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Pregnant. Started heavy bleeding with clots. Ultrasound done. Am I miscarrying?

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Practicing since : 1999
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At roughly 4wks+?days due to heavy bleeding with clots that lasted a few days. SCH was dx at that visit via ultrasoind also gestational sac was present and measured OK. Followed up a week later hcg was increasing sac plus yolk sac visible and measuring OK. One week later went again after another gush of bleeding that stopped immediately after it passed. Hcg has increased to 24,???. No other development inside sac but it has gotten bigger. OB said the sac has irregular shape and low hopes for viable pregnancy since nothing can be seen within the sac. Going for ultrasound in 5days. Doc hasn't drawn anymore blood for hcg levels. Is this hopeless or should I still have hope for viable pregnancy?
Posted Sat, 11 May 2013 in Women's Health
Answered by Dr. Timothy Raichle 24 minutes later
Hello, I would be happy to help you with your question.

I have a few questions:
1. What was the first day of your last period?
2. What are the dates and values of all of the HCG levels if you have them?
3. Did you have regular periods before the last one?

Please answer and I will help!
Above answer was peer-reviewed by
Follow-up: Pregnant. Started heavy bleeding with clots. Ultrasound done. Am I miscarrying? 13 minutes later
LAST PERIOD: 2/26/13
Not for sure on these levels but they are close: 8000,0000,0000
Periods were like clock work cycle from the start of one to start of the next is about 28 daysbt However right before conception they were a tad bit irregular. Not sure aboit my ovulation. I still feel pregnant with sore/swollen breasts, frequent urination, bloated, heartburn. No bleeding since the last gush that came and went pretty quickly. Concerned that OB isn't still tracking hcg. I feel like he's thrown in the towel because of the ultrasound results alone. Everything except for that seems like there could be hope.
Answered by Dr. Timothy Raichle 1 hour later
Thank you for the followup clarification. So what I am hearing I would summarize as follows:

1. You were seen at about 4 weeks with bleeding, and an ultrasound and HCG level were performed. The ultrasound showed bleeding around the sac and your HCG level = 8,000
2. One week later, you had a followup ultrasound that showed a sac, yolk sac, and an HCG of 13,000
3. One week later, you had another gush of blood, an ultrasound with an irregular sac (no fetus yet) and an HCG = 24,000
4. You are scheduled for a followup scan in 5 days

Here are some basic facts that I consider in all of these situations (these are generalizations):

1. Bleeding at about 4-6 weeks is common and associated with 'implantation'
2. HCG levels double early in the pregnancy, but this doubling starts to slow down as you approach 6 weeks
3. At an HCG level of ABOUT 10,000, which usually correlated with about 5-6 weeks, I expect that we might see a fetus and a heart beat
4. Certainly at an HCG level of 24,000, I would expect to see a fetus with a heartbeat.

So in terms of your situation, I am concerned about the following:
1. You have had multiple episodes of bleeding
2. There is no evidence of a fetus with an HCG of 24,000
3. The sac has developed an irregular shape.

While I would love to be able to give you more hope about the situation, I agree with your doctor that things are not going well. While it is not out of the realm of possibility to be wrong, these are probably the earliest signs of a miscarriage in your case. I agree, though, with the followup ultrasound as scheduled.

I am very sorry about your situation. I wish you the best. Please ask if you would like clarification!
Above answer was peer-reviewed by
Follow-up: Pregnant. Started heavy bleeding with clots. Ultrasound done. Am I miscarrying? 6 minutes later
Thanks so much for your input.
Answered by Dr. Timothy Raichle 8 minutes later
It is my pleasure. If there are future questions about this or other situations, please state "This is for Dr. Raichle".

Good luck to you and your partner.
Above answer was peer-reviewed by
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