HCG levels and twins

  I had an ruptured ectopic pregnancy in 11/98 and am now pregnant again.  A quantitative HCG was drawn on Mon, 2/22 was 200.  At that point I was 5 weeks 3 days post LMP, but only 4 weeks 3 days post ovulation (by rise in basal temp).  An ultrasound was completed the next am to rule out ectopic.  No gestational sac was seen; however, 2 small blips (not sure what else to call them) were seen that could not be confirmed or ruled out as an interuterine pregnancy, though the possibility of an early twin pregnancy was raised.  I do have a history of a twin pregnancy that miscarried at 10 weeks. No evidence of an ectopic was seen.  An HCG level drawn 44 hours after the first was 420.  My question is, would I expect the HCG levels to rise more rapidly in a 48 hour period if this was twins?  Also, what else could explain the two "blips" in the uterus?

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Dear Amy:
The levels of hCG are higher with a multiple gestation and the doubling time is the same. The doubling time reflects cell growth. The level of hCG reflects the total number of cells.
An early ultrasound image which is not recognizable as a discrete structure has may snowflake-like things that have no meaning. The blips may be bits of endometrial lining, sound echoes, pure atrifacts of magnification and gain settings.
Keywords: hCG doubling and multiple pregnancy
This information is provided for education purposes and is not a medical consultation. If you have specific questions, please speak with your physician.