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Consistent spotting, positive pregnancy test. Ultrasound did not show gestational sac instead detected cyst. Conception chances?

I have been spotting for 2 weeks. A couple days I was pretty crampy but now its gone. Last saturday I took a pregnancy test and it came out positive. I went to the er on Monday b/c I don t have insurance and wanted to check everything b/c of the continuous spotting. It showed a hcg level of 799 but the ultrasound showed no gestational sac . But they did find a napothian cyst and a hemmoragic cyst on my right ovary where some of my pains were. Do you think the cyst on my ovary could be the cause of the spotting and pains. I have still feelings of pregnancy. And this is unlike any of my other 4 miscarriages. I m praying this will pass and the pregnancy will continue okay!! erika
Asked On : Wed, 23 Jan 2013
Answers:  3 Views:  94
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General & Family Physician 's  Response
Dec 2012

Thank you for post on this forum

From your description there are a good number of possibilities for your condition. I'll list a few ( most probable for you and discuss them).
- Miscarriage
Your beta hCG levels are consistent with a pregnancy that is about 5 weeks from LMP. Bleeding during early pregnancy can come out as a miscarriage without you noticing any products of conception as they are still very very small. Reason why, ultrasound showed no pregnancy but increased beta HCG levels (positive test). Bleeding and cramping might continue for a couple of days to weeks if incomplete miscarriage. Your doctor would have to perform a D&C.
- Early less than 6 weeks pregnancy
It is possible for pregnancy less than 6 weeks from LMP not to be detected on ultrasound, hence you are having a normally evolving pregnancy with 1st trimester physiologic bleeding which has no immediate hard but can subsequently cause a harm if not managed properly. Hence meet your gynobs.
- Ruptured ectopic pregnancy
Here is another classic possibility. Ultrasound showing hemorrhagic cyst ( could still be a gestational sac) on the right ovaries. Ultrasonography is at times not very specific when it comes to certain presentations in the woman's pelvis. If that is the case, your gynobs would surely need to do a culdocentesis / paracentesis to determine if intraperitoneal bleeding. Emergency laparotomy will be done.
- Gestational trophoblastic disease
Such as molar pregnancy and choriocarcinoma are pregnancy related tumors. Normally might be missed on ultrasound. Your above presentation could be as a result of either one of the two. Beta hCG levels need to be monitored and abnormal increase will strongly demonstrate the presence of one of the gestational trophoblastic disease.
- Ovarian tumor
beta HCG levels usually increase when presenting with this plus the fact that an ovarian mass (in your case, a cyst). Your gynobs still have to review especially if your bleeding persist within a couple of days.
While they are a wide range of possibilities in regards to your presentation, the above are the most common conditions we could try to eliminate.

Hopefully this helps
Answered: Wed, 23 Jan 2013
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OBGYN Dr. Rishma Lakhani's  Response
Hi if you spotting since last 2 weeks,and ultrasound shows no gestational sac,it is less likely that you are pregnant,this is what we call a biochemical pregnancy,in which the pregnancy test comes positive but no gestational sac seen. Yes the hemotrhagic cyst could be the reason for your spotting and pain. You need to get yourself investigated as you have a history of four miscarriages,so kindly fix an appointment with your gynae
Answered: Wed, 23 Jan 2013
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OBGYN Dr. Nilofer AR's  Response
Thanks for the query.

Pregnancy test positive indicates you were pregnant. Cramps and spotting suggest you might be having miscarriage mostly complete one..

Napothian cyst and haemorrhagic cyst does not cause spotting.

Other possibility is you are in your early stage of pregnancy.

I recommend you to repeat your USG after 2 weeks to localize gestational size and to know if hemorrhagic cyst is resolving.

Dr Nilofer
Answered: Wed, 23 Jan 2013
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