Living abroad, and confused post-mc.

[AnnaKissed]

Hello, I've read so much good advice on these boards over the last couple of months and I hope you lovely ladies can help me again. I'm living abroad and the medical care here is certainly different from the NHS! I'm very confused at the moment.

I had a mmc diagnosed in mid March, at about 6-7 weeks, but baby only measuring 5 weeks. I bled on and off for a couple of weeks and then I ended up having medical management in hospital on April 1st and 2nd. I bled for a few more days at home after passing most of the tissue in hospital.

I had about 5 weeks of no bleeding, until a few days ago. I'm not sure if it was a period, but it was very light with a couple of big clots. On 27 April, I had a blood test - hcg levels of 2.

I had a follow-up appointment with a gynaecologist a couple of days ago and a scan today. There was something on the scan which was bigger than anything on the scans when I was discharged from hospital after the medical management. I had another blood test - hcg levels of 19.

So there's a possibility that I'm pregnant again???

The doctor spoke as if this is a terrible outcome, he had told me off the other day for having sex before getting my first post-mc period, and said not to TTC for at least 3 more months. (Outdated advice, compared to the UK, I think). I will do another hcg test after 48 hours, to confirm and discuss my treatment then.

But if I am pregnant again, what about the light bleeding I've had for the last few days??

I don't know if this is good or bad news, or what to hope for on Thursday?

Thanks for any advice!

Also, is it worth doing a hpt? Do they pick up levels of hcg that low?

I think you need to wait for the results of Thursday's test. In a new viable pregnancy HCG should approximately double, and I would assume they would rescan to see if there is a visible sac.
The worry is that you either have retained material which is still leaving traces of HCG, or (rarely) that it was a molar pregnancy.
The standard advice in the UK would be to wait for a negative test and preferably one AF before TTC again, I don't think anyone here would suggest a 3m gap if you felt ready.
Hope you get more clarity on Thursday and that it turns out to be a new bean in there.

First response tests pick up 12.5 mIU, clearblue/ supermarket ones 25 mIU, hospital tests 100 m IU, so if HCG is doubling you should get a positive in a couple of days.

Thanks so much for replying bakingtins. I see your name on these boards a lot - It's so good of you to post so much and so supportively on such a sad topic.

Hi Anna, sorry about your MC.

I have just been through a nasty scan wait to see if it was a new pg/retained products and they are horrible, so I'd really love to have a definitive answer for you, but don't think that is possible yet.

I think you will be in a better position to know after Thursday's HCG bloods.

A few bits of background in case they are useful:

In the UK they don't have the 3 months wait thing, as Bakingtins said. (Some docs still have the idea that you need to wait or else the womb lining won't be strong enough to support another pregnancy, but most docs who actually work in this area as opposed to GP's etc think this is rubbish) so the advice here is to:

1. wait to get a negative test, to be sure all the products have gone and
2. wait to get a first period as this would then make dating a future PG easier.

I would say that if you HCG blood test on the 27th April came back as 2, you have in fact had a negative test because at a blood level that low, you would get a negative on a home pregnancy test. So you have got point 1 already.

You would have been cleared to conceive here with the addendum that if you didn't wait for a period, then dating a new PG would be a bit harder initially.

The fact that you were scanned before you left hospital last time is a good sign as the point of this scan is to ascertain that there aren't any retained products that could regrow. This and the negative to positive HCG results does suggest a new pregnancy is possible.

The only thing that throws it is the fact that more could be seen on the scan - at a HCG level of 19 nothing would really would show up on a scan yet, as far as I am aware, so that is a confusing element.

Light bleeding in very early PG can mean either nothing at all, just a bit of breakthrough hormones and not suggestive of any problems, or it can mean it is a chemical pg or start of an early MC. Or of course it could be implantation bleeding, which would fit in with it being a new PG....so I don't think you can use the bleeding to figure anything out at this stage.

A couple of questions for you:

-Was any genetic analysis done on the products from your last pregnancy?

-Was there any mention of a corpus lutetium in your scan report?

{FWIW My last PG ended in MC & analysis showed it was a partial molar. I got PG following the MC before I had a period. I got a positive pregnancy test about an hour before the letter arrived from the hospital with the genetic analysis that there was a molar element and therefore I should not TTC-oops too late! so then had a very hard wait till a 6 week scan to see if it was molar material regrowing or a new pregnancy- they were lloooonnng days, so I am with you in spirit on this one}

Thanks Armadale, that's really helpful. I'm in awe at how knowledgeable you are! I hope you had good news at your scan?

To answer your questions, unfortunately most of the products were passed into the toilet so nothing was taken for testing. And I haven't had a scan report but no one has mentioned corpus lutetium. (And googling it has just made me even more confused!)

So is it possible that the mc was a molar pregnancy? But only being picked up several weeks later due to the retained products and rising hcg?

I don't want to get my hopes up for a new pregnancy, the early bleeding and low hcg levels are all too familiar, and not good signs. Although I have stopped bleeding now. Maybe it was a period - but would you get AF with an hcg of 19 and retained products?! Argh I'm so confused!

Thanks

No advice or experience I'm afraid, but thinking of you and hope you get some answers soon xx

Well, my hcg today was 64. Can I start to hope?

Was the HCG of 19 on Tuesday? If it's more than doubled that sounds positive, but it's still not correlating well with 'something' on the scan. HCG should be about 100 at the point AF was due (4 weeks) and the earliest they look for sac is 5 weeks, foetal pole and Hb at 6 wks+. Could it just be thickened lining on the scan? Did you get to speak to a doctor today?

Hi Anna, I just logged on hoping you might have updated, I have been thinking of you today.

I have the same question as baking, was the level 19 on Tuesday? or did you just get this result of Tuesday, from an earlier sample?

If it was from Tuesday it is rising very fast! Double every 48-72 hours would mean they would want it to be at 38 by today to suggest things were proceeding. And you at over x3 and not far off x4 the first reading.

Basically this means something is definitely growing, which is of course a reason for optimism, but if it has risen that much in 48 hours I would still be a bit cautious at the moment. I think it is really important you are given good care and watched carefully just for the moment.

My thinking is it has one of three explanations:

1. It could be a new pregnancy, and you produce a lot of HCG, some women do, so you would be on the high side of the 'usual' numbers if that makes sense:

hCG levels in weeks from LMP (gestational age) :

3 weeks LMP: 5 – 50 mIU/ml
4 weeks LMP: 5 – 426 mIU/ml
5 weeks LMP: 18 – 7,340 mIU/ml - you can see how wide the variation is if someone can have 18 and someone be over 7 thousand and them both be ok numbers!

1. It is a multiple pregnancy, which would also mean HCG rises very fast.

1. Hopefully it is not this but in a molar pregnancy the rate of HCG rises more quickly than in a normal pregnancy, so it would be good to rule this out once and for all now so you can relax.

Basically you would need the HCG to get over 1000 to see anything on a scan, the rule of thumb would be you won't see a pregnancy sac till it is between 1 and 2000. I would expect them to monitor your HCG with further blood tests and then check that it is a healthy new pregnancy you have got in there once it reaches this level, or book you in for a future scan now based on when they estimate your level with reach this point.

(The reason I asked about corpus lutetium is I was wondering if this was what was being picked up on the scan- these are large compared to ovaries and degrade if an egg is not fertilised, but not if the egg is fertilised (they produce some hormones till the placenta takes over) so sometimes one can be seen and can be a good sign of a new pregnancy- but is often overlooked or not evidenced, so don't worry about that.)

PS everything I learnt about this stuff I learnt from Mumsnet!! I am unfortunately a bit of a veteran but have been helped massively by these boards. Keep posting x

Thanks again both of you.

Yes, the hcg reading of 19 was on Tuesday, and 64 on Thursday, so it had more than tripled in 48 hours. I have to go back for another blood test in Sunday. (I'm in the Middle East - the weekend is Friday and Saturday.)

I saw a different doctor yesterday, whose attitude was: it's probably a new pregnancy and whatever was seen on the scan might be a mistake. I managed to see the scan report on her computer, it said there was something 3 x 1.6cm possibly remnants, possibly blood clot. Last week when I was bleeding lightly, I passed blood clot about that size, I think. But that was before the scan so it's not that. But maybe another one?

Depending on the results of the blood test, I might have another ultrasound on Sunday, but it sounds like it's too early to see anything related to the potential new pregnancy.

It's funny, 3 months ago, I had never even heard of beta hcg, but I'm soon going to be a bit of expert! The mmc was diagnosed partly through low and slow rising hcg, only got to about 1800 iirc, when I should have been eight weeks.

I think I am getting good care, this is all being done through the obgyn emergency dept at the hospital, so there's no waiting for appointments, it's all there and then. If I hadn't had the scan and tests, I would have no idea I could be pregnant, so at least I'm back on the folic acid and off the booze etc!

So, my next hcg level will be 72 hours after the last. I'd be expecting it to double or triple again by then, yes?

My main concern is that whatever was seen on the scan could affect the new pregnancy, if that's what it is.

But I'm also wondering if the mc was a molar pregnancy and this is the molar material regrowing. Is that possible? As I said, I had low hcg in the mc so that doesn't fit with a molar pregnancy.

If you were me, what questions would you be asking the doctors?

Hi Anna, I hope the blood test is good today- It sounds as though they are really taking care of you well and keeping an eye on things.

I did mention the quick rising HCG is seen in molar pg's, just so you could keep an eye on it, but a regrowing molar would have exhibited very high HCG last time, and it sounds like yours was on the low side, which is a really useful bit of info, so this does sound extremely unlikely that this is a regrowing molar.

I have no idea if a blood clot could affect a new PG- would be interesting to see what the doc thinks about this. Just thinking round it, in a twin PG for example, each sac manages to make enough room with something else there, so I don't know if the same principle would be at work here?

I know what you mean about not knowing what a HCG test was a few months ago- it is quite a steep learning curve, isn't it.

Good luck for today

This morning my hcg was 227, so it has more than tripled again, although this test was 72 hrs after the last one. Armadale you don't know how much I appreciate your help. I waited 5hrs to see a doctor before giving up, the ultrasound dept was closed by then anyway. I'm going back tomorrow to try again. Will update for anyone in the future in a similar situation!

I wandered onto your thread by accident one day and have been following it ever since. I don't understand too much of what's going on but am really hoping that you get some good news!

With an hcg of 19, you wouldn't see anything on a scan that could be a new pregnancy.

With your levels tripling each time, there's a possibility it could be a multiple pregnancy though. Good luck x

Thanks TheTerribleBaroness and Tranquilitybaby

I've seen a doctor this morning, who confirmed this is a new pregnancy. and I'm having yet another blood test and a scan on Sunday, although like you say it'll be too early to see anything.

Just in case anyone reads this who is in a similar situation, the gynaecologist said that the small bleed I had 10 days ago, and the potential blood clot seen on the scan, are nothing to worry about because the hcg levels have been rising since then.

It all seems so unreal and unlikely. I have always had trouble conceiving, and last month DH and I only DTD properly once, without a thought for if it was the right time of month!

Ok, off to lurk on the pregnant after mc threads. Best wishes to everyone still going through the horror of mc.

So pleased for you xx

That's lovely news! Congratulations and I wish you all the best. xx

Wonderful! Am so chuffed for you!

Great news Anna