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

I know the waiting must be hard monkey but you're already a couple of days closer to speaking to someone with sense (GP). FX'd for you and please update when you have some news :)

have you thought of just going to A&E?! When i bled with my first 2 pregnancies thats were I went - they will be more reluctant to leave you given your symptoms? They do fairly quick blood tests too?

sunny I will go to a&e if things change from how they are right now, but right now I feel okay

I'm annoyed because my GP wanted ectopic ruled out and I trust that GP
the gynae doc said he ruled it out, job done! (based on single hCG levels) which he CAN'T DO at this stage with this information.

I feel embarrassed and foolish now about even going to womens heath, I felt neurotic calling the ward back (and thinking about calling the other gynae on-call tomorrow), they've really made me feel like an idiot , they don't listen they talk over you before you've given the whole story, I don't feel like they are diagnosing ME, I feel like they are just diagnosing me as one of those silly women who attend womens health before 6 weeks, silly silly women who wont face up to early losses - it happens dont they know! but I DID NOT SELF REFER!! I didn't even ask my GP to refer me I went to him to chat about how long I should put it down to "normal" spotting and pain and what I should look out for as "abnormal", and HE referred me

the gynae SHO didn't even bother phoning to let me know when he decided it was "just" an early MC, he said on wed he would call on thur, I didn't get to speak to him till nearly 5pm on fri after a lot of chasing up!

I'm in a shit and slightly fragile mood about it all now (maybe due to the hormones he says I don't have enough of

It's totally understandable that you feel that way. Hold on to the fact that you can see your nice GP on Tuesday and that you know what to discuss with him.

I think he will understand the reasons for requesting the serial blood tests - it is in the guidelines after all. I cannot see how the SHO could possibly diagnose a miscarriage with the information available to him. He should have referred you for follow up scan and blood tests.

If you are offered a scan to check location of pregnancy, make sure you get the blood tests too. I had some big clots come out with stuff in them (sorry that sounds really gory). The doctor thought it was the "product of conception" and as the scan showed nothing in my womb (and apparently in the tubes either) they thought it was a miscarriage. It was the HCG levels not doubling that really made the doctors look for the ectopic.

Sorry I should clarify the HCG levels thing. My blood was checked more than twice. In the first two tests the HCG did not double as it should have done. This, combined with the bleeding, led to the scan which showed my womb was empty. In a third (and possibly fourth test too - can't remember now) my HCG level was still going up. It should have been reducing if I'd actually had a miscarriage. So, for me, it was really the blood tests that showed it was an ectopic pregnancy rather than a miscarriage.

Thanks Charlie, I chickened out of calling the on call gynae doc this morning , my symptoms have faded and I have very strong +ive POASs. No spotting now and pain is reduced to more of a general light stretching all over rather than just R side, so I felt like ringing up would just be ringing to argue the point IYKWIM rather than ringing because I needed to fight for immediate medical attention. I don't think I'm in a danger zone right now and fell I can wait to see the GP as my symptoms that worried him have faded, of course if they come back I will go to the GP.

I know I'm not "all clear" but will keep an eye on things and am not immediately worried

I've been reading through this and am really sorry you're going through all this.

I've had 2 eps, 1 miscarriage and loads of IVF. Some doctors were shockingly ignorant about ectopics and I really had to argue hard to get tests and scans in early pregnancy when I was bleeding. Even although I knew I was at a higher risk of another ep after the first one, some staff tried to make out I was being neurotic or pushy for wanting to be checked out. So much depends on getting a good doctor, nurse or midwife onside. The whole "wait until 6 weeks for a scan" is a complete pile of shite.

Ectopics are so difficult to work out though as the symptoms can be completely different - during my first I had contraction-type pains that came and went in the evening, during the second I felt constipated and had really heavy bleeding.

Have you tried the Ectopic Pregnancy Trust website? If anyone will be able to advise you online about hcg levels and what to do next, it's them. www.ectopic.org.uk They really are fantastic.

I hope it's all ok.

oh lor', i don't want to be a horrible doom-monger but please don't take the fact that you're no longer bleeding as a sign that it can't be ectopic. there's not the same blood supply in a fallopian tube as there is in the womb, so things can go very slowly, stop burrowing, start burrowing, bleeding has time to coagulate etc.

it's a sign that it might not be miscarrying, but again not conclusive re ectopic. of course i hope everything's absolutely fine, but just wanted to double check your logic.

I know aitch, I know that anything could happen/be happening still I am in limbo, I just don't feel in immediate medical danger right now, I feel like I can wait until Tuesday and if that changes I will go to A&E. - I am still very much "on alert" for further worrying signs

TBH I really don't think ringing the unit today would have got me anywhere anyway

thanks panda, I'll have a look at the link

Hi, just wanted to sympathise and say your doc sounds like an absolute knob.
I too had the 'LMP vs what I knew' argument with many people because I have a really long cycle (45 days) so kept being told I was a couple of weeks ahead of when I was. Ultimately my thinking was I know my body better than any doc, but they wouldn't accept my suggested due date until my dating scan- which means all of my appointments had been scheduled in the wrong place.

I think doctors can sometimes forget that we are people and individuals.

I'm sorry you're having this worry. Given that the helpful people on this post have helped you conclude that your hcg level does NOT indicate a miscarriage (and hcg levels mean nothing individually anyway, only when compared over several days) and that your main symptom was spotting (which many women get during early pregnancy) and pain (which many women get- I had one sided pain from 5 weeks which led me to get a transfanny scan at 6 weeks because I was terrified of ectopic- it was all normal- and due to the corpus luteum), it is worth just trying to relax for now?

I understand you needing a definitive answer because you want to either grieve / be happy and excited, and it's awful being in limbo.

Are you in a particularly high risk for ectopic such as older or suffering with endometriosis? Symptoms for ectopic would usually develop around 6 weeks.

BUT if you are concerned, you should just go to A and E. They have to take you seriously and have to investigate because an ectopic, if left untreated, is dangerous. An ultrasound at this stage won't show much, but may just show that the sac is in the right place.

Sorry for rambling. Good luck.

London the only risk factor I have according to linked site is previous abdo surgery (CS)

Sounds like you are getting typically rubbish treatment from the EPU, sadly. Mine have decided in their wisdom that they don't do scans before 8 weeks, even though a lot of ectopics (mine included) will have ruptured/needed emergency surgery by then.

BUT what I would say is that if you really are only 4 weeks by LMP, then that IS very early for ectopic-like pain, and that a CL cyst sounds a much more likely possibility. With both my children post-ectopic, I ended up in A&E with pain and bleeding just before 5 weeks, thinking I was having a repeat ectopic, and in both cases a cyst was responsible and baby was growing fine in there.

However, if I were you I'd give the ectopic pregnancy trust helpline a ring, as you can get through to someone both medically qualified and with specific expertise on ectopic pregnancy. Their forums are also great, though I have issues with their moderation rules which treat women like rather dim 4-year-olds.

sorry, CL - corpus luteum

oh god, honestly. it's not unusual to have pain at this stage. i did. there really is no point in speculating as to what's normal regarding ep. nothing's normal. some things are just more common, that's all.

good that you're on the alert for any change, MM, i bet you're right about the doc today. the ept site is great, it's a total lifesaver for a lot of people.

Spotting can be really normal as the embryo is implanting and burrowing in. Cramping is also really normal as your uterus is getting used to having something in it. hCG levels really vary woman to woman, and as long as you're not experiencing heavy bleeding and really painful cramping, you should be fine. If they are going to do your bloods again, I would ask them to check your progesterone. Often times low levels are the culprit for cramping and spotting as the pregnancy progresses.

I know it sounds a bit patronizing, but really try to not get stressed out, it can make things much harder to deal with.

Fingers crossed for you, monkeymoma. Sending healthy pregnancy vibes your way!

don't 'oh god, honestly' me aitch - a lot of us have been through ectopic here and I know as well as anyone that it usually doesn't present in a standard way - but all the same, if you look at the advice on the EPU site and message boards, then the inimitable Izzy (who has adviced many 1000s of women with ectopics) will also tell you that pain is unusual at 4 weeks for an ectopic. That is what she told me, anyway.

If you are seriously worried monkeymoma then obviously go to a&e - as aitch points out, ectopic is sneaky in lots of ways - BUT all the same don't lose sight of all the other much more likely possibilities for what this might be.

every time i've said it could be absolutely fine, and pointed out that my 'classic' ectopic symptoms actually turned out to be DD1, but there is just no point in saying that x or y is unusual to someone who may not actually 'get' how serious this could be.
this isn't the ept website, where people go when they've had or might be having an ep, this is mn, there are heaps of lurkers who pick up info that they might need to use later on, so we need to be careful about what we say is usual or unusual, especially as we are aware how sneaky eps can be.
you can already see on this thread that people have picked up erroneous info and are advising MM wrongly. and as for the doctors...
have buzzed izzie on FB, anyway, am curious to know how rare it is to have pain so early, as i most definitely did and they weren't CL cysts. perhaps there is a difference between comforting someone who you know is already seeking treatment, and quoting proper stats.

Hi monkeymoma, I hope everything has been ok for you today. It sounds as though your immediate symptoms had abated by yesterday. I just wanted to say please please do get to the doctors tomorrow and ask for the serial blood tests.

I know bleeding and some pain is common in early pregnancy. Unfortunately this led to my GP not even considering an ectopic. As your GP was concerned last week, and you have had bleeding and pain, I think it's best to rule out any possibility of an ectopic.

Think of it as just being on the safe side. I really hope you come back this week and say everything was fine with your tests!

Name change fail... I was Charliechoc!

hi, I will phone my GP tomorrow x

I know nothing about ectopics, but do have experience with low HCG. A Dr can not possibley say if you are having a miscarriage from one HCG reading - you have to be abe to compare it withanother reading.

I know this because I am now 26 weeks pregnant witha pregnancy, and my hcg started off lower than yours. At 4+4 my hcg was 58. 2 days later it was 85. 2 days later it was 156. So mine was low and didn't double. Not once did the Dr say I was going to miscarry. And it doesn't have to double every day - as long as it increases by 60% or more than that is Ok apparantly. I was concerened this was another MC as I already had 3.

Some pregnancies are just slow starters :) Good luck xx

Do, Monkey.

Sorry, when I said private scan I meant could you get bloods done privately. Or could you even try a different EPU (I'm on London and several of the big hospitals have them).

But call your GP and see the lay of the land tomorrow. Hope you're managing to get some rest.xx

I have an update

at 6am this am my CBD was still 2-3, just now it's 3+
(last tues morning it was 1-2, last wed afternoon after I left hospital it went up to 2-3) - (CBDs tell you weeks since conception not weeks pg so add 2!)
Based on OV I should be between 4+4 and 4+6 today (by LMP I'm 5+6)

I know it's not the same as blood tests, but it does seem to be showing that my levels are doing what I think they should be doing roughly by MY dates

and from what I understand about ectopics (please DO correct me if I'm wrong about this!), in ectopics the levels rise but not as fast, so by that rationalle if it was an ectopic I probably wouldn't be "graduating" on CBDs on time every week?

anyway I do have an appointment with my GP tomorrow morning, but I'm feel pretty positive!

thanks for sharing your results batteryhen!

sastra, when my GP originally referred me to womens health he first tried the other EPU nearby but they refused me and said I had to go to my nearest one so unfortunately I don't think I can choose my EPU, they're all referral based.