hcg levels

Q: My hCG levels jumped from 720 to 20000, Could I be having twins?

Original question:

My hCG levels were at 720 at four weeks and 5 days. They took my blood two days later and my levels had jumped up to 20,000. Could I be having twins?

Answer:

I would tell you, yes you’re pregnant with twins but the doubling is not logical, hCG can be increased two times within 48 hours, but your beta hCG levels double too many times within 48 hours which leads to suspicion in the accuracy of both hCG tests.

Recommendation:

Please repeat the beta-subunit test again two consecutive times in a well-respected medical laboratory.

After that, you can compare your beta-hCG level with those expected with twins pregnancy in the bHCG level for twins chart

meaning of hcg

Is BHCG less than 5.0 considered a Positive or a Negative Pregnancy Test Result?

Many women sent such results to the Facebook page’s inbox, like this

The medial laboratory interpret the BHCG levels like that:

  1. Beta hCG < 5.0 mIU/mL, any hCG number less than 5 means that there is no pregnancy yet or that the pregnancy is still very early and at its first beginning, and therefore the level of the pregnancy hormone appears very little to a degree less than 5.
  2. Beta sub-unit from 6 up to 24, an hCG number in this range means that pregnancy is at its beginning and that the pregnancy hormone still needs more time to increase and rise, so we have to repeat the B-hCG blood test again after at least 48 hours to make sure that the pregnancy hormone increases as time passes. Also after re-doing the quantitative hCG test, if the hormone level increases, then this is a good sign of the continuation of the pregnancy, but it cannot be considered evidence of the viability of the pregnancy. Know why. But if the pregnancy hormone level has stopped increasing to a remarkable number or becomes less than the result of the previous test, then this is a very important sign of the end of pregnancy and the loss of the fetus in the very early stage.
  3. If Quantitative hCG test result >25, <100, any hCG number equal to or greater than 25 is considered a pregnancy from the first test, but this hCG number must double every 48 hours, and that the menstrual cycle must be delayed by a day or two at the most so that the result can be interpreted as a pregnancy at an early beginning. Practically we find most hCG readings between 25 and 100 in the first days after delayed menses often go down which leads to pregnancy loss, so that your doctor may prescribe progesterone supplements to increase the hCG level in the pregnant’s blood and to help maintain a healthy pregnancy.

Conclusion:

B-hCG < 5.0 usually means negative pregnancy test, but if the date of menses is still early, the hCG lower than 5 may mean a very early pregnancy, that’s because the hCG hormone can be detected 6 days earlier before the due date, and therefore you must repeat hCG test after the menstrual cycle is late than the usual date every month, and this repetition is to make sure that HCG 5 increases and that it was due to very early pregnancy.

Also, hcg <5 can be seen if the woman is in premenopausal (before girl puberty) or postmenopausal stage (usually after age 50 of women there’s no menstruation), it means the girls before menopause may normally show b-hcg number lower than 5, and women stopped their menstruation can still naturally see hCG number lower than 10 without pregnancy or any disease.

Note that some tumors can see slowly increasing hCG levels, but this is another article, be tuned.

10 Blighted Ovum HCG Levels Must Know

Blighted ovum HCG levels with doubling time and rising levels of the pregnancy hormone.

From real case’s complications:

  • A woman done her first pregnancy test and show a faint line which means weak positive pregnancy.
  • After a week, cramps and slight bleeding.
  • In the emergency ward at the local hospital, the Gynecologist done an internal ulstrasound and can’t see any sac.
  • She told the doctor that she’s in the week 6 and 3 days.
  • At the clinic one day later, the Gunecologist repeated the ultrasound scanning with transvaginal probe and found a little white speck in the sac.
  • Tomorrow at laboratory: take a quantitative beta subunit HCG blood test and the results show rising HCG levels at 5 weeks and 5 days post LMP.

The woman told me that she was worried and confused about the conflicts of BHCG levels and ultrasound.
The first doctor recommended methotrexate upon diagnosis as ectopic pregnancy but the second doubling HCG blood test with white dot sac suggests a blighted ovum which require a dilation and curettage procedure.
What’s the opinion of medical science?

What blighted ovum is?

A blighted ovum is an early pregnancy failure after the fertilized ovum attached to the uterine but failed to develop an embryo even after 14 week LMP. That’s why I have blighted ovum pregnancy?

When blighted ovum is occurred during the pregnancy?

A blighted ovum occurs during the early pregnancy term (the first trimester), may be the woman didn’t know that she’s pregnant yet.

Do HCG levels double with blighted ovum?

Blighted ovum HCG levels still rise and high but not doubling enough as in normal pregnancy, blighted ovum symptoms is the same with normal pregnancy. lack of symptoms of blighted ovum is common.
From a real blood work for a pregnant women:

At 5 weeks

HCG level 680, after 48 hour HCG level 1800, no sac on ultrasound, no bleeding and no cramps.
Had a blighted ovum?
Answer: The case is for a normal pregnancy till now and the time scale can’t tell the right expectation, the advice is to wait until the week 8 at least.
Full: HCG level chart

At 20 weeks:

blighted ovum HCG levels
Ultrasound noticed one inch empty sac, still feel pregnant even blood pregnancy test is negative and urine pregnancy test is negative too.
Felt a baby in my belly, discharges from my breast when squeezed.

Can be a blighted ovum even after 12 weeks?

The Answer: A small sac with nothing in it and HCG level below 5 units after 5 weeks must refer to a blighted ovum. You had missed miscarriage. Get the Ob/Gyn advice for natural miscarriage or by D&C operation.
 blighted ovum hcg levels ultrasound

What to do for blighted ovum management?

If your body still acting as you’re pregnant, doctors would recommend to wait few days until the body passes this anembryonic (no embryo) pregnancy naturally.
And can conceive as close as the next week, as the period is due within a month and HCG levels can back after nearly two weeks.
If you’ve blighted ovum conception your doctor will have two options, the pills or surgery.
You shouldn’t be scary of D & C, it’s for your safety. The sac would expel by it’s own but remnants in the uterine may cause infection, so that the D & C would be beneficial to avoid complications.
But woman must wait three consecutive cycles before trying to conceive again, the reason is to allow the uterine lining to rebuilt itself in the way to sustain another pregnancy.

What to do with blighted ovum hcg levels and ultrasound?

Blighted ovum is difficult to see on ultrasound until the week 10 LMP.
Blighted ovum HCG levels 5 weeks LMP is within expected levels for normal pregnancy.
Even with no embryo inside the sac the placenta and corpus luteum continue to produce pregnancy hormone at early pregnancy.
At week 4 and 5 a yolk sac and fetal pole but no heartbeat, heart beat is the baby’s life determining factor inside you.
You would find heart beat after week 11, and only babies with heart beat deemed live.
See: HCG level ultrasound and heart beat chart

What to do for blighted ovum with HCG levels rising?

Most woman scarred after week 9 with no bleeding or pregnancy, so please understand first.
If you have or expect a blighted ovum just relax and retest BHCG blood test and ultrasound until the week 12.
Confirm blighted ovum after week 14 with low HCG levels, no visible embryo sac, and no heart beat.
Never rely on the sac size small or big or how sac is measuring when it’s empty.

When do hcg levels drop with blighted ovum?

From 4 to 7 weeks and up to 12 weeks for some women after a successful m/c or d/c operation, beta subunit HCG test after d/c can predict the dropping rate of HCG levels after blighted ovum miscarriage.
Read: HCG levels after miscarriage
We’re welcome to explain your pregnancy blood test results.

High B-HCG Levels and No Image on Ultrasound, What to expect?

How to deal with the confusing problem of not seeing the baby on ultrasound while your hcg blood test say you’re pregnant, how to avoid delay diagnosis of baby? how to protect yourself from misdiagnosis at early pregnancy?
firstly, you must know why pregnant do sono early?
The purpose of the scan is:

  • to confirm that there is a heartbeat
  • to assess the baby’s size and growth
  • to estimate the delivery date and
  • to check whether there is one baby, or twins or more.

What is the best routine ultrasound scan of pregnancy?
There are two ways of doing an ultrasound scan for pregnancy:

  1. Trans-vaginal (internal) scan: where a probe is safely placed in the vagina, accurate and clearer early picture. useful before 11 weeks for earlier detection, and after 12 weeks if a trans-abdominal scan doesn’t give a clear enough sono picture.
  2. Trans-abdominal scan: useful from 11-12 weeks and at the routine booking-in scan, at early pregnancy it’s less clear than an internal scan and that could delay diagnosis. the woman doing the scan spreads a special gel on the lower abdomen specifically below your belly button and above the line of pubic hair, the doctor then moves the scanner over the gel, sometimes pressing down, until the womb (uterus) and pregnancy can be seen.

Is ultrasound scan do work to detect pregnancy without the hcg blood test?
No, both are used to detect and confirm the progress of pregnancy, although the hcg test results may come up with the earlier sign of pregnancy as closer as 7 days after ovulation and successive implantation which is much more than ultrasound scan do, at 6 weeks of gestation hcg level is well detectable but sonogram is a bit unclear until the week 8, however hcg results only can’t confirm a viable pregnancy until a sac and heartbeat can be clearly detected on the sonar screen.
what to expect from the heartbeat results?
As long as there is a heartbeat, the risk of miscarriage decreases as the gestational weeks go by.
You will asked to repeat the scan and beta subunit hcg if:

  • There’s a heartbeat, but I’m still bleeding? Then check your beta subunit hormone, FSH, LH, E2, and Prog. levels and repeat ultrasound after few days, if ok, then progesterone medication may be suitable.
  • if the pregnancy is too small for the heartbeat to be visible, or there may be nothing much to see at all and it’s not clear what is happening, then retest and rescan after 1-2 weeks for the results to be clearer.high beta hcg levels ultrasound no image

7 weeks and no image on sono, no heartbeat, no sac, low hcg levels, what to expect?
Your doctor thinks you might have an ectopic pregnancy or silent miscarriage, take blood tests and/or a laparoscopy.
Remember that: An ectopic pregnancy is a medical term for a pregnancy that is developing outside the uterus, usually develop in one of the Fallopian tubes or inside the abdomen.
Hydatidiform Mole/molar pregnancy: where the cells of the placenta grow very quickly while the baby can’t develop. difficult to be diagnosed on scan so you might find out only after the miscarriage.
let us take this pregnancy quiz to discover why pregnancy hormone is normal but the baby not showing in Ultrasound scan?
Suggested causes and solutions:

  • Recalculate your ovulation days and gestational age.
  • Repeat HCG blood test after a week and rescan ultrasound, have you got a strong baby heartbeat and a sac on the monitor? have your bhcg count raised?
  • In the early pregnancy at 6 weeks gestation, the developing embryo show on monitor is very small because the baby is only 5-9mm long or may be smaller in many cases,  to get a better image of the baby on sonar at early pregnancy ask your doctor to use transvaginal ultrasound, Asking your doctor to scan your vagnia with vaginal probe to see any smaller mass is not difficult and not hurting, nevertheless, is more accurate to detect the baby than the abdominal probe.
  • Sudden unplanned miscarriage may be suspected if you had bleeding, the best indicator of abortion is the vaginal bleeding not spotting, although ultrasound scan may show dies baby some weeks earlier than visual bleeding and any pain. The medical term for this is “missed” or “delayed” miscarriage. This can come as a considerable shock and need a difficult medical decision by your doctor.
  • If dates are correct and no bleeding then check if there is irregular past periods or interrupted menstrual period due to hormonal imbalance, take blood tests for progesterone, LH, FSH, TSH and E2, if all are within expected ranges then it’s ok.

Examples:

  1. hcg levels 1600 and no image on sono? if HCG hormone count is normal, no bleeding from vagina, but still no heart beat or image seen on ultrasound, you may be diagnosed earlier or you have abnormal pregnancy, waiting 10 days on average is the ideal solution.
  2. Bhcg levels 15000 and no image on sono? it is a risk of ectopic pregnancy, use vaginal ultrasound and retest the beta hcg.

The hcg levels chart for viable pregnancy at 6 weeks from LMP (gestational age) :

  • 3 weeks LMP: 5 – 50 mIU/ml.
  • 4 weeks LMP: 5 – 426 mIU/ml.
  • 5 weeks LMP: 18 – 7,340 mIU/ml.
  • 6 weeks LMP: 1,080 – 56,500 mIU/ml.
  • 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml.
  • 9 – 12 weeks LMP: 25,700 – 288,000 mIU/ml.
  • 13 – 16 weeks LMP: 13,300 – 254,000 mIU/ml.

Read the full interpretation of: hcg chart, hcg for twins, and am I pregnant or late period?

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