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Family Medicine (Expert Forum)
Post Miscarriage Complications
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.
Post Miscarriage Complications
by CBD, Jun 28, 2002 12:00AM
At nine weeks pregnant, we lost the heartbeat and scheduled a D&C. I had severe cramping, passing tissue, and light bleeding for 2 weeks post. Spotted watercolor brown for a few weeks, then had light period like bleeding for 2 weeks. At this point I saw our RE and he suggested an ultrasound and a blood test. Ultrasound revealed a 5 cm cyst on my left ovary and blood test revealed hcg levels of 28 and 2 days later, 31. Had 2nd D&C (and this point about 8 weeks after the first D&C) and hysteroscopy. Ob-gyn felt she really cleaned out the uterus and all tissue. Since I haev had zero pain or spotting. Now, 10 weeks post 1st D&C and 1 1/2 wks post 2nd, my hcg level is still at 14. I am terrified.
I do not trust my OB_GYN and am finding a new one. She should have ordered a beta test at my 2 wk check-up post the 2nd D&C to see what was going on. My RE is giving advice but I get the impression my OB should be leading the way and she's both unaggressive and now has made several mistakes with my care.
What sort of treatment should I be getting now? What tests should I be asking for? What dangers does the corpus luteum cyst pose to my fertility and health? So much time has passed and my body obviously isn't rectifying the situation on its own. I can't imagine that I should have a third D&C. Should I be seeing some type of specialist?
Please advise.
I do not trust my OB_GYN and am finding a new one. She should have ordered a beta test at my 2 wk check-up post the 2nd D&C to see what was going on. My RE is giving advice but I get the impression my OB should be leading the way and she's both unaggressive and now has made several mistakes with my care.
What sort of treatment should I be getting now? What tests should I be asking for? What dangers does the corpus luteum cyst pose to my fertility and health? So much time has passed and my body obviously isn't rectifying the situation on its own. I can't imagine that I should have a third D&C. Should I be seeing some type of specialist?
Please advise.
Doctor's Answer
by Forum-M.D.-DT, Jun 29, 2002 12:00AM
Thank you for visiting the Family Practice Forum
The rate of fall of the hcg after miscarriage is about as fast as it rises during pregnancy, i.e. a halving each 48-72 hours after miscarriage or a doubling every 48-72 hours during pregnancy. Thus after a miscarriage it depends upon what the absolute level is; an HCG of 50,000 will take longer to fall than one at 1000. It also depends upon if all the tissue is expelled from the miscarriage at once or if some is retained. With a D&C it should have all gone at once. The rate of fall of hcg after a miscarriage therefore can vary from about 2-4 weeks.
It is possible that you still have retained products of conception despite the D&C. An ovarian cyst in and of itself does not necessarily reduce your ability to become pregnant, in fact, the cyst may have been there during your pregnancy.
It sounds like you are uncomfortable with your OB/GYN which leads me to believe that you should get a second opinion preferably from an OB/GYN who specializes in high risk pregnancy. While your future pregnancies may not be considered "high risk" ... I have found that OB/GYNs who specialize in high risk pregnancies tend to be those most capable of handling situations such as yours.
The rate of fall of the hcg after miscarriage is about as fast as it rises during pregnancy, i.e. a halving each 48-72 hours after miscarriage or a doubling every 48-72 hours during pregnancy. Thus after a miscarriage it depends upon what the absolute level is; an HCG of 50,000 will take longer to fall than one at 1000. It also depends upon if all the tissue is expelled from the miscarriage at once or if some is retained. With a D&C it should have all gone at once. The rate of fall of hcg after a miscarriage therefore can vary from about 2-4 weeks.
It is possible that you still have retained products of conception despite the D&C. An ovarian cyst in and of itself does not necessarily reduce your ability to become pregnant, in fact, the cyst may have been there during your pregnancy.
It sounds like you are uncomfortable with your OB/GYN which leads me to believe that you should get a second opinion preferably from an OB/GYN who specializes in high risk pregnancy. While your future pregnancies may not be considered "high risk" ... I have found that OB/GYNs who specialize in high risk pregnancies tend to be those most capable of handling situations such as yours.
