possibility that there may be retained products of conception inside the uterus and the medical abortion may not have been complete yet. If the bleeding does not decrease or the pain does not decrease then an ultrasound pelvis would be mandatory to check for completion of miscarriage. The best would be that she should visit her prescribing doctor or gynecologist and get the USG done to check for completion of abortion. Unless the abortion is complete, the body shall keep trying to remove the products naturally by increasing the intensity of uterine contractions and also accompanied by increased bleeding and possibly clots. Please get the USG done and follow up with reports. Regards.


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