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Suggest ways to manage pregnancy after a miscarriage

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Posted on Thu, 14 May 2015
Question: This is my second pregnancy and very concerned about miscarriage I had a m/c last year at 8 weeks. This pregnancy started off normal had some mild cramping but no bleeding my HCG numbers doubled on the first test the HCG test was drawn on March 30th and was 1954 so I was about three weeks (had IUI done March 13th 2015) Progesterone was normal at 18.5 then second HCG level was done around 7 days later and was 8,348 and was a slow rise had normal ultrasound at 5.3 weeks fetal pole/sac was noted the Dr. mentioned I may have had two eggs fertilized and the other one is abnormal or could be an area of bleeding then 4 days another HCG level was drawn at 6weeks and increased only to 11,598 again rising but not doubling was worried went in for ultrasound it was normal with a heartbeat had last HCG Drawn at the beginning on my 7th week and was 15,689 again steady rise but not doubling my progesterone was drawn at my request and was 8.3 however my doctor is not concerned because it can fluctuate. I had an ultrasound done at 7.3 weeks and had a normal scan with a very healthy looking yok sac and heartbeat of 140. I have a follow up in two weeks then if everything is ok he will discharge me to a regular OB. Have you experienced this with other patients non doubling HCG levels and normal pregnancy outcomes? Should I see a high risk OB or other specialist because of my advanced maternal age and the testing that I will need. Is my miscarriage chance lower now that I have had normal ultrasounds? See medical history below Other then what is listed I am an active and healthy.
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Answered by Dr. Ivo Ditah (50 minutes later)
Brief Answer:
As of now, there are no reasons to suspect a miscarriage!

Detailed Answer:
Hi and thank you so much for this query.

I am so sorry to hear about the previous miscarriage you had. I have reviewed your information fully and this is very consistent with the normal findings of a pregnancy. In the early days, HCG doubles but not that this would continue to double all the times. The values are in the normal range and increasing which are suggestive of a normal and growing pregnancy. All these findings with normal ultrasound and hormonal levels are very reassuring and raise no suspicion for a possible miscarriage at this time or any time soon.

Given your age, it would be best to see an OBGYN all through and be followed in a high risk clinic. You would need special testing for diseases that are common with pregnancy in later years of life. Also, the risk of having pregnancy related complications is high and would be best that you are followed by an OBGYN in a high risk pregnancy clinic.

In all, your findings so far are reassuring and raise no suspicion about possible complications or miscarriage at this time. Continue with a specialist in a high risk clinic and benefit from intensive monitoring and testing for diseases related to pregnancy in later ages.

I hope this helps. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Ivo Ditah (41 minutes later)
since my progesterone changed from 18.5 to 8.3 in the 7th week Dr was to concerned because levels can drop during this week but stated I can supplement if it would make me feel better called in Prometrium 200 mg at bedtime would it be advised to supplement since levels should be above 10 or let it raise on its own and get retested
doctor
Answered by Dr. Ivo Ditah (10 minutes later)
Brief Answer:
Because of your age, we better be safe than sorry!

Detailed Answer:
Hi,

Because recommended levels are above 10, I would advice that we continue to the supplementation. Higher levels do not harm the body and I would rather want to play safe than tell you am sorry. Also, you had a bad experience with the previous miscarriage and no one should take the risk of maybe having to deal with that again.

These are my thoughts and I believe they are very much in line with what your doctor is doing and probably what you would also advocate for.

I wish you well. I wish you a safe pregnancy. If need be, am always at your disposal for assistance.
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3992 Questions

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Suggest ways to manage pregnancy after a miscarriage

Brief Answer: As of now, there are no reasons to suspect a miscarriage! Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about the previous miscarriage you had. I have reviewed your information fully and this is very consistent with the normal findings of a pregnancy. In the early days, HCG doubles but not that this would continue to double all the times. The values are in the normal range and increasing which are suggestive of a normal and growing pregnancy. All these findings with normal ultrasound and hormonal levels are very reassuring and raise no suspicion for a possible miscarriage at this time or any time soon. Given your age, it would be best to see an OBGYN all through and be followed in a high risk clinic. You would need special testing for diseases that are common with pregnancy in later years of life. Also, the risk of having pregnancy related complications is high and would be best that you are followed by an OBGYN in a high risk pregnancy clinic. In all, your findings so far are reassuring and raise no suspicion about possible complications or miscarriage at this time. Continue with a specialist in a high risk clinic and benefit from intensive monitoring and testing for diseases related to pregnancy in later ages. I hope this helps. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.