Dr. Sameer Kumar
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My wife is 39-year-old, and this was her first pregnancy. She had an early miscarriage with light bleeding. She was approximately four weeks pregnant. We went to the hospital due to very light bleeding, and they did an ultrasound (transvaginal) which did not detect anything, as well as a beta hCG blood test which showed a result of 4 IU/L. After two days, we did a second hCG test which came back at 6 IU/L. We were asked to come back after two weeks for a follow-up. The bleeding was mild and continued for approximately five days. Since then, there have been no more symptoms, and we went for a follow-up consultation and another ultrasound. The ultrasound showed a small suspected blood clot in the uterus. Both ovaries showed follicles. Beta hCG was 75 IU/L. Unfortunately, our doctor is away till next week, so we did not understand what this means.
1. How come the hCG was at four to six levels two weeks ago, and after the bleeding started it is now at 75 IU/L with no symptoms?
2. Will this clear up by itself?
3. What course of action to undertake?
Hello,
Welcome to icliniq.com.
The presence of positive beta human chorionic gonadotropin indicates a developing pregnancy, but if it is not intrauterine, then it is likely to develop outside the uterus as a possible ectopic pregnancy. You should wait for two weeks for a repeat USG (ultrasound) pelvis to check for a possible intrauterine gestational sac, as pregnancy this early may not be seen on USG.
Thank you.
Patient's Query
Hello,
Thank you for reply doctor,
We have done two more hCG as well as a transvaginal ultrasound which again only showed a blood clot in the uterus (labeled as possible RPOC, retained products of conception), but nothing else. However as you can see in the attachment, the hCG levels have suddenly started to rise two weeks post miscarriage. What could be the cause of this? Could it mean that there is a pregnancy after all?
Hello,
Welcome back to icliniq.com.
I have gone through the reports (attachment removed to protect the patient's identity), and the facts are evident that there has been a constant rise in hCG levels since last we interacted. There has been an adequate doubling of hCG levels which indicates that there is a possible ongoing pregnancy. If not inside the uterus, then it could be outside, but it is also a known fact that until the hCG levels reach around 1500 mIU/dl, the gestational sac or a fetal pole is not appreciated inside the uterus. So it is suggested to repeat ultrasound after ten days from today to localize pregnancy, and also, serial beta hCG may be repeated after a week. You should be placed on progesterone support to avoid bleeding and support pregnancy. Consult a gynecologist before taking any medications.
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Obstetrics and Gynecology
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