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Pregnant. Noticed brown discharge. Ultrasound showed no heartbeat. Blood test indicated miscarriage. Should I go for D&C?

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Went to emergency last week due to brown discharge. Underwent trans vaginal ultra sound and they found no heartbeat. Also had blood test and it also indicated miscarriage. My nurse practitioner called and told me to wait for everything to come out. I am concerned because I don't have any pain and the brown discharge is on and off. When I have had a discharge it is only a small amount. Do I continue to wait or do I need to request a D & C or medicine from my NP? I am concerned about blood clots or infection because I am having on and off discharge and there has been no cramping indicating that something is coming. I do have some pain in the area of my diaphragm.
Posted Sat, 3 Aug 2013 in Pregnancy
Answered by Dr. Timothy Raichle 22 minutes later
Hello, I would be happy to help you with your question.

Did they do an HCG test?
If so, do you know the number / level?
Did they see ANYTHING on the ultrasound such as a sac in the uterus?

Let me know and I will help you!
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Follow-up: Pregnant. Noticed brown discharge. Ultrasound showed no heartbeat. Blood test indicated miscarriage. Should I go for D&C? 47 minutes later
Yes, they did an HCG twice. I can't remember the number but it was very low, that was why they concluded a miscarriage. They did see a sac in the uterus with no heartbeat and it was very small. So the doctor said to have a follow-up ultra sound on Wednesday. On Monday I went to emerg they did blood test and trans-vaginal ultra sound that indicated miscarriage. I went for follow-up blood test on Thursday and the HCG was very low. At this time I have only a slight brownish discharge and no pain.
Answered by Dr. Timothy Raichle 37 minutes later
Thank you for the followup.

I always hate when Practitioners make assumptions. Your NP has assumed that this is a miscarriage (which it probably is) but there was no consideration of other things like an ectopic pregnancy.

An ectopic is a pregnancy that does not implant in the tube. Usually the HCG levels are lower than expected, and sometimes there is a "fake sac" in the uterus, called a pseudogestational sac. In light of the fact that your body is NOT behaving like a miscarriage AND you are now having other abdominal complaints (upper abdominal pain), then the following MUST happen as soon as possible:
1. You need a visit with an OB/GYN (if you cannot get this today then you should probably go to an ER)
2. You need a repeat HCG level now AND an ultrasound to see if there is any 'free fluid' in the abdomen which might indicate either a ruptured ovarian cyst OR an ectopic pregnancy

Do not take your NP's word for it that this is just a miscarriage. It would have been much more appropriate for her to refer you to an OB/GYN at the point that she made this call. And yes, you need a D&C. If there is no pregnancy tissue in the D&C specimen, then you are very likely dealing with an ectopic pregnancy.

I wish you the best of luck!
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