hCG rising but not doubling. Miscarriage risk?

[gentlemangamer]

Hi all. Just got back from a GP visit and would like to hear your thoughts on a potential miscarriage. Here’s the chronology of events so far:

6 April (6w0d LMD) - Noticed some pinkish discharge. First GP visit to confirm pregnancy. First bloodwork scheduled in two days.

8 April (6w2d LMD) - Went to the emergency department of a hospital specialising in pregnancy complications due to bloody discharge with a pea-sized clot. Did a transabdominal ultrasound and found gestational sac on one side of the uterus and bleeding on the other side. Bleeding subsided later that day and brownish discharged continued to reduce over two days. First hCG bloodwork done - 23,518 IU/L. Emergency ward doctor and two senior doctors mentioned that hCG looks to be in range and ordered a transvaginal ultrasound for 15 April.

10 April (6w4d LMD) - Second hCG bloodwork done - 34,734 IU/L

12 April (6w6d LMD) - Follow-up visit with GP where she mentioned that hCG levels are too low and not increasing fast enough. Coupled with the earlier bloody discharge, she was confident that it’s the start of a miscarriage, and the ultrasound on 15 April should confirm this.

Now, I find it odd that she mentioned my hCG levels were too low. I noticed that she ticked the “6 week” line item under “Weeks after Fertilisation” column in the bloodwork results. After doing a bit of research I believe she shouldn’t refer to 6 weeks as the first results were taken 6w2d after my last menstrual date?

Also, my hCG levels not doubling within 48 hours is also a concern, but from what I’ve read, my hCG increase should be normal based on my hCG levels?

6w2d LMP HCG IU/L 23518

6w4d LMP HCG IU/L 34723

2 Day change = 47.6 % increase.

Doubling time =3.6 days or 85.39 hours

My GP doesn’t specialise in antenatal care and while she said my hCG is low and I should expect a miscarriage at this stage, the doctors at the hospital (renowned in our state for handling pregnancy complications) said the first result is within range (NOTE: they only saw the first results, not the second) and I shouldn’t worry until I get a transvaginal ultrasound done at 7 weeks or if I have heavy blood flow that soaks through a pad in an hour.

Is this pretty much the start of a miscarriage? Or am I in denial?

 

[naturalism]

@gentlemangamer I’m not a Dr, but HCG stops doubling at about 6000 and seems on track because you want a 96 hr rise. At this point, HCG levels are less useful instead of scans. It is too early for transabdonimal ultra sounds and should be transvaginal. What will be more indicative is if there is anything in the sack. The blood could be from SCH. Of course, be guarded, but I wouldn’t panic until you get the transvaginal scan se the drs look for heart rate. Then it’s definitive:

 

[josephjurg]

@gentlemangamer Youre too far along to worry about doubling times.

 

[singleloser50]

@gentlemangamer After 6000 it can take 96+ hours to double. Betas really aren’t useful at this point unless they’re watching to see if they drop. I wouldn’t stress about these numbers - they look good imo! I hope your ultrasound goes well

 

[inquirer17]

@gentlemangamer At this point betas can’t tell you much and you should have an ultrasound to know what’s happening.

I had spotting and bleeding from 6w-13w with my LC and with my current pregnancy (almost 16w now). Oddly, they both started at exactly the same GA (6w3d) and both ended almost right around 13w.

GP’s have no idea what is going on when it comes to HCG or early pregnancy. I went to the ER at 9w in my current pregnancy because of bleeding and they took my HCG levels (pointless, which I knew…) and the ER doctor (who is a GP) said my levels were low at 164,000. I knew enough to know he was bonkers. And I have no idea what chart he was looking at because if you look online that is by no means low and even the auto chart that showed in my portal had it right in range. I asked for an ultrasound and baby was of course on track with a great HB. Every test I’ve had has come back good, genetic testing, growth, etc is all on track.

My OB never could find a source of the spotting/bleeding. She said it just happens.

This is my 5th pregnancy with 3 losses. I will say the major difference in the spotting/bleeding between my healthy pregnancies and my losses is that with my losses, once it started it just got heavier and heavier until I was actively passing the gestational sac. With 1 loss, it was actually the only pregnancy where I had NO spotting at all and had to be medically managed. With my healthy pregnancies, I would have some spotting/bleeding but not enough to soak a pad and then it would stop and turn brown. It never progressed and would be off/on here and there once or twice a week.

It sounds like from your first ultrasound you had an SCH and you were just passing that. I wouldn’t be too worried yet, and especially not about your HCG.