High levels of HCG and enlarged yolk sac

We are nearly 10 weeks along in our pregnancy. We have had 3 ultrasounds which have all shown a good heartbeat and a fairly normal embryo.  However, they have tested my HCG levels twice, once at nearly 8 weeks and once at nearly 10 weeks. Both times the level is over 200,000.  The Yolk Sac is enlarged, what the tech called "off the charts."  We have had a sub-chorionic bleed also and a fold in the placenta which they have been watching.  The bleed appears smaller but not gone.  My question is, what could be wrong with this baby?  Is it possible that there were twins and we lost one?  Is there any hope of delivering a normal child after all this bad news?  Our first son was born 5 years ago with no complications.  We see the doctor for the fist time next week.

[Kevin Pho, MD]

I am not an OB/GYN, so I'm not sure I can answer your question with any more detail than your personal physician.  

There can be variation in the HCG levels.  
* 0-1 week: 0-50 mIU/ml
* 1-2 weeks: 40-300 mIU/ml
* 3-4 weeks: 500-6,000 mIU/ml
* 1-2 months: 5,000-200,000 mIU/ml
* 2-3 months: 10,000-100,000 mIU/ml
* 2nd trimester: 3,000-50,000 mIU/ml
* 3rd trimester: 1,000-50,000 mIU/ml
* Non-pregnant females: <5.0 mIU/ml
* Postmenopausal females: <9.5 mIU/ml

A level of over 200,000 is high.  It may be possible that twins are present, but in most cases, the HCG levels will fall within the levels of singletons.  It is impossible to base any conclusions on HCG levels alone.  Another possibility would be a hydatiform mole, however this would be unlikely if the ultrasounds have been normal.  Of course, some normal pregnancies can have an elevated HCG levels as well.

You may want to discuss this with your OB physician.

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:
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