WOMENS-HEALTH Messages for November, 2000: Re: slow rising beta hcg levels... ectopic???

Re: slow rising beta hcg levels... ectopic???

From: anon (anonymous@obgyn.net)
Wed, 22 Nov 2000 18:51:51 -0600 (CST)

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At Wed, 22 Nov 2000, J. wrote: >
>SITUATION:
>Last menses 9/7, diagnosed with threatened miscarriage 10/20, passed
>clot-like material 10/23. Went to Dr. as I still had positive hpt on
>11/16, beta level was 278. Dr says it is new pregnancy. Follow-up beta
>level on 11/20 was 336, dr says probably ectopic or abnormal pregnancy.
>I just did my 3rd level today and demanded an ultrasound he says I will
>be waisting my money because they wont be able to see anything. I
>wanted this to rule out ectopic pregnancy. Strangely enough though, he
>did offer a D&C which made no since because if he thinks it is an
>ectopic, that would not help the situation one bit. I am 28 had 2
>healthy, problem free pregnancies and 2 miscarriages and I am basically
>looking for opinions on this situation...
>
>QUESTIONS:
>
>With these levels like this could there be any slim chance of a normal
>pregnancy????
>
>Could they detect EARLY ectopic pregnancy on ultrasound or do you have
>to be further along in the pregnancy?
>
>Thanks for any advise you could give me.
>

J. Ellis,

If we simply consider the two quantitative HCG levels which rose (but not like a normal pregnancy should) your doctor is right, this is likely a spontaneous abortion (miscarriage) or ectopic pregnancy. It is very unlikely that it is a normal pregnancy (if the levels went down we could say absolutely not a normal pregnancy) and by very unlikely I mean we are sure enough we would not hesitate to do a D&C. Your HCG levels are too low to see a normal pregnancy or spontaneous abortion on ultrasound. It might be possible to see an ectopic with these low levels but unlikely. Ectopics are more often diagnosed by not seeing a pregnancy in the uterus when there should be one (HCG level > 1,500) than by actually seeing the ectopic itself. I would not do an ultrasound.

What was the 3rd HCG level?

I would also suggest a D&C. If this is a spontaneous abortion the D&C will end it and allow the HCG levels to decrease to zero. Finding pregnancy tissue in the uterus will confirm it is not an ectopic (if you know what a heterotopic is...give me a break). If it is an ectopic the D&C will find no pregnancy tissue in the uterus and the pregnancy hormone levels will not drop to zero and then we will know what's up.

Talk to your doctor. Ask him these questions. Sounds like he knows what he's doing.

Next message: Ronna: "Endometriosis and WBC count......"
Previous message: jared: "can a girl get pregnant if she is a virgin and her partner does not ejaculate inside her"
In reply to: J.: "slow rising beta hcg levels... ectopic???"
Next in thread: Lynn D. Montgomery, MD: "Re: slow rising beta hcg levels... ectopic???"

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