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Pregnant. Started spotting and feeling constipated. Am I miscarrying. What else could it be?

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Hi. I am (or was) just shy of 5 weeks pregnant. I ovulated on XXXXXXX 24th. I had an IUI with monitoring so I am sure of the date. I had a positive pregnancy test on 7/9 (14 DPO) and a blood confirmed with a low HCG of 15.7. I had HCG tested again on 7/11 and it was 39.8. I had a third HCG test on 7/13 and it was 79. I've also been on 100 mg progesterone suppositories 2x a day since a couple days after I ovulated. I have an appointment for an ultrasound this Thursday and we were not contemplating further blood tests since the numbers were doubling, although low. The hope was that the ultrasound would provide more insight.

I have had brown spotting every day since I got my positive pregnancy test. It's varied from very light spotting to medium spotting and at for a few days was more like a very light flow. It's very light brown with small flecks of tissue. A couple times when I've wiped there's been pink or a dark red/brown but never consistently. I've also had very mild cramping on and off the entire time which seems to get a little worse in the evenings (I do have a CL cyst on my right ovary but the cramping hasn't been confined to either side, sometimes on one side, sometimes on another, sometimes right below my belly button).

Today I've had cramps that I'd rate at a medium level - substantially lighter than cramps at the start of my period. I've also been a bit constipated today so presumed that was contributing. I tried to make a bowel movement this afternoon and was not able to move much but when I wiped there was a 3 to 4 inch white/red stained tissue about 1/4 -1/2 inch thick (from my vagina - not my rectum). There was about a teaspoon or two of dark brown/red blood that followed. Since then I've been back to light spotting. My abdomen has remained tender.

I will call my doctor tomorrow but am presuming this was a miscarriage. Is there anything else it could be?

Thanks very much.
Posted Sat, 4 Aug 2012 in Pregnancy
Answered by Dr. Timothy Raichle 53 minutes later

Hi, I would be happy to help you with your question.

First of all, I will offer you cautious congratulations on your pregnancy. While the numbers were perhaps lower than expected, you are right, they were doubling in an appropriate fashion.

In addition, you can have bleeding in early pregnancy that we sometimes attribute to "implantation" of the fetus. In your case, this could be normal, but it is perhaps a little more than I would expect.

So there are three possibilities for what is going on:

1. This is a normal pregnancy
2. This is a possible miscarriage
3. This is an ectopic pregnancy (a pregnancy that has implanted in the tube)

I do not want to alarm you about #3, but it should definitely be on your doctors mental radar. In most ectopics, the doubling is not normal and patients report daily bleeding like you are describing. They eventually have pain on the side that the ectopic has implanted. Given your lower than expected hCG levels, persistent bleeding and "tenderness", this is a real concern.

Reason to call you doctor now would include: persistent bleeding and pain that moves to one side or the other. Also, if you felt dizzy, light-headed, or had decreased urine output. It certainly would not be a bad idea to consider contacting your doctor or anyone who is on call for them tonight. The latest that you should followup with your doctor is tomorrow morning. You need to demand an hCG level and someone should perform an exam to see if you are tender on one side or the other.

I hope this helps - please let me know!
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