My HCG levels are decreasing gradually. Is this a sign of miscarriage?

Question

Hello doctor,

I am 29 years old, mother of two healthy children, and pregnant for the third time. My LMP was 13th of last month and had only had intercourse only twice in the last three months. In the last month, I had intercourse only once before three to four weeks before having a positive pregnancy test and then a day or two after getting the positive test. I have a retroverted uterus. At an ultrasound, at 9 weeks, I was showing signs of being only 5 weeks pregnant with a gestational sac and yolk sac. At a follow-up ultrasound, one week later, the ultrasound technician thought maybe it was a molar pregnancy. There is now a fetal pole and one small ball-like shape but not any visible growth of the gestational sac. My HCG levels went from roughly from 69000 to 65500 in 48 hours. At the third ultrasound, a week after that showed the gestational sac, yolk sac, and what looked to me like two balls inside the gestational sac. My HCG levels are still going down. I was told it is a miscarriage but have had no signs other then the ultrasound saying it is a miscarriage, so I am reluctant to agree to any further action at this point. There has been no heartbeat yet, although the third ultrasound did come to a lot closer to almost finding one, but it was likely just my heartbeat, according to the technician. I need a second opinion as I am now only eight weeks and viable it would mean I miscarried the first and got pregnant immediately or I have two pregnancies going on at once. Both are very rare, or it is, in fact, a miscarriage? Also could high progesterone levels be masking the miscarriage? We have not tested yet since HCG levels are decreasing slowly already. What is stopping the contractions from happening?

Answer 1

Hello,

Welcome to icliniq.com.

By your history, it is a missed abortion and not miscarriage. It is just a single pregnancy only.

Let me explain in detail. Normally pregnancy increases along with an increasing level of BhCG (beta chorionic gonadotropin). If HCG levels are decreasing, that means the pregnancy is not increasing, and instead, the further process started. In sonography, firstly, one sac is seen around four weeks. After that, fetal pole and yolk sac are seen around the fifth week. At this time in sonography, two sac-like structures are seen, which is normal. During the sixth week, cardiac activity starts in fetal pole, up to 12 weeks baby is ready with almost all organs prepared and then increasing in size and function in the rest of pregnancy.

If your sonography says 5 weeks at 9 weeks, it can be normal or abnormal both. I have explained that. If pregnancy shows 6 weeks at 10 weeks or 7 weeks at 11 weeks, then it is normal, and your pregnancy was delayed but now growing well. But when it shows 5 weeks at 10 weeks, 5 1/2 weeks at 11 weeks, or no cardiac activity and just increasing the sac size only then it is not normal and pregnancy is not having good enough growth or not growing at all. Now once if pregnancy has a problem, then there are some ways your body reacts.

1) The uterus starts contraction and bleeding starts, and there may be complete abortion or incomplete abortion according to whether everything comes out or not with contractions.

2) The uterus does not react, and pregnancy remains as such, in that case, it is called missed abortion. (means abortion should happen, but it is just missed due to some reason), further, there may bleed at a later time, or sac may organize in the uterus and make mole. It can have some other complications. So in this condition, we advise cleaning of uterus directly for sucking out the sac from the vagina with a suction machine (called suction and evacuation). So the best option for you is, stop taking even medication and get done with suction and evacuation.

My HCG levels are decreasing gradually. Is this a sign of miscarriage?

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