Miscarriage/partial molar pregnancy/viable fetus???

[christy312]

I am a 39 year old female with recent history of miscarriages.  One confirmed in 10/2007 and possible two others since.  Became pregnant on or about 12/01/2008 (LMP 11/17/2008).  Had (transvaginal) u/s on 01/08/2009.  Baby measured 6w1d, rather than 7w4d but we did see HEARTBEAT (only 90 bpm).  Pregnancy progressed well, we thought.  Doctor could not detect heartbeat at regular visit on 02/06/2009 (12w4d).  Not unusual, since uterus tilts way back.  Scheduled viability u/s yesterday.  NO HEARTBEAT; NO BABY.  Still feel and look very pregnant; no bleeding or cramping.  U/s report states "...fluid collection in the endometrium with some heterogeneous echotexture suggestive of embryonic gestation.  Note is made of some increaed echotexture posteriorly that may represent focal contraction.  The possibility of some trophoblastic disease is not completely excluded."  Doctor ordered hcG levels yesterday which were 33,756, which he admitted "suggests" I am still pregnant.  But he is leaning toward a molar pregancy.  Anybody experiece anything like this???  Is it possible to have had a molar pregnancy with a fetus that had a heartbeat?  What about the hcG level?  I live in a very rural community and my doctor is a family practitioner.  What tests should I insist on?  Do I need a specialist?  What questions should I be asking?  Is it possible that I have an abdominal pregnancy out there, too???  He wants to schedule a D&C --- is that advisable?  Will my hCg levels be higher/lower/same when he checks again on Friday if this is molar?  Other suggestions???  Thank you so much!  Have a blessed day!!!

[christy312]

     The technician who took my blood yesterday had a molar pregnancy, too.  She had an u/s at 7 w which showed HB, like mine ... then an u/s at 12 w when the doc couldn't find her baby's heartbeat by doppler either ---JUST LIKE MINE.  She said the doctor didn't check her hcG levels, so I don't have anything to compare mine to, but just based on that factor alone, mine doesn't sound molar.  I wonder if my progesterone level is too low.  I've gained 25 pounds in the past year, which is NOT normal for me (I have a hard time gaining 10 pounds during pregnancy) and have other symptoms that correlate with low progesterone (gall bladder disease, thyroid dysfunction, vaginal dryness, breast tenderness, fibrocystic breasts, water retention, irregular menstrual cycle, & blood clots during menstruation).  I did think that this past year, as I approach 40, things just suddely seemed to "slow down".  I'll ask the doctor to check it on Monday morning for me.  I am bleeding now --- steady like a regular period.  Far, far too much during pregnancy.  No tissue and no clotting.  Some cramping; feels more like small contractions where I have to stop talking to breathe but not bad at all.  So my little brain is slowly accepting that this baby has in fact gone to heaven, too.  
     After having that one sharp, twisting pain abdominal pain where my uterus was last Thursday, I am more convinced than ever that we did indeed suffer two additional miscarriages in the past year.  Felt like someone reached in and grabbed my whole uterus and just torqued it as hard as they could.  I felt that twice in the past year and began bleeding the next day but had not had any bloodwork done to prove whether I was pregnant or not ... and immediately I sensed that I had just lost a baby.  Never felt that sharp twisting pain before ... until last week ... and this time I know we were pregnant.  Anyone experience that sharp, twisting pain???
     Thank you for all your kind prayers and comments.  
---Christy

[40smama]

I wanted to add I'm sorry that you're having to go through all of this - it's heartbreaking.  This is a wonderful forum to talk about issues like this and get the support that you need - good luck and God bless!

[40smama]

Now that I think about it, there was a heartbeat until 16 weeks.

[40smama]

I had a partial molar and there was a heartbeat so that's not completely true but w/your hcg levels are, I too don't think your pregnancy's a molar.

[YvetteY]

Hi Christy.....

Are you having the D&C?    On my previous post I mentioned someone in a very similar situation and she did have D&C and she got word today that it was definitely not molar.   I really doubt that yours is molar.  It totally does not sound like molar.   Just failing pregnancy from bad egg.   And like I said before since you did hve the HB, its' not molar.

[SoCalTricia]

Don't hcG levels begin to drop at about 12 weeks in a normal pregnancy? Gosh, I really hope everything is okay. Are you going to see your doctor today?

[christy312]

UPDATE:
Today's hcG level was down to about 22,000 --- almost 12,000 points lower than the levels just 2-1/2 days ago.  Doctor expected them to triple into the 100,000 range ... but a drop that significant doesn't sound good.
---C

[christy312]

Hi all.  Thanks for all your comments!  I go back in a few minutes for my second hcG.  I did stat spotting very slightly yesterday and have had some VERY MILD cramping.  I read a reply from the OB here in reply to an almost-identical situation in which the inquirer's 6w u/s showed a heartbeat of "only" 90 and the baby measured a week smaller, as did mine.  Tat doctor replied that was absolutey NORMAL ... and that our technology now allows us to check HB earlier and earlier, but some doctors and sonographers have not correlated that yet.  She said the HB would rise to about 160 bpm within week or so then level down about 140.  So the "slow" HB at 6 weeks is apparently not an indicator of trouble at all.  Still very confused and looking for answers.  Will let you ladies know what today's hcG level is as soon as the lab calls me.  If it remains the same, I'll be insisting on another u/s and perhaps a referral to a specialist (unless the bleeding/cramping increases, but truly is very slight, just a tinge overnight).  If the hcG "triples in to the 100,000's" like my doctor expects, then I'll accept it as molar.
BTW I do have five healthy biological children, ages 3-18 ... so I take great comfort in the fact that the good Lord comforts me through their hugs and kisses.
---Christy

[40smama]

I had a partial molar pregnancy many, many moons ago.  There was a fetus but of course it wasn't viable.  From what I understand, it's fairly uncommon to have a fetus w/a partial molar.  When it's a complete molar (for lack of a better word), there's no fetus present.  The HCG levels on both partial and complete molars are off the charts.  Once a D&C is performed, the hcg levels are monitored until they return to 0 - there's lots of scary info out there in cyberworld about molar pregnancies so read only the reputable sites

[YvetteY]

Definitely not molar since there was a HB according to a friend that posed this question to her specialist.

[YvetteY]

I also meant to say that I am sorry for your loss.   I know this is difficult.  It sounds like you are just getting bad eggs and this is due to your age.   A lot of us are dealing with this and the high chance of miscarriages in your late 30s /early 40s.   That's why I don't think you had a molar pregnancy, and it's more of bad egg thing.    

Also the testing they do on the products of conception after your D&C will tell you for sure if  it's molar.   Molar pregnancies occur because two sperms will fertilize an egg and you will have 23 or whatever it is chromosomes more.  

And I told this to my friend, taht I just didn't think you'd get a HB with a molar pregnancy. I don't believe it will develop to that point.

[YvetteY]

Oops...I meant to say , "Yes you should get the D&C" (not HCG) , you proably need to do this with a molar and this ensures that all the tissue is out of your uterus.  

[YvetteY]

Have you had a D&C?  If you have a D&C they can get the products of conception and tell why you miscarried.  

I'm not sure if your pregnancy is partial molar of friend of mine is going through the same thing...I told her I didn't think it was a partial molar (her concern) because on hers she had a fetal heartbeat too.   Her fetal HB was about 90 at about 6 weeks and we figured it was too slow, thus the pregnancy failed.  Now she thinks it's partial molar, but I am not so sure.

Also the HCG level is generally very high and your hcg isn't so high for being 12w4d.   I would make sure you have another ultrasound just to make sure there is no HB.  Your pregnancy can fail and you will still have hcg in your system for a while. This is due to the products of conception still being in the uterus.    They should check your HCG levels until they get to zero.  

The bad thing about molar pregnancies is that it's linked to cancer and they advise you not to try to conceive for a year.  I would see an OB versus the family practitioner.  

Yes, you should probably get the HCG and then have them test for chromosomal problems.   After the D&C you should have HCG tested until you get down to under 5.   Also google molar pregnancies and learn all y ou can about them and write down all your questions.   Good luck!