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Fluctuation HCG Levels - Ectopic or Vanishing Twin?
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Fluctuation HCG Levels - Ectopic or Vanishing Twin?

I found out I was pregnant on June 27th. My LMP was May 26th 2007. On July 8th I went to the ER because of cramping and spotting, which I thought was a miscarriage. They did a blood test and my HCG levels came back at 331. They told me this was low (I thought I was about 5 weeks pregnant). So they did an internal ultrasound and the tech could not find anything at all. Not even an ectopic pregnancy. So, I went in for a 2nd blood test on July 10th and my HCG levels went down to 211. I was told that I was miscarrying and that the pregnancy failed. I started to bleed a little heavier, but not like what they told me I would bleed. I used a tampon or two per day, so the bleeding was not 'that' heavy. Anyway, I had some cramps associated with this but nothing severe. After about 3 days the bleeding stopped and turned into very light brown spotting. I went back to get another HCG test on the 17th of July to make sure the levels were going down back to normal. To my surprise, the levels went UP. They are now at 418.

I'm wondering if I could have gotten pregnant again, or if it was possibly a Vanishing Twin. If not, and this is an ectopic pregnancy, shouldn't I be in some severe pain???

Any suggestions or advice? HELP!

Thanks
Courtney
Related Discussions
242596_tn?1192429549
Hi Courtney,

You sound like you are dealing with all of this quite well.  Your circumstance is a difficult one (very frustrating for patients and physicians), but one gynecologists deal with often.  You could have an early pregnancy that will be normal (and yes, because of the drop then subsequent rise in hCG, a twin pregnancy with the loss 'vanishing' of one twin is a possibility.  One must also consider the possibility of a heterotopic pregnancy--one in the uterus and one outside of the uterus, usually in the tube, with the loss of one and persistence of the other), an early pregnancy in the uteurs that is abnormal, or possibly an ectopic pregnancy.  

Given what has happened thus far you should continue to have hCG levels drawn every 48hrs, and a pelvic ultrasound performed if you begin to experience abdominal or pelvic pain or have worsening bleeding.  The earliest a normal pregnancy in the uterus can be seen on pelvic ultrasound is ~ at an hCG level of 2000 (depending upon the equipment and skill of the sonographer).  

A lab test that might be helpful is a progesterone level.  A progesterone level >20 usually indicates a normal pregnancy, while <5, a pregnancy destined to fail.  Values in between are a gray zone.

Have patience and remember you are not out of the woods.  Close follow up will be necessary until this episode resolves.

Best of luck,

Dr. Downing
14 Comments
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Avatar_n_tn
First let me say I know you are stressed to death about this. But you said you used a tampon at anytime you should not use a tampon during pregnancy and especially if you are miscarrying because it stops the flow and it could possibly cause you to need a d&c cause you are not allowing the products to flow out.. anyway to your question.. from my personnal experience i would think possible ectopic... I have had 3 one 5 years ago one in 11/06 and one right after that one in 1/07..I actually did not think my levels were all the way down i never came on but i think because i was still going thru the first one it caused the 2nd one but anyway in my experience my hcg was going up but not doubling it was going from like 50 to like 63 and y other one started at like 300 i had the brown spotting and orange bleeding i never felt any pain during my ectopics the only way i knew was cause i went to dr for bleeding during intercourse..you would only start to feel pain when you were further along cause at that time it is getting too big for your tubes also fluid in your diagram can cause shoulder tip pain.. but when i had brown spotting with mine it was very watery that is also what alerted me it was possibly happening again.. also it is possible for twin loss if it starts to double and kep going up but detecting a tubal is very hard cause u can rarely see anything i had to go to fetal specialist to do the ultrasound to detect that it was in my tubes. usually in detecting ectopic they go mostly by numbers cause they will increase but very slowly..

I hope all works out well for you... good luck  
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Avatar_n_tn
hello, im sorry to post her but the forum was full and i desperately need some advice. im 19 years old, my last period was on june 6th, im now 2 weeks late. im naseous, fatigued, my breast have already went up one size im gaining weigt, not drastically, but steadily. i seem to have a constant rolling or fluttering feeling in my lover abdomen, but far too frequent to just be gas. the problem is, even after 2 weeks and so mnay symptoms, my hpt's have all been negative, the only free clinic around only does urine tests and i dont have insurance and cant afford to go to an obgym. i know it sounds corny, but i "feel" pregnant, and if im not, then what could be causing these symptoms and late period? is it possible that even though im already late its still too early for a hpt to detect?
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Avatar_f_tn
Ok, I had more blood drawn on Friday and the HCG level did go up, but only to 549, which is an increase of 131. My test on Tuesday, the 17th was 418. So today at 4:30 I will have an ultrasound to see what can be found. I don't know if this is a viable pregnancy or not. I'm hoping it is.

Thanks :)
Courtney
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Avatar_n_tn
I am 41 with 2 children and 2 miscarriages going through fertility treatments. I am currently 5.5 weeks pregnant and have now seen my HCG levels which were doubling perfectly last week, slow down and then drop today (went from 1479 on Thursday to 2149 on Sunday to 2505 on Monday, 2349 Wednesday (today).  The ultrasound confirmed no ectopic GS of about 10mm with good yolk sac just this morning.  Growth has been about 1+mm a day in the gestational sac.  No hc seen.  My doctor seemed suprised at the drop in my HCG levels and said it does not look good just a few hours after the ultrasound did look good.  I am sure I only ovulated with one egg so there is no vanishing twin effect.  

Is this hopeless?  Can anyone tell me if they have ever seen a pregnancy recover or if we should assume this will end in miscarriage?  
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Avatar_n_tn
i HAD MY TUBES REVERSED ON MARCH 28 OF THIS YEAR AND FOUND OUT I WAS PRG AND MY HCG WENT UP AND THEN DROPED AND NOW GOING UP AGAIN I WOULD LIKE TO NO SOMETHING ONE MIN THEY SAY ITS A MISCARGE AND NOW A TUBLE I WAS ON FERTILETY PILLS AND WHEN THEY DID A ULTERSOUND THEY THOUTH THEY SEEN A SAC COULD I HAVE A TUBLE AND A UTERS PRG I AM NOT BLEEDING THERE IS NO CRAMPING NOTHING IS THERE A CHANCE I MIGHT HAVE ABABY
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Avatar_n_tn
I am in need of help, i'm not sure what i should think or do! I am a 26 year old type 1 diabetic and i have PCOS and last week i found out i was a prg, but the doctor i seen said i should be 8 weeks, but i tried to explain to her that i do not my period every month. so she did t hcg/beta levels blood test, late monday after noon my level was 5,000 then early wed. morning it was only 6,000. She called me on friday and the first out of her mouth was " So are ya bleeding yet?" I am so heart broken that she would put it that way. She said to me that there is no resaon to have any hope, that it just a matter of time before i m/c. AND then at the end of the convo, she turns arounds n sayd " well i could be wrong but i dout it, so get ready for the pain n bleeding!" I guess my question is, is there any hope???? We all are so inlove with the fact that we are havin a baby and i feel like this lady crushed all my hopes. If anyone has have the same levels or close to this, please let me know what happened, as i am very scared.
Thanks for listening
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Avatar_n_tn
she stated she thinks i am only a few weeks along and the u/s showed the black sack with the white in it and the tech said it is in my utrus ( not sure how to spell rigth now) i forgot to add that in
thanks again
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Avatar_f_tn
I went through an IVF cycle last month and I had 3 fresh embyros transferred. My first HCG test indicated I was pregnant with a number of 183.  Went back 2 days later and up to 523.  The third time I took th test it went to 336 and then went down again to 324.  I went back two days later and it went up to 650.  Went back again to get tested for my HCG and it went up to 952.  They stopped my progesterone when  it was at 324, but a week later they tood me to start it again.  They are given me an utrasound tomorrow which I am fearing the worst.  I feel like I am going through an emotional roll coaster.  Has anyone had their numbers do this?
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269634_tn?1189759436
Let us know how your doing???

I'm going through almost the same thing,, my HCG levels began at 9 ,,, then 63 ,,, then 112. Plus heavy bleeding which lasted for 24 hours. My doctor is afraid of Ectopic, I'm scared for it too.
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Avatar_n_tn
   Hi... I guess I'll fill you in with some info before my question. I'm 25 years old and have been pregnant 5 time in the last 3 years. My first pregnancy was a miscarry, then my second (3months later) was successful (healthy baby boy) I delivered 6 weeks early, my third (a year later) was an eptopic and my right tube was removed, my forth (18 months later) was also an eptopic but was in the stump of my right tube at which point the rest of that tube was removed and my last pregnancy (four months later) was a natural misscarry (08/09/07) no D&C done. For this last pregnancy I have had a lot of blood work done to check my HCG levels. My first HCG Level was done 07/27/07 and was 157 then on 07/29/07 it was 277 then on 07/31/07 it was 133. By the ninth I started to bleed...it wasn't as much as the doctor said it would be but definitely different then AF. My doctor said that he wanted more blood work done two weeks later to make sure my HCG levels were back to normal on 08/29/07 my level was 73.8... wasn't low enough so on 08/05/07 I had more blood drawn only to our surprise my level is going back up it was 98. So now for my question... Could this be the old pregnancy making this level rise or would it be a new one (my husband and I never use "protection") It just seems a little early to think that this could be a new baby.

Thanks,
Amanda
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274396_tn?1227213079
Wow, I am glad I found this blog!! I have been going through some of the similar issues many of you have been going through. I found out 8/22 that I was pregnant with Hcg of 390. Had another done 8/24 of 610 because of slight bleeding. The bleeding got worse so I went to the ER on 8/25, levels 678. They said I was losing the baby. I was 5 weeks along. I had a recheck that monday 8/27 of 229 and 8/29 of 142. Amazingly my levels on 9/8 went to 698. Someone please explain this one. I know I flushed most of what was in uterus out because I had major cramping and clotting two weeks ago. But why would it increase again?
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Avatar_n_tn
Hi there - I can totally relate to what you are going through. All this waiting is killing me. I had a positive pregnancy test on 9/5 with hcg of 136. my hcg was checked again on 9/7 - 247, 9/10 - 360 and 9/12 - 437. My doctor has said that since hcg is rising slowly likely outcome is not good. they still want to repeat blood test again on 9/14. i am now 5 weeks and 1 day.
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