Rising hCG Despite No Fetal Pole On Ultrasound

QUESTION

Dear Midwife,
My LMP was 8-29-09. Date of conception ~ 09/15. Spotting and cramping yielded very early US on 10/05. Abnormal US "showing large subchorionic hematoma "probably abortion in progress, with no fetal pole." Quantitative Bhcg went from 15999 to 30000 in 48 hours (10/06-10/08). Saw OBGYN 10/12 w/repeat U/S.

Her thoughts were there is no hematoma, but that it is a collapsed second sac. No fetal pole or heartbeat seen in other sac. OB states 99% sure not a viable pregnancy. Had repeat bhcg same day, up to 60,000.

I do not understand why bhcg is still increasing. My final US scheduled for 10/20 to be 100%, D&C scheduled for 10/23. Please help me understand why hcg can still increase.

Thank You.

ANSWER

If there is not a viable pregnancy and the hcg's are rising rapidly, there is a small possibility that you have something called a molar pregnancy. The D&C will say for sure. But I'd agree, if you had a positive pregnancy test by 10/5 and still see no pole by 10/23, it is not a viable pregnancy.

I am so sorry.

-- Cynthia, CNM. PhD.

Cynthia Flynn

Cynthia Flynn, CNM. PhD, is the General Director of the Family Health and Birth Center which provides prenatal, birth, postnatal, gynecological and primary health care to underserved women and their families in Washington, D.C. Recently Cynthia served as Associate Professor of Nursing at Seattle University. There she not only taught, but remained in full scope clinical midwifery practice at Valley Medical Center where she cared for pregnant and birthing women, and practices well-woman gynecology, family planning, and treatment of sexually transmitted diseases.

Cynthia founded Columbia Women's Clinic and Birth Center, where she took care of pregnant women and infants up to two weeks of age and attended both birth center and hospital births. Before Cynthia earned her CNM, she worked as a registered nurse in labor and delivery and postpartum and is a certified Doula and Doula trainer.