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Pregnancy (Expert Forum)
Fluctuation HCG Levels - Ectopic or Vanishing Twin?
Answered by
Keith Downing, MD - Obstetrics, Gynecology
MA
This forum is for questions and support regarding pregnancy issues such as: Alcohol/Drugs, Bleeding, Caesarean Section, Childbirth, Diabetes, Depression, Fetal Monitoring, Genetic Testing, Hormonal Changes, Labor, Lamaze, Morning Sickness, Nutrition, Parenting, Prenatal Care, Weight gain.
Fluctuation HCG Levels - Ectopic or Vanishing Twin?
by cjwilson80, Jul 19, 2007 12:00AM
I found out I was pregnant on June 27th. My LMP was May 26th 2007. On July 8th I went to the ER because of cramping and spotting, which I thought was a miscarriage. They did a blood test and my HCG levels came back at 331. They told me this was low (I thought I was about 5 weeks pregnant). So they did an internal ultrasound and the tech could not find anything at all. Not even an ectopic pregnancy. So, I went in for a 2nd blood test on July 10th and my HCG levels went down to 211. I was told that I was miscarrying and that the pregnancy failed. I started to bleed a little heavier, but not like what they told me I would bleed. I used a tampon or two per day, so the bleeding was not 'that' heavy. Anyway, I had some cramps associated with this but nothing severe. After about 3 days the bleeding stopped and turned into very light brown spotting. I went back to get another HCG test on the 17th of July to make sure the levels were going down back to normal. To my surprise, the levels went UP. They are now at 418.
I'm wondering if I could have gotten pregnant again, or if it was possibly a Vanishing Twin. If not, and this is an ectopic pregnancy, shouldn't I be in some severe pain???
Any suggestions or advice? HELP!
Thanks
Courtney
I'm wondering if I could have gotten pregnant again, or if it was possibly a Vanishing Twin. If not, and this is an ectopic pregnancy, shouldn't I be in some severe pain???
Any suggestions or advice? HELP!
Thanks
Courtney
Doctor's Answer
by Keith Downing, MD, Jul 19, 2007 12:00AM
, Jul 19, 2007 12:00AM
Hi Courtney,
You sound like you are dealing with all of this quite well. Your circumstance is a difficult one (very frustrating for patients and physicians), but one gynecologists deal with often. You could have an early pregnancy that will be normal (and yes, because of the drop then subsequent rise in hCG, a twin pregnancy with the loss 'vanishing' of one twin is a possibility. One must also consider the possibility of a heterotopic pregnancy--one in the uterus and one outside of the uterus, usually in the tube, with the loss of one and persistence of the other), an early pregnancy in the uteurs that is abnormal, or possibly an ectopic pregnancy.
Given what has happened thus far you should continue to have hCG levels drawn every 48hrs, and a pelvic ultrasound performed if you begin to experience abdominal or pelvic pain or have worsening bleeding. The earliest a normal pregnancy in the uterus can be seen on pelvic ultrasound is ~ at an hCG level of 2000 (depending upon the equipment and skill of the sonographer).
A lab test that might be helpful is a progesterone level. A progesterone level >20 usually indicates a normal pregnancy, while <5, a pregnancy destined to fail. Values in between are a gray zone.
Have patience and remember you are not out of the woods. Close follow up will be necessary until this episode resolves.
Best of luck,
Dr. Downing
You sound like you are dealing with all of this quite well. Your circumstance is a difficult one (very frustrating for patients and physicians), but one gynecologists deal with often. You could have an early pregnancy that will be normal (and yes, because of the drop then subsequent rise in hCG, a twin pregnancy with the loss 'vanishing' of one twin is a possibility. One must also consider the possibility of a heterotopic pregnancy--one in the uterus and one outside of the uterus, usually in the tube, with the loss of one and persistence of the other), an early pregnancy in the uteurs that is abnormal, or possibly an ectopic pregnancy.
Given what has happened thus far you should continue to have hCG levels drawn every 48hrs, and a pelvic ultrasound performed if you begin to experience abdominal or pelvic pain or have worsening bleeding. The earliest a normal pregnancy in the uterus can be seen on pelvic ultrasound is ~ at an hCG level of 2000 (depending upon the equipment and skill of the sonographer).
A lab test that might be helpful is a progesterone level. A progesterone level >20 usually indicates a normal pregnancy, while <5, a pregnancy destined to fail. Values in between are a gray zone.
Have patience and remember you are not out of the woods. Close follow up will be necessary until this episode resolves.
Best of luck,
Dr. Downing
I hope all works out well for you... good luck
Thanks :)
Courtney
Is this hopeless? Can anyone tell me if they have ever seen a pregnancy recover or if we should assume this will end in miscarriage?
Thanks for listening
thanks again