Early Pregnancy Complications: HCG Levels and Ultrasound Insights

Pregnancy issues

Hello Doctor, my last menstrual period was on November 3, 2017.
I took a home pregnancy test which showed positive on December 18.
I went to a gynecology clinic for a transvaginal ultrasound, and the doctor confirmed that I was pregnant and could see the yolk sac in the uterus.
During my follow-up appointment on December 25, the doctor did not inform me of the embryo size but mentioned that there was no heartbeat and suggested waiting another week.
On the night of December 28, I experienced bleeding similar to a menstrual flow.
On December 29, there was no further bleeding, but during an evening visit, the doctor said that early pregnancy can be unstable and prescribed medication to support the pregnancy.
Another ultrasound was performed, but there was still no heartbeat.
The doctor ordered a blood test to check my hCG levels.
During my follow-up on January 1, the doctor reviewed the blood test results and indicated that my hCG levels were too high to be normal.
The ultrasound was performed again, and there was still no fetal heartbeat.
The doctor then referred me to a larger hospital for further evaluation, suggesting that it might not be an embryo but possibly another type of cyst.
I would like to ask the doctor if my hCG level of 150,000 mIU/mL, considering I am approximately seven to eight weeks pregnant, is abnormal?

Nicole, 30~39 year old female. Ask Date: 2021/01/03

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is possible that it is an atrophic ovum.
We should observe for a few more days to see if there is a heartbeat.
If there is still none, it should be confirmed.
Wishing you good health.

Reply Date: 2021/01/03

More Info

In early pregnancy, monitoring human chorionic gonadotropin (hCG) levels and ultrasound findings is crucial for assessing the viability of the pregnancy and identifying potential complications. Based on your description, it appears you are experiencing a complex situation that requires careful evaluation.

Firstly, hCG is a hormone produced by the placenta shortly after a fertilized egg attaches to the uterine lining. In a normal early pregnancy, hCG levels typically double every 48 to 72 hours. However, the absolute value of hCG can vary significantly among individuals and can be influenced by various factors, including the timing of implantation and the overall health of the pregnancy.

In your case, you mentioned that your hCG level was 150,000 mIU/mL at around 7 to 8 weeks of gestation. While this value may seem high, it is essential to consider the context. High hCG levels can sometimes indicate a multiple pregnancy (twins or more) or, in some cases, a molar pregnancy, which is a rare complication characterized by abnormal growth of trophoblastic tissue. However, the absence of a fetal heartbeat on ultrasound is concerning and suggests that the pregnancy may not be progressing normally.

The presence of bleeding, especially if it resembles a menstrual flow, can also be indicative of a potential miscarriage or other complications. In early pregnancy, some women experience spotting or light bleeding, which can be normal; however, heavy bleeding accompanied by cramping is more concerning and warrants immediate medical attention.

Your doctor’s recommendation to refer you to a larger hospital for further evaluation is prudent. They may perform additional ultrasounds and hCG tests to monitor the situation closely. If the hCG levels continue to rise but there is no evidence of a viable pregnancy on ultrasound, it could suggest an abnormal pregnancy, such as a non-viable intrauterine pregnancy or an ectopic pregnancy.

It is also important to note that while hCG levels can provide valuable information, they are not the sole determinant of pregnancy viability. Ultrasound findings are equally critical. The presence of a gestational sac and yolk sac is a positive sign, but the absence of a fetal heartbeat after a certain point in gestation (usually around 6 to 7 weeks) raises concerns.

In summary, your situation requires careful monitoring and possibly further diagnostic testing. High hCG levels in the absence of a fetal heartbeat can indicate a non-viable pregnancy, and the bleeding you experienced adds another layer of complexity. It is essential to follow your healthcare provider's recommendations closely and seek immediate care if you experience severe pain or heavy bleeding. Early intervention can be crucial in managing complications and ensuring your health and well-being.

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