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Family Medicine (Expert Forum)
HCG Rising following miscarriage and laparoscopy
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
HCG Rising following miscarriage and laparoscopy
by Jonny1, Dec 13, 2004 12:00AM
Hi
My partner Eileen had a slowly rising HCG level, up to 600, then fell to 400, then had a miscarriage (passing clots and blood). This was at about approx 6 weeks
After the miscarriage, her HCG level was checked, and it was 600, and the next day was 1000
Her Doc performed an ultrasound, and saw no evidence of a pregnancy in the uterus, nor in the tubes, but pointed out that tubal pregnancies are not often visibile by US
That evening (10th Dec) she had a laparoscopy, on the basis that there was a probable ectopic pregnancy.
But no pregnancy was found.
The following day (Sat 11th Dec) another US by the consultant, no preg found, he said she was a 'mystery'
Since then, she has used a home pregnancy tester each day, and line gets stronger each time she tests.
Today (Mon 13th) we had an HCG check done, but results not back for a day or 2.
But, considering that she has had a miscarriage, increasing HCG following that, a laparoscopy, and now strengthening lines on the prenancy tester, I am worried what could be going on
I realise we will need to wait for the HCG to be confirmed that it is going up, but it seems likely that it is
Can you please help shed some light on what could be going on here if HCG increasing in this scenario?
I have heard it could be a molar pregnancy, and also that this has the potential to lead to a form of cancer. IS this right? And if yes, how would one treat it?
Thank you for your help
Jon
My partner Eileen had a slowly rising HCG level, up to 600, then fell to 400, then had a miscarriage (passing clots and blood). This was at about approx 6 weeks
After the miscarriage, her HCG level was checked, and it was 600, and the next day was 1000
Her Doc performed an ultrasound, and saw no evidence of a pregnancy in the uterus, nor in the tubes, but pointed out that tubal pregnancies are not often visibile by US
That evening (10th Dec) she had a laparoscopy, on the basis that there was a probable ectopic pregnancy.
But no pregnancy was found.
The following day (Sat 11th Dec) another US by the consultant, no preg found, he said she was a 'mystery'
Since then, she has used a home pregnancy tester each day, and line gets stronger each time she tests.
Today (Mon 13th) we had an HCG check done, but results not back for a day or 2.
But, considering that she has had a miscarriage, increasing HCG following that, a laparoscopy, and now strengthening lines on the prenancy tester, I am worried what could be going on
I realise we will need to wait for the HCG to be confirmed that it is going up, but it seems likely that it is
Can you please help shed some light on what could be going on here if HCG increasing in this scenario?
I have heard it could be a molar pregnancy, and also that this has the potential to lead to a form of cancer. IS this right? And if yes, how would one treat it?
Thank you for your help
Jon
Doctor's Answer
by Kevin Pho, MD, Dec 14, 2004 12:00AM
, Dec 14, 2004 12:00AM
A molar pregnancy is certainly possible. Studies have shown that after treatment or miscarriage that the HCG levels can remain elevated between 50 and 90 days. Typically the HCG should return to normal 2 weeks after a miscarriage, so more evaluation into a molar pregnancy should be considered.
The ultrasound is a reasonable test - if non-reveaing (as seems to be the case here) - a dilatation and curettage can be considered to sample the tissue inside the uterus.
This option can be considered in conjunction with the OB/GYN. If a mole is present, treatment is dependent on the type and amount of spread. There are various chemotherapeutic agents that can be considered - however, I would focus on obtaining a diagnosis first. You may want to consider being referred to a major academic medical center for further evaluation.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
The ultrasound is a reasonable test - if non-reveaing (as seems to be the case here) - a dilatation and curettage can be considered to sample the tissue inside the uterus.
This option can be considered in conjunction with the OB/GYN. If a mole is present, treatment is dependent on the type and amount of spread. There are various chemotherapeutic agents that can be considered - however, I would focus on obtaining a diagnosis first. You may want to consider being referred to a major academic medical center for further evaluation.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
This was her second pregnancy, the first was full term to a healthy baby 12 years ago.
She has not experienced nausea, vomiting, weight loss.
Today her stomach looked larger than normal which we found surprising, though there was no mention of enlarged uterus in during the transvaginal ultrasound examinations.