Am I miscarrying?

I am 5 and 1/2 weeks pregnant. Last Sunday (6 days ago), I woke up bleeding. I didn't notice any tissue or clots, but there was enough blood that I thought I was miscarrying. But when I woke up on Monday, my temp was still up, the pregnancy test was positive, and later that day, blood tests revealed that my HCG levels were rising appropriately (from 80 on 3/25/09 to 303 on 3/30/09). My OB ordered a second test on 4/1/09. This time my numbers were only 431. My OB said it was good that they were rising but that it was too soon to tell. She ordered an ultrasound for this coming Wednesday. Since then, I've had no more bleeding, almost no cramping (very mild if any), but also no real symptoms of pregnancy (I never really had any to begin with). I was feeling like there could be a chance that everything was ok, but then I happened to see my regular doc for an unrelated appointment this week. She spoke to me as if I had already miscarried because of the slow rising numbers. She said the ultrasound was just to check if there was anything that still needed to be cleaned out. Now, I'm confused. My OB didn't give me that impression at all. Who should I listen to? So, my questions are:

1. Is it possible that the slow rising numbers are a result of a threatened miscarriage? Could my body resume normal rising numbers?

2. If I'm miscarrying, how come I'm not experiencing any bleeding or cramps?

3. I am on progesterone suppositories (because of a suspected luteal phase defect). Could the progesterone be prolonging the inevitable? My BBT is still high, my pregnancy tests are still strong - is this the result of the progesterone supplement or is my body fighting to save the pregnancy?

[J.M. Keyes, MD]

Hi there,

You won't be able to tell for sure whether you have experienced a threatened or complete miscarriage until your ultrasound.  I am assuming that when your OB examined you, your cervix was closed, or he/she would have told you that miscarriage was inevitable/complete.  You can have slowly rising hCG levels and go on to have a normal pregnancy, or it could be a sign of miscarriage.  You probably have not had an ultrasound yet this pregnancy because you are so early, so you will also have to have ectopic pregnancy ruled out on the ultrasound.  The progesterone supplement shouldn't affect the pregnancy test, as it is testing hCG.  

I'm sorry I can't give you a definitive answer- there is a chance that you had just a threatened miscarriage, but you won't know for sure until Wednesday.  If you had a completed miscarriage, you may be finished with bleeding/cramps- at 5 wks you may not notice passing of tissue.  Either way, try to take it easy until you get your ultrasound results.  I know this will be a stressful few days for you- good luck, and I hope you do well.

JMK  MD