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What Does Bleeding During Pregnancy Indicate?
Question: I am pregnant/having a miscarriage and not sure what to do or what this means... I have been bleeding since the 8th (17 days now). The first week was spotting then the second week was like a light period and then it got very heavy with clots. My OB/GYN said it sounded like a miscarriage but we would wait on my hcg levels. On Thursday, they were 637 and when I retested on Monday, they were 839. He said that the pregnancy is not viable but I don't understand why my levels would still be going up when I was certain I miscarried over the weekend (sat & sun heavy bleeding with clots) so I would have thought by monday, the levels would begin to drop. The entire time the blood has been bright red. He said we could watch and wait and recheck my hcg levels at the end of the week or I could do a d&c under local. I'm not sure what to do and any advice as to what is going on with my body would be very helpful! Is there an expected drop rate for hcg when having a miscarriage? Does this mean I already passed it if my bleeding is getting a little lighter or could there still be more?
Brief Answer:
Get an ultrasound of uterus done to look for pregnancy tissue.
Detailed Answer:
Hi,
Welcome to Healthcare Magic.
I am Dr Ramadevi Wani. I will be answering your concerns today.
From your notes it appears that you are having a miscarriage. But you did not write about ultrasound findings. There may be still some pregnancy tissue remaining in the uterus. That is giving such HCG readings.
In case of COMPLETE miscarriage the hormone levels drop by about 50% when repeated after 48 hours.
I suggest that you consult your doctor and get an ultrasound done to see how much of pregnancy tissue is in the uterus.
If large amount of tissue is there you will need a D&C. If it is less than 1.5 cm it gets expelled on its own in due course of time. Repeating HCG test is not going to help much.
I hope this helps.
If you have further concerns, I will be happy to answer.
Best wishes,
Dr Rama
Get an ultrasound of uterus done to look for pregnancy tissue.
Detailed Answer:
Hi,
Welcome to Healthcare Magic.
I am Dr Ramadevi Wani. I will be answering your concerns today.
From your notes it appears that you are having a miscarriage. But you did not write about ultrasound findings. There may be still some pregnancy tissue remaining in the uterus. That is giving such HCG readings.
In case of COMPLETE miscarriage the hormone levels drop by about 50% when repeated after 48 hours.
I suggest that you consult your doctor and get an ultrasound done to see how much of pregnancy tissue is in the uterus.
If large amount of tissue is there you will need a D&C. If it is less than 1.5 cm it gets expelled on its own in due course of time. Repeating HCG test is not going to help much.
I hope this helps.
If you have further concerns, I will be happy to answer.
Best wishes,
Dr Rama
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Wani,
I had the transvaginal ultrasound on wednesday (8/19) where she said she could see that I had a thick uterine lining but could not visualize a sac or anything in my fallopian tubes. Would I need another transvaginal ultrasound to determine this? What could it mean if my hcg levels continue to rise? If there is an amount larger than 1.5 cm, should I wait a little longer or just go ahead and schedule a d&c? I was a little concerned about it being done under local which is what my doctor suggested but then online, I read that most are done under general and my friend who works in ob said that she would discourage it being done under local. There isn't any emotional distress due to this being an unwanted pregnancy but I am concerned about the pain/discomfort. Do you have an opinion about which way would be better and if I would have to take any time off of work post d&c? As a nurse, I should know this but I really expected my hcg to drop after the amount of bleeding and pain I was in over the weekend.
I had the transvaginal ultrasound on wednesday (8/19) where she said she could see that I had a thick uterine lining but could not visualize a sac or anything in my fallopian tubes. Would I need another transvaginal ultrasound to determine this? What could it mean if my hcg levels continue to rise? If there is an amount larger than 1.5 cm, should I wait a little longer or just go ahead and schedule a d&c? I was a little concerned about it being done under local which is what my doctor suggested but then online, I read that most are done under general and my friend who works in ob said that she would discourage it being done under local. There isn't any emotional distress due to this being an unwanted pregnancy but I am concerned about the pain/discomfort. Do you have an opinion about which way would be better and if I would have to take any time off of work post d&c? As a nurse, I should know this but I really expected my hcg to drop after the amount of bleeding and pain I was in over the weekend.
Brief Answer:
Keep me informed about the new HCG result.
Detailed Answer:
Hi,
Welcome back.
Yes, you need to repeat the ultrasound first. This will also help us exclude ectopic pregnancy. From the description of bleeding that you had, I do not think ectopic could be a possibility. If the pregnancy remnant is more than 1.5 cm, you can wait but it takes a little longer time to be expelled.
In normal healthy pregnancy HCG increases by at least 66% every 48hours. If such satisfactory rise is not seen first thing to be considered is ectopic pregnancy. Miscarraige can give such varying HCG results sometimes.
You can definitely go for D&C under local. Your doctor will prescribe pain killers. So do not worry about it.
Keep me informed about the new HCG result.
I hope this helps.
If you need further clarifications I will be happy to answer.
Keep me informed about the new HCG result.
Detailed Answer:
Hi,
Welcome back.
Yes, you need to repeat the ultrasound first. This will also help us exclude ectopic pregnancy. From the description of bleeding that you had, I do not think ectopic could be a possibility. If the pregnancy remnant is more than 1.5 cm, you can wait but it takes a little longer time to be expelled.
In normal healthy pregnancy HCG increases by at least 66% every 48hours. If such satisfactory rise is not seen first thing to be considered is ectopic pregnancy. Miscarraige can give such varying HCG results sometimes.
You can definitely go for D&C under local. Your doctor will prescribe pain killers. So do not worry about it.
Keep me informed about the new HCG result.
I hope this helps.
If you need further clarifications I will be happy to answer.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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