Pregnancy or Miscarriage: Your Symptoms and Next Steps

Is it pregnancy or miscarriage?

My menstrual cycle is irregular.
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 faint second line an hour later.
In the evening, I had a blood test at the gynecologist's office on August 18, which indicated a beta-hCG level of 29.
On August 20, I experienced bleeding and lower abdominal pain with blood clots (similar to menstrual flow).
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, during a follow-up visit, the ultrasound, ovarian examination, and pelvic exam did not reveal anything.
The doctor mentioned that they would continue to monitor or conduct 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 pregnancy 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.
Is the likelihood of an ectopic pregnancy high?

Tian Tian, 30~39 year old female. Ask Date: 2017/08/25

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Xiaohong is not very punctual with her menstrual cycle.
My last period started on July 13.
During my menstrual period, I had intercourse with ejaculation inside, and at other times, it was external.
Until the morning of August 17, I took a home pregnancy test and saw a faint second line one hour later.
In the evening, I had a blood test at the gynecologist's office, and on August 18, I was informed that the hCG level was 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 seen.
The doctor mentioned that they would continue to monitor or conduct 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 pregnancy 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.
Is the likelihood of an ectopic pregnancy high?
Answer: Please consult your physician for detailed answers.
If the description is unclear, consider switching doctors for a consultation.

Reply Date: 2017/08/25

More Info

Understanding the symptoms and risks associated with pregnancy, especially in the context of potential miscarriage, can be quite complex and emotionally taxing. Based on your situation, let’s break down your concerns and provide some clarity.

1. Am I pregnant or having a miscarriage?
From your description, it appears that you initially had a positive pregnancy test, indicated by the beta-hCG level of 29. However, the subsequent bleeding and abdominal pain you experienced, along with the presence of blood clots, raise concerns about a possible miscarriage. In early pregnancy, it is not uncommon to experience some bleeding, which can sometimes be associated with implantation bleeding or other benign causes. However, the presence of significant bleeding and pain, especially with blood clots, is more concerning and could indicate a miscarriage.

2. What should I do if I cannot see the embryo?
If an ultrasound has not detected an embryo, it is essential to follow up with your healthcare provider. They may recommend repeat ultrasounds and blood tests to monitor your hCG levels. If your hCG levels are rising, it could indicate a viable pregnancy, but if they are falling, it may suggest a miscarriage. It’s crucial to keep in close contact with your healthcare provider during this time for appropriate monitoring and guidance.

3. Can I use a home pregnancy test to check my status?
While home pregnancy tests can provide some information, they may not be as reliable in early pregnancy, especially if there are complications like bleeding. If you are experiencing a miscarriage, the hCG levels may drop, leading to a negative test result. Therefore, while you can use a home test, it is advisable to rely on the medical evaluations and blood tests for a more accurate assessment of your pregnancy status.

4. Can I switch doctors for a second opinion?
Yes, you absolutely have the right to seek a second opinion. If you feel uncertain or uncomfortable with the care you are receiving, it is perfectly reasonable to consult another healthcare provider. A fresh perspective may provide you with additional insights or alternative approaches to your situation.

5. What is the likelihood of an ectopic pregnancy?
Ectopic pregnancies occur when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. The risk factors for ectopic pregnancy include previous ectopic pregnancies, certain reproductive health issues, and specific surgical histories. Given your symptoms, it is essential to discuss the possibility of an ectopic pregnancy with your healthcare provider, especially if you continue to experience pain or if your hCG levels do not rise appropriately.

In summary, your situation requires careful monitoring and communication with your healthcare provider. Early pregnancy can be fraught with uncertainty, and it is essential to prioritize your health and well-being. If you experience severe pain, heavy bleeding, or other concerning symptoms, seek immediate medical attention. Remember, you are not alone in this, and there are resources and support systems available to help you navigate this challenging time.

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