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Pregnant. Started spotting with cramps. Feeling nausea, bloated and tired. Am I miscarrying?

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Practicing since : 1999
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Hi, I found out I was pregnant on the 18th of February, however, one week later I started to spot and went to the hospital. My blood results came back at 49! And I was told it was probably a miscarriage. I went back two days later and my levels were around 100. I had a scan it showed nothing. Two days after I had another and it was 89. Then went back up to 94. Then another two days it was 76, repeat bloods two days after showed 47 and so on. Around 3 weeks ago my levels had dropped to 7 and I was discharged, but a week later I was asked to do another preg test and it came back positive so they did more bloods and it came back at 18 which was 11 days ago now. But on Friday I began bleeding with cramping and some clots, but it has now stopped and today I am still getting positive pregnancy tests. I'm due to return for more bloods this week, but why would my levels go back up after reaching 7? Please can you help give me some insight into what's going on with my body. My boobs are very sore and I'm very bloated, as well as tired and nauseated which had gone a few weeks ago but now returned when my levels XXXXXXX again. Could I be pregnant again? Or is my body still miscarrying? Is it normal to take this long? Thanks. XXXXXX
Posted Sun, 28 Apr 2013 in Pregnancy
Answered by Dr. Timothy Raichle 1 hour later
Hello, I would be happy to help you with your question:

First answer the following questions:
1. Do you have any pain?
2. Were your cycles regular leading up to this pregnancy?
3. Is this your first pregnancy?
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Follow-up: Pregnant. Started spotting with cramps. Feeling nausea, bloated and tired. Am I miscarrying? 2 minutes later

No I don't have any pain as such, just a bloated feeling and a little bit of cramping/pressure (if that makes sense).

Yes my cycles were regular (between 28 and 32 days) normally around 29 I think though.

And I have a son who is 4 in three weeks
Answered by Dr. Timothy Raichle 3 minutes later
I am sorry, one last question - what was the first day of your last period?
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Follow-up: Pregnant. Started spotting with cramps. Feeling nausea, bloated and tired. Am I miscarrying? 3 minutes later
My last period was 20th January, then the bleed around the 28th feb about a week after I got a positive pregnancy test which I was told was a miscarriage due to hcg levels falling, then my bleed which started on Friday afternoon, but my hcg was 18 11 days ago, a week after it had fallen to 7
Answered by Dr. Timothy Raichle 7 minutes later
XXXXXXX thank you for the information. Just to summarize:
1. Your last period began on 1/20th
2. This would have made you about 4 weeks along on 2/18
3. You started spotting on about 2/25
4. An HCG then was 49, increased to 100 after 48 hours
5. The HCG level then did the following: 89, 94, 76, 47, 7, 18

In all pregnancies where there is bleeding, the possibilites include:
1. Normal implantation bleeding
2. A miscarriage
3. An ectopic pregnancy (a pregnancy in the tube)

This is NOT a normal pregnancy and either represents #2 or #3. If it were a miscarriage, the blood levels would have steadily gone down, and by now, a pregnancy test should be negative. This leave #3. Ectopic behave just like your pregnancy is behaving - irregular bleeding and HCG levels that can be confusing. This needs to be sorted out immediately and should involve all of the following:
1. A repeat HCG level now
2. A D&C to make sure there is no pregnancy left in the uterus
3. If the D&C does not show any pregnancy tissue, AND the HCG level does not return to zero, then you need to discuss use of a medication called methotrexate with your doctor.

This all needs to happen as soon as possible. Please ask if you have followup questions.
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Follow-up: Pregnant. Started spotting with cramps. Feeling nausea, bloated and tired. Am I miscarrying? 3 minutes later
Hi thanks for this, I am going back tomorrow for another blood test. Is there no way this could be a new pregnancy that's why my levels are rising again?

It was three weeks ago nearly that the levels dropped to 7, then they XXXXXXX to 18 11 days ago. I have had scans that show nothing in my tubes and nothing in my uterus but that was 3 and a half weeks ago.

Answered by Dr. Timothy Raichle 2 hours later
Hello, thank you for the followup.

It is incredibly unlikely that this is a new pregnancy, but given the timing that you mention, I guess that it is possible. When they check the HCG levels, if they are rising they will need to entertain this possibility if they are rising appropriately for a normal pregnancy. But in reality, I do not believe that this is likely based on your story. Certainly, it is confusing. I am left, though, with prior HCG levels that absolutely were not behaving normally, even for a miscarriage.

With regard to the scan (which was done at an HCG level of 100) even in a normal pregnancy you would see absolutely nothing - the scan is too early to detect anything!

I hope this helps and good luck tomorrow!

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