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

[monkeymoma]

"Possible thats what he's thinking?"

not really, he said it was definitely not an ectopic because it was definitely a MC, from what I can see online and the info I've got from this thread he sould not have conclusively said either with the information he has at this point, say I listened to him and then went on to have more severe ectopic signs I could have put it down to MCing as he said that that is what is happening and it is NOT a MC. At this stage IMO I could still go on to have either a MC or an ectopic, or neither, he was wrong to rule out one and diagnose the other at this stage.

what's been really annoying me today is that even if he was going by 5+3, then he was still wrong to tell me that it had to be >1000 to be viable because ALL the tables I've found online say it doesn't need to be >1000 till 6 weeks

[monkeymoma]

"as he said that that is what is happening and it is NOT a MC"

that was meant to say:
as he said that is what is happening and he said it is NOT an ectopic

I think he was wrong, but what if I trusted him and now believed it was impossible for me to have an ectopic and ignored more serious pain or bleeding thinking "that's prob just what happens in MCs I suppose"

[AitchTwoOhOneTwo]

it still could be anything, mm, and tbh stats-wise he is more likely to be right that it's a mc. but the individual doesn't behave as a statistic, and i beat the odds twice. it's one in a hundred pregs for ep, and one in four i think for mc, which is why doctors' ignorance over ep protocols often don't bite them in the arse.

[monkeymoma]

I know it could still be anything

which is why I'm increasingly annoyed that he said it CANNOT be an ectopic, so if I believed him then had increased pain I wouldn't get it investigated I'ld just dose myself up and wait for the MC he said I am DEFINITELY having

and I know I could still have a MC, but not based on his reasons (i.e. levels not being >1000 last wednesday), just cause it's common and its early and I still could

[monkeymoma]

if I can get another blood test from my GP on tuesday, what sort of pattern should I expect for the 3 possible outcomes?

[NannyPlumIsMyMum]

Docs can't 100% say you are miscarrying unless they examine your cervix as to whether its opening.
In the absence of any proper blood loss there is still hope.

[monkeymoma]

he did examine my cervix on wed and said there was nothing to see and said THEN that it didn't look like a MC at that stage
he diagnosed me on friday over the phone as definitely having a MC based on having levels of 288 (at 14 days PO, 5+3 by LMP), he said they should have been >1000

[NannyPlumIsMyMum]

And GP really is a git for not re testing hcg levels in 2 days time.

[monkeymoma]

it wasn't the GP it was the gynae SHO

[NannyPlumIsMyMum]

TBH he sounds like he is talking through his arse.
He really cannot diagnose a mc over the phone ! ESP when he examined your cervix previously and there was no cause for concern.

[NannyPlumIsMyMum]

Am frustrated for you OP.
Am so sorry your going though this.

[Sastra]

Is it worth just blowing the expense and going to have a private scan?

[monkeymoma]

no the private place only scan from 8 weeks +, and that's not really what I needed anyway I needed a 2nd set of bloods yesterday

[AitchTwoOhOneTwo]

a scan might not tell you too much anyway at this stage. i'm so sorry you are going through this, MM. it's absolutely not the first time i've seen women get terrible epu care on these and other boards.

[monkeymoma]

I know, we phoned the private place to see if we could book in for a fortnight if nothing has passed by then, but they don't do 6/7wk scans

[monkeymoma]

also they only do referrals not self referrals, but given my experience of the womens health unit so far I think I'ld rather go there, so if my GP does want me scanned at 6 weeks I might ask to go there instead of womens health

[2ndDestiny]

Monkeymoma I see you're already getting good advice on here but just wanted to add my twopence worth because your symptoms are exactly the same as the symptoms I had with DS at 4 weeks - spotting and one sided pain.

In answer to your question, at 4 weeks with DS my HCG was 159. DS is now 18 months and alive and kicking. So yes you are right, a figure of 288 is categorically not sufficient to diagnose a MC.

My dates were also adjusted based on ovulation, not LMP, because I have PCOS and ov'd on CD50. LMP would have put me at 8 wks, which would have been absurd. It's not unreasonable to adjust dates in this way - so you are right about that too.

The tests carried out were:

-HCG blood tests 72 hours apart to check that they were doubling (you already know that you need these). These don't confirm a viable pregnancy but can help to spot or rule out an ectopic.

• progesterone blood test - also a sign of whether the pregnancy is likely to be in the womb, I think they like to see over 40 but perhaps over 60 - can't remember.
  
• when my HCG went over 3,000 (at 5 weeks) they did an internal scan to confirm the pregnancy in the womb, even though this could not confirm viability (too early for a heartbeat).
  

-a further scan at 7 weeks to check for heartbeat and thus confirm viability

The speculum exam sounds unnecessary to me (they never do those in my EPU) but it's done now.

I don't know how you get this tests given that they dr you've seen is next to useless, hopefully your GP will help with the bloods. But just wanted to reassure that there is every possibility of a good outcome, even though you DO need the proper tests to rule out EP in the mean time and I wish you luck getting those - sorry you are having such a battle.

[2ndDestiny]

PS. the one-sided pain turned out to be the corpus luteum cyst but obviously this can't be assumed.

You are absolutely right to be pushing for these tests, hope it all works out for you.

[monkeymoma]

thank you for sharing your experience 2ndDestiny, very helpful! and glad you had a good outcome!

just waiting for DH to take my mum to town out of my way (she's staying with us and will tell all our rellies/friends if she suspects and I cannot be doing with that if we don't even know what's happening ourselves) then I think I will ring the ward and say I have questions about what the doc said

I am not hopeful that I'll get any sense/joy out of them, but I'll at least try and then contact GP on tues

[monkeymoma]

rang the ward, no docs available spoke to nurse

she said "oh well it does sound low"
I asked what she thought it should be
"oh well most of the people we see here have at least 600
so I asked how far along most of the people she sees are
"we usually see from 6 weeks"
"so why do you think it's low for 14 days post conception?"
"well it sounds low to me"

then she said it usually doubles every week (does it not usually double every 2/3 days at this stage?)

FFS, they ARE wrong arent they about the levels? I'm not just in denial?

anyway she said that there will be a different gynae doc on tomorrow morning so I can ring then

[2ndDestiny]

Yes it doubles every 48-72 hours at this stage

She sounds really vague and not sure what she's talking about

MM, trust your own knowledge, you seem to have the misfortune to have some unusually (and shockingly) ignorant staff at your EPU IMHO.

Hope tomorrow's gynae is more clued up. Good luck

[FoxyRoxy]

I would see if you can get an appt tomorrow with your GP and explain what happened, I do not believe 288 is low for 14 days past ovulation. Do also call the gynae at the epu tomorrow as without a comparable blood test they have no idea of what's going on in your pregnancy. Pain when sneezing, coughing and stretching is normal, as is spotting at around implantation. You are quite possibly having a normal pregnancy and it's awful that you've been told you're miscarrying from one isolated bit of data.

[2ndDestiny]

Btw (me again) my EPU never so much as hinted that 159 was 'low HCG' for weeks; they said it 'all looked normal', although they did emphasise that it's the doubling time was is more significant than a single figure. You are not in denial MM. fingers x'd.

[monkeymoma]

my GP is good, if I was to call him tomorrow it'ld be with the out of hours doc

I'm having enough of a talking down to from the womens health unit TBH I don't think I want to potentially speak to someone else who is just guessing and giving me their opinion without clinical backing like the womens health unit. The out of hours might be good, they might not, I know my GP is good

I'll ring the on-call doc in the morning, otherwise I'll wait to speak to MY GP on tues because I know he will listen, I've had enough of being spoken to like I'm a hysterical idiot who's OBVIOUSLY "just" misscarrying
(I've not acted hysterical BTW I've been calm and factual on the phone, I'm just getting a "silly woman" vibe back IYKWIM)

If I need to I will go to A&E, but I don't think I do right now. If the on-call wont do a repeat blood test tomorrow, and I feel okay, I'll just wait till next week (sigh)

[DarrellRivers]

What a dreadful lack of knowledge from the EPU.
There are really no absolute values for bhcg at this point, people have tried to put them in ranges for gestation but it is notoriously unreliable.
Only sure fire is a doubling in 2-3 days.
Am
Might expect a GP to not be as tip top with the figures but the EPU junior doc/nurse should be ashamed of themselves