What Causes Abdominal Cramps, Back Pain And Repeated Bleeding With Positive Pregnancy Result?

Brief Answer:
Please do not ignore, need specialist attention ASAP

Detailed Answer:
Dear XXXXX,

I hope I have spelt your name correctly, if not, please correct me.

You are having repeated bleeding, your pregnancy test is positive and you are getting bouts of severe abdominal pain is warranting a close medical supervision and intervention as per the need.

Before I advise you I would like you to have some investigations done:

1. Please repeat urine pregnancy test. If the test shows one line faint (weak positive result) or if Beta hCG test reveals lower than expected levels of hCG, then you have to suspect the possibility of ectopic pregnancy.
2. Please get ultrasonography done. In spite of positive (may be weak) pregnancy test, if the uterine cavity is empty, it suggests that the pregnancy is somewhere outside the uterine cavity; which confirms the diagnosis of ectopic pregnancy.
3. In such event, it is advisable to go for Laparoscopy to locate the site of ectopic pregnancy, which if unruptured, may be treated with Methotrexate local injection also.

Ectopic pregnancy is a condition where the implantation of the fertilized ovum has taken place outside the uterine cavity. Most of the times it is in the tubes; however, it can get implanted anywhere. Such pregnancy does not progress to the successful pregnancy and land into threatening complications. The commonest event is rupture of the pregnancy and the site of implantation causing severe intraabdominal bleeding requiring emergency surgical intervention and many units of blood transfusion.

An Obstetrician has to be ectopic minded to diagnose an ectopic pregnancy.

Hence I am urging you not to wait expectantly to get relieved automatically. Please report to the Obstetrician ASAP with the suggested investigations.

Please upload all the images and reports of the investigations done so far and the images and reports of suggested investigations to equip me better to advise you further. I am keenly awaiting for the requested information and reports.

For any more information and advice, I am always available for you, XXXXX.

Dr. Nishikant Shrotri

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Brief Answer:
Prima facae seems to be miscarriage

Detailed Answer:
Dear Mrs. Vayan,

I must complement you for providing me such a detailed history of your case. I appreciate day-to-day account you have informed me.

Let me explain you about your last question about the level of hCG.

An hCG level of less than 5mIU/ml is considered negative for pregnancy, and anything above 25mIU/ml is considered positive for pregnancy. A single hCG reading is not enough information for most diagnoses. When there is a question regarding the health of the pregnancy, multiple testings of hCG done a couple of days apart give a more accurate assessment of the situation.

Following table regarding the hCG levels in early pregnancy may throw some light to clarify your doubts:

hCG under 5mIU/ml: Negative, not pregnant.
hCG between 5-25 mIU/ml: Uncertain; possible pregnancy but not definitive. May be miscarriage, ectopic pregnancy or blighted ovum. Repeat test in a couple of days indicated.
hCG over 25 mIU/ml: Positive indicating pregnancy

Your post bleeding hCG levels were 17.5 mIU/ml.

It has been found that a single hCG low hCG level has also resulted into successful pregnancy. Therefore, when such ambiguous levels are seen, it is advisable to repeat hCG test after few days. If still they remain in the range between 5 and 25 mIU/ml, conditions like abortion, ectopic pregnancy or blighted ovum may be suspected and investigated for. Blighted ovum is a pregnancy wherein there is gestational sac present without embryo in it. Your hCG level 17.5 mIU/ml. Hence the home pregnancy test was repeated on you, which as per your narration is negative. I would have appreciated the quantitative values of hCG after 7th of March.

At this stage, from your previous low hCG values, now becoming reporting negative results, I would say that you were aborting when the values were 17.5 mIU/ml and now have completed the abortion for more than a week. It takes about a week or 10 days for the pregnancy test to become negative after an abortion. Hence now HPT is negative. Since the abortion was complete by itself without any intervention, the chances of Blighted ovum seem to be more.

Now that you had your menses and have ovulated between 15th to 17th March, I feel it was a miscarriage which surprisingly and luckily was complete abortion without any complication, probably because it was blighted ovum. However, I would have opted to confirm the completeness of abortion by ultrasonography. Will you please inform me how the ovulation was confirmed? Was it by home kit or ultrasonography?

Since you have not submitted the products of conception for histopathology nor to chromosomal studies, it is difficult to guess the underlying cause of your miscarriage. However, most of early miscarriages in first three months are due to chromosomal abnormalities in the baby, which are not compatible for continuation of pregnancy. One such miscarriage does not mean that you will have the same outcome next time, though the chances are increased by 10 %.

You have an option of submitting both of you for chromosomal culture to detect whether there is any issue in your chromosomes or common recessive genes responsible for chromosomal abnormalities in the baby. Any foetal medicine consultant will advise you this issue.

Clinically, please remember:

1. Any bleeding during pregnancy should be reported to the Obstetrician without delay.
2. Any pain in abdomen, particularly associated with bleeding during first three months of pregnancy indicates that the pregnancy cannot be salvaged.
3. Early reporting to Obstetrician immediately after missing period is advisable.
4. Start Tab. Folic acid daily if you are planning for pregnancy. It prevents many foetal abnormalities.
5. Right from now start consuming plenty of green leafy vegetables, fresh fruits, bean sprouts and milk. This will help you an uneventful pregnancy in future.

If you are satisfied with me, you may please think of posting a good review with 5 star rating for me. Of course, please feel free to ask me for any more information or advice.

Dr. Nishikant Shrotri

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