Pregnancy or Miscarriage: Your Symptoms and Next Steps

Is it pregnancy or miscarriage?

My menstrual cycle is not very regular.
My last period started on July 13.
During my period, I had intercourse with ejaculation inside, and at other times, it was external.
On the morning of August 17, I took a home pregnancy test and saw a second line one hour later.
In the evening, I had a blood test at the gynecologist's office on August 18, which showed a beta-hCG level of 29.
On August 20, I experienced bleeding and lower abdominal pain with blood clots (the amount was similar to a menstrual period).
On August 21, I returned for a check-up, but the ultrasound did not show anything, and I was prescribed medication to support the pregnancy.
On August 24, I returned for another ultrasound, ovarian examination, and pelvic exam, but nothing was visible.
The doctor mentioned that they would continue to monitor or perform blood tests, otherwise it could be an ectopic pregnancy.

I have the following questions:
1.
Am I pregnant, or have I had a miscarriage?
2.
Since I cannot see the embryo, what should I do next?
3.
Can I use a home urine test to check for two lines to determine my current status?
4.
Can I switch doctors for a re-evaluation based on the above description?
5.
What is the likelihood of an ectopic pregnancy?

Tian Tian, 30~39 year old female. Ask Date: 2017/08/24

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Please consult the physician for a detailed answer.
If the explanation is unclear, consider seeing another doctor.

Reply Date: 2017/08/24

More Info

When it comes to understanding the complexities of pregnancy, especially in the context of potential miscarriage, it is crucial to consider various symptoms and medical evaluations. Based on your situation, let's break down your questions and concerns.

1. Am I pregnant or have I miscarried?
Given your timeline, it appears that you initially had a positive pregnancy test with a beta-hCG level of 29, indicating that you were likely pregnant. However, the subsequent bleeding and abdominal pain, along with the presence of blood clots, are concerning signs that could suggest a miscarriage. It is not uncommon for early pregnancies to end in miscarriage, especially within the first few weeks. The fact that you experienced bleeding similar to a menstrual period, along with the absence of an embryo on ultrasound, raises the possibility that you may have had a miscarriage.

2. What should I do if I cannot see the embryo?
If the ultrasound did not reveal an embryo and your beta-hCG levels are not rising appropriately, it is essential to follow up with your healthcare provider. They may recommend repeat blood tests to monitor your hCG levels. If the levels are decreasing, it may confirm a miscarriage. If they are stable or rising but you still cannot see an embryo, further evaluation may be necessary to rule out conditions such as an ectopic pregnancy.

3. Can I use a home pregnancy test to check my status?
While home pregnancy tests can provide a quick indication of pregnancy, they may not be reliable in your situation, especially if you are experiencing bleeding. The presence of hCG in your urine can still yield a positive result even if a miscarriage has occurred. Therefore, it is advisable to rely on blood tests and medical evaluations for a more accurate assessment of your pregnancy status.

4. Can I switch doctors for a second opinion?
Absolutely, seeking a second opinion is your right as a patient. If you feel uncertain about your current doctor's assessments or if you want further clarification on your situation, consulting another healthcare provider can provide you with additional insights and options for care.

5. What is the likelihood of an ectopic pregnancy?
Ectopic pregnancies occur when a fertilized egg implants outside the uterus, often in a fallopian tube. While the risk factors include previous ectopic pregnancies, certain surgeries, or conditions like pelvic inflammatory disease, the likelihood varies based on individual circumstances. If your healthcare provider suspects an ectopic pregnancy due to your symptoms and the absence of an intrauterine pregnancy on ultrasound, they may recommend further imaging, such as a transvaginal ultrasound, or monitoring your hCG levels closely.

In summary, your symptoms and the timeline suggest that you may be experiencing a miscarriage, but it is essential to follow up with your healthcare provider for accurate diagnosis and management. Monitoring your hCG levels and possibly seeking a second opinion can help clarify your situation. Remember, it is crucial to prioritize your health and well-being during this time, and do not hesitate to reach out for support from healthcare professionals.

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