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Re: Threatened miscarraige - please read

From: R. Daniel Braun, MD (anonymous@obgyn.net)
Wed, 27 Sep 2000 20:43:08 -0500 (CDT)

At Wed, 27 Sep 2000, Kallie wrote: >
>Wow - I wish I had known this board was here 3 weeks ago. I was busy
>sharing all this stuff with my friends on the PCOS board and didn't even
>consider that there was a better place for me. PLEASE PLEASE PLEASE
>bear with me and read /respond to this post even though it is long - I
>would really appreciate feedback. I've tried to provide an abbreviated
>account of the last few weeks.
>
>1st of all I have a syndrome called Polycystic ovaries. One symptom of
>this is that the ovaries often don't produce enough progesterone to
>sustain a pregnancy. When I first saw my OB on 8-28 I aked him about
>this and he agreed to monitor the progesterone levels and added that
>test to the "standard" prenatal lab work. According to my LMP I should
>have been 5 weeks along at this time. As it turns out I had an u/s 9-11
>that did not show a heartbeat but the radiologist said I only measured 5
>weeks- come back in two weeks for a follow up. Now this was a little
>bothersome because I was supposed to be 7 weeks along but we figured
>okay - dates could be off - but lets check those hCG levels... Well -
>as it turns out the levels were as follows
>Spet. 12 - 7100
>Sept. 14 - 8200
>Sept. 18 - 9100
>Sept. 21 - 11500
>
>In the meantime - I started spotting a light brown mucus on Sept. 19th
>- Doesn't look so good considering that although my hcg is going up - it
>hasn't doubled in 10 days. But on Sept. 20 I see the OB because the
>blood is sometimes red - but he says my cervix is tight as a drum and
>sends me immediately for another ultrasound.
>
>The ultrasound - to everyones suprise - shows a heartbeat. But I still
>measure 5 weeks. On the 21st I talk to the doctor because I started
>bleeding heavier and he said he was going to have the lab test my
>progesterone levels and in the meantime he was going to start me on
>200mg. vaginal suppositories 2x per day. and I should stay off my feet
>as much as possible.
>
>Over the weekend bleeding continues, it does not bleed like a regular
>period but when ever I sit or stand up I feel a little "gush" I am not
>soaking 10 pads a day so the doctor does not need to see me. The
>bleeding has been very red sometimes thick, sometimes clots (I am
>assuming because of the bed rest) and I have had contraction type
>mentral cramping - mainly in the evening and into early hours.
>
>The doctor said we can forgo the bloodwork today because no matter what
>the results say - we are both going to want to wat for the u/s scheduled
>Wednesday afternoon (yep today at 4:30 pm) He tells me though that he is
>glad we've started the progesterone treatments though because on 9-21-00
>my level was only 5.1 - I asked him what it was after the 1st test and
>he said 7.7. ((Now if the baby is okay we are set up to get bloodwork
>every Thursday))
>
>I was curious as to why I wasn't put on suppliments then and he told me
>that I was in the normal range at that time. That normal progesterone
>levels during the 1st trimester are 6-90. This confuses me because
>before he told me we want them above 20 and what I found on the internet
>said above 25.
>
>So I guess here are my questions:
>
>Can a prenancy sustain with a "normal" baby with those HCG levels?
>
>Does it sound like progesterone would have been a good idea after the
>first test to anyone but me? Or are those levels (6-90) really accurate
>and was I safe at 7.7?
>
>I know that 1 in 5 women will experience spotting but this was a bit
>more than spotting and has lasted a week. It is too late for this to be
>implantation bleeding - right?
>
>There are SO many oddities about this pregnancy - the dates and size,
>the bleeding woth clotting, the cramping, the hcg levels and the
>progesterone - Several RNs and even my own Dr.s have said "It is rare
>but I have seen it it a few normal pregnancies" about several of the
>symptoms - mainly the clots and the hcg levels - what are the odds this
>could be a normal pregnancy. -
>
>It is important to note that I have a son that will be 3 in December. I
>did have comon problems like swelling, my pelvic bones softened early so
>there was some added pelvic pain from about 5 mo on. And I had a
>c-section for arrested disent. However - there were none of these
>symptoms (except normal cramping.) Since that time I have had 2
>laperoscopies for my right ovary adhering to the c-section scar, my
>ovaries have been drilled (one yr ago) and I had a salpingogram to flush
>my fallopian tues in April 00.
>
>Any experience would be helpful - I am trying to prepare myself for what
>seems most likely but I'd love to know your opinons.
>
>Thank you SO much!
>Kallie
>
>--
>Kallie
>

Based on the HCG levels you reported, I would expect that this is not a good pregnancy. The pregnancy produces HCG the HCG does not support the pregnancy. The only real value that I am aware of for Progesterone in the first trimester is to follow a patient who has proven Inadequate luteal phase or to try to rule in or out an ectopic pregnancy At 4-6 weeks if the progesterone is aboe 25, it is not a tubal pregnancy, if it is below 5, it likely is an ectopic pregnancy. In between it could be either. I could be and hope that I am wrong, but the most likely outcome based on those HCG levels is a miscarriage. Your Ultrasound should tell. If it has not grown, it is not a normal pregnancy.

RDB 

--
R.Daniel Braun, MD  FACOG   FOG


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