low hcg in early pregnany, is the doctor wrong?

[monkeymoma]

My GP referred me to the womens health unit 2 days ago because I had spotting (never a flow, never red blood) combined with R sided pain

I kept explaining to the doc at the womens unit that although on the day my dates by LMP were something like 5+3, I was actually 4+0 (based on OV dates, same situation as when I had DS) - he didn't really listen

had bloods taken at 4+0 MY dates (5+3 by LMP dates), the result was 288, doc says this is too low and is a MC

I'm wondering if anyone can shed any light because I don't think the doc listened to me re dates

Is 288 low for 4 weeks EXACTLY or is it low for 5+3 which he is insisting on going by (despite me repeatedly telling him I was 4+0 on the day the bloods were taken), I asked him to clarify what it should be at FOUR weeks, he was vague and said for 4-5 weeks it shoudl be >1000

Thanks! I'm not trying to be in denial if it IS too low for my actual dates, I just want to know if its low for what I REALLY am x

[AitchTwoOhOneTwo]

he doesn't have enough evidence to rule out an ectopic, i'm sad to say. believe me, i really do know what i'm on about here.

[AitchTwoOhOneTwo]

www.rcog.org.uk/womens-health/clinical-guidance/bleeding-and-pain-early-pregnancy-information-you

these are the guidelines. note, 'blood test(s)'

[ellangirl]

Monkey my hcg levels at 4+1 were 180 and I was told that was a good strong positive (post ivf so dates are exact). On the basis of that number I did not need any repeat blood tests, if the tests number was low, I.e. 50 they would have repeated 48 hours later to see if it was doubling.

[AitchTwoOhOneTwo]

www.rcog.org.uk/files/rcog-corp/Ectopic%20Pregnancy.pdf

[monkeymoma]

thanks Aitch, at least that says that vaginal exams are normalish, I was a bit stumped by that one, couldn't work out what there'ld be to see at that end!

[AitchTwoOhOneTwo]

honestly... with pain and bleeding you cannot make a diagnosis from one test. doctors do, of course, all the bloody time, and most of the time they get lucky. but they should not.

[AitchTwoOhOneTwo]

an abrasion on your cervix, i guess.

[lotsofcheese]

Bloody SHO's - they know nothing!! I avoid them whenever possible & ask for a Senior Registrar/Consultant opinion.

I think you'd be well within your rights to phone the unit back, ask to speak to the sister in charge & say you're not happy with the care received from the Dr you saw. You'd like a second opinion & a blood test, to discuss scan to rule out ectopic. I think you'll find it'll be a much more sensible conversation with her, and you can at least have a discussion about these issues, even if it's just over the phone.

Is your EPAU open on a Saturday morning? I hope so, and you can phone them tomorrow.

I can imagine how stressful & upsetting this is for you - I had a miscarriage last year (which turned out to be a molar pregnancy) - it was such a difficult time

Hope all goes well

[monkeymoma]

thanks ellan, so sounds like he is not making any allowances for my "real" dates, he didn't even say possible MC, he said it WAS one based on those levels and it was not an ectopic

but now I feel like the MC diagnosis is unfounded, so that's good, but on the other hand a possible ectopic that was enough to worry my GP wasn't properly ruled out as I should have hand another blood test today!

We were so chilled and happy when I got this BFP! in stark contrast to the sheer "what-are-we-doing??" panic when I got my first BFP with DS and was so looking forward to really enjoying this pregnancy (as it was planned), and now this limbo..

[AitchTwoOhOneTwo]

it[s awful. i'm really sorry.

[monkeymoma]

lotsofcheese the EPU and womans health unit are all the one place, and I don't know how far I'ld get with them

when I went on wed I went to the EPU room, they said "well it wont be here we're closed" and didn't direct me to the ward, I knew where the ward was myself so went there and the ward said "it'll be the EPU it's up there" (no it wasn't and anyway don't you know it's closed?) till I eventually convinced them that I was in the right place and my GP had referred me, they took my GP letter, eventually found my name on their list, and sent me to wait in the infertility waiting room up the hall for an hour, then the doc brought me onto the consutation room on the ward and saw me there.

Then when I rang the ward to say noone had rung me with my results, the first woman just said "I'll transfer you" and hung up on me, the second woman took my phone number but few other details and said someone would ring back (noone did), the third woman at first kept telling me I was seen in the EPU (I wasn't I was seen on the ward) but then once I DESCRIBED the part of the ward I'ld been seen on she actually looked for me on the system (which took ages plus the complicated game of "describe your doctor") and the doc rang back after that

so not sure ringing the nurses again will get me much more joy, I really wanna speak to my GP, he actually listens, but that wont be till monday!

[CharlieIsAChocolate]

I feel really sorry that you have to worry about this. Please do get the serial tests. If your GP is concerned, that is a flag. Mine wasn't and the hospital doctor wasn't- they should have been.

[FoxyRoxy]

monkey I really feel for you. The one thing I will say is that he can't tell you you're miscarrying from that blood test result, nor can he rule out an ectopic although the pain should be worsening if it's an ectopic and one sided pain is quite normal.

How many dpo are you? Considering that a +ve pregnancy test usually shows at around 4 weeks pregnant (14dpo) and are generally looking for 25mlu-50mlu being told 288 is low is a bit bullshitty. There's a list somewhere online of how much hcg triggers the 1-2, 2-3 and 3+ on the cbd which should indicate the "norm" for those weeks past ovulation.

[AitchTwoOhOneTwo]

the pain may worsen, it may not. the one absolute with ectopic is that there are no absolutes.

[CharlieIsAChocolate]

That experience sounds awful. The EPU will be better set up to check for and rule out ectopic pregnancies. Can you ask your GP if this is the case and to refer to the EPU when you see him next week?

I really hope all will be ok for you.

[ellangirl]

From what I know, 2-3 is over 200, and 3+ is over 1000 but I could have made that up!

[monkeymoma]

foxy I was 2 weeks post OV exactly on the day of the blood test
the same day I got my first 2-3 weeks on CB digital
I'm 4+2 now, the cheap not very sensitive tests are strong positives just not quite as dark as the control line (but darker every day) and the sensitive FR type test lines are as dark as the control lines

the pain isn't worstening, its not constant but it can sometimes stop me in my tracks, particularly if I stretch or sneeze. No spotting for last 2 days

[monkeymoma]

The EPU will not see me till 6 weeks apparently, but its the same place/department/team, it's within the womens health unit, I was just seen on the womens' health ward itself rather than EPU

[CharlieIsAChocolate]

I agree with Aitch- there are no absolutes and people experience all sorts of different symptoms- pain may not be one of them.

[AitchTwoOhOneTwo]

please don't read too much into what was said about the pain worsening... it's not true. plus, there are a gazillion reasons why you might have pain anyway. my most classic ectopic in terms of what doctors are taught at medical school turned out to be my daughter. the other two... some pain, intermittent, got better, no bleeding in one, some bright red (as opposed to classic ep brown/plum) blood with the other... both ectopics. only blood tests and scan can help.

[monkeymoma]

tonight the test lines on FR are STRONGER than the control line so by POASs levels are going up every day

[monkeymoma]

Bugger Monday is a bank hol!

[FoxyRoxy]

Doctors are open on bank hols aren't they?

Pain when stretching and sneezing is normal, by the way. No one can rule out an ectopic unless you have a scan or bloods, I can't believe this dr was so blasé with you but the increasingly stronger positives are a good sign.

[sunnyday123]

I don't know anything about ectopic but is it possible that maybe he said wait another week because its not too much of a risk (in medical terms- not distress for you) by waiting? Most people wouldn't even know they were pregnant yet at 14 days po and problems with ectopics (i think) happen when the tube bursts as the pregnancy gets too big for the tube. Therefore at only 14dpo maybe thats not his concern yet given its only really just starting to implant. Possible thats what he's thinking?

With DD1 i had spotting and one sided pain and went A&E at 5.5 weeks (3.5wks po) and they left me waiting for a scan to confirm position for another 4 days as it was the weekend and no trained sonographer

I would have thought (could be wrong!) at 14 dpo its a bit early for 'ectopic' like pains as the pregnancy isnt the size to be causing any trouble?? I would still be thinking along the lines of implantation - my mate had an ectopic which was discovered at 10 weeks following pain then - she had nothing earlier.

Given you spotted with DC1, i wouldn't be overly concerned with spotting either - my consultant said some people are more prone to spotting and will bleed with every pregnancy (as I did). My cousin has this week found out she is 20 weeks pregnant having had full periods and pain all the way through. Everyone is different but i wouldnt overly worry about ectopic yet as even it if is (and i hope it isn't), its surely very early to cause any major problem before next week.

[AitchTwoOhOneTwo]

with the greatest respect, you are wrong. there's nothing to be gained from not letting a patient know where she stands... does monkeymoma seem unworried currently?
and we really don't want the tube to burst, that's when the danger becomes fatal, and quickly.
of course, it may not be ectopic at all, everything may be absolutely fine, or indeed not, and bleeding will start before next week. but the doctor is taking a disgraceful risk and, given her symptoms, not actually adhering to the RCOG green top guidelines.