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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Elevated HCG Levels With Absent Gestational Sac On Pregnancy Scan?

Hi, may I answer your health queries right now ? Please type yAround 3 weeks ago, I had a positive pregnancy test on a Saturday, Sept 11th. Went to the doctor that Monday...they did a Serum HCG and it came back negative, but took another home test and it still showed positive. Monday night I started cramping and bleeding bright red blood....went to ED on Tuesday Sept 14th to be positive that I was miscarring bc I had positive test and negative Hcg serum, my levels at the ED were at a 7 for Hcg. Bleeding stopped Tuesday...was asked to repeat Beta Hcg on Tuesday. I was curious so over the weekend took another test...still showed positive?? Had my labs done Tuesday Sept 21st and they increased from 7 to 101. Set up gyn appt. and went for my appt Sept 29th, they did a ultrasound and no gestational sac or signs of pregnancy are apparent. I still have the symtoms of tiredness, frequent urination, metal mouth, and increased appetite. They said maybe i miscarried three Tuesdays ago at the ed or maybe im early in pregnancy and couldnt see it being my levels were so low. Repeated Hcg Sept 29 and and levels increased again to 204. What im confused about is why would my Beta Hcg go from 7-101-204 in a 3 week toime span if nothing is there? Im confused...any answers??our query here...
Mon, 11 Apr 2016
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OBGYN, Maternal and Fetal Medicine,  's  Response
Interesting case. Not a frequent one too. In short, pregnancy test is positive but since levels of BHCG are below the discriminatory levels nothing is seen at the Transvaginal (endocavitary) scan. You need about 2000 mIU/dL BHCG for a pregnancy to be seen in a high resolution scan. You have a condition called PUL (Pregnancy of Unknown Location) and serial measurements of BHCG can lead to the right diagnosis, options are: in this order of frequency
1.- Normal intrauterine pregnancy (IUP), 75%
2.- Miscarriage (spontaneous abortion, SA), 25%
3.- Ectopic pregnancy (EP), 1%

Since BHCG duplicate its levels every 72 hs and considering 7 as the initial level by sept 29th your BHCG levels should have been about 400-500, this means that:
1.- no normal duplication pattern is seen, pregnancy might not be right and there might a miscarriage or an ectopic pregnacy
2.- discriminatory levels are not met and that explains why a gestacional sac GS is not seen
3.- there is still the posiibility of a normal pregnancy

What would I do? Wait, repeat BHCG in about a week and perform another scan with the new results

Levels fall, no GS on scan: miscarriage
Levels rise, duplicate and GS seen: IUP
Levels rise but do not duplicate or reach about 2000, no GS is seen: considering EP and new levels are measured and scan performed about a week later

if more than 2000 units are measured and no sac is seen, I would consider / perform a laparoscopy


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What Causes Elevated HCG Levels With Absent Gestational Sac On Pregnancy Scan?

Interesting case. Not a frequent one too. In short, pregnancy test is positive but since levels of BHCG are below the discriminatory levels nothing is seen at the Transvaginal (endocavitary) scan. You need about 2000 mIU/dL BHCG for a pregnancy to be seen in a high resolution scan. You have a condition called PUL (Pregnancy of Unknown Location) and serial measurements of BHCG can lead to the right diagnosis, options are: in this order of frequency 1.- Normal intrauterine pregnancy (IUP), 75% 2.- Miscarriage (spontaneous abortion, SA), 25% 3.- Ectopic pregnancy (EP), 1% Since BHCG duplicate its levels every 72 hs and considering 7 as the initial level by sept 29th your BHCG levels should have been about 400-500, this means that: 1.- no normal duplication pattern is seen, pregnancy might not be right and there might a miscarriage or an ectopic pregnacy 2.- discriminatory levels are not met and that explains why a gestacional sac GS is not seen 3.- there is still the posiibility of a normal pregnancy What would I do? Wait, repeat BHCG in about a week and perform another scan with the new results Levels fall, no GS on scan: miscarriage Levels rise, duplicate and GS seen: IUP Levels rise but do not duplicate or reach about 2000, no GS is seen: considering EP and new levels are measured and scan performed about a week later if more than 2000 units are measured and no sac is seen, I would consider / perform a laparoscopy