Using hCG Levels to Identify Miscarriage

 

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With serial hCG measurements, quantitative hCG blood tests are drawn two to three days apart. This is because ordinarily, in early pregnancy, the hCG level in your blood doubles every two to three days. If your hCG doubling time is slower than expected, or if it decreases over time, this may be a sign of a miscarriage or an ectopic pregnancy. In the event of a miscarriage, hCG levels typically decrease from previous measurements.

For example, a baseline level of 120 mIU/mL that’s dropped to 80 mIU/mL two days later can indicate the. After a pregnancy loss, hCG levels will return to a non-pregnant range (less than 5 mIU/mL) between four and six weeks later. 5  However, the exact length of time it takes for your hCG levels to lower depends on a variety of factors, including how the loss occurred (spontaneous miscarriage or dilation & curettage) and how high your levels were when you miscarried. Miscarriage is a pregnancy loss before 20 weeks of gestation.

Low hCG levels can sometimes indicate that you have had or will have a miscarriage. Normal levels of hCG vary between women and the stage of pregnancy however so low levels of hCG are not always a sign of miscarriage. hCG levels at the moment of miscarriage may vary depending on how many weeks pregnant the woman was when she miscarried. For instance, hCG levels at week six—i.e. two weeks after the first missed period—range from 1.080 mUI/ml to 56.500 mUI/ml.

How Doctors Diagnose Miscarriage Quantitative hCG Blood Test. Human chorionic gonadotropin (HCG) is a hormone produced by the body during pregnancy. Ultrasound Scans. Ultrasound machines use sound waves to get a rough image of the fetus and gestational sac. Definition.

Early pregnancy loss is defined as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6/7 weeks of gestation 1.In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably, and there is no. HCG usually doubles after every 48-72 hours during early pregnancy and hCG tracking is generally done to detect if there is an issue. If they don’t increase or there is a sudden change, that is the bodies way of telling you that something is off with the pregnancy and most likely a miscarriage is about to occur. Once the gestational sac and baby have reached a significant size, ultrasound findings can definitively diagnose miscarriage. 4  Misdiagnosis From Slow Rising or Falling hCG Levels Doctors consider slow-rising hCG levels to be a warning sign of possible ectopic pregnancy, although hCG levels occasionally rise slowly in viable pregnancies.

The HCG or Human chorionic gonadotropin is the hormone that is produced in the body of a woman when she is pregnant. Hence some doctors may try and establish a link between miscarriage and hcg levels to determine whether the women is still pregnant or a spontaneous abortion has occurred.

List of related literature:

If levels of hCG in the blood do not rise by 66 percent to 100 percent after 48 hours, then an abnormal pregnancy (either ectopic or potential miscarriage) is suspected.

“The New Harvard Guide to Women's Health” by Karen J. Carlson, Stephanie A. Eisenstat, Stephanie A. Eisenstat, M.D., Terra Diane Ziporyn, Alvin & Nancy Baird Library Fund, Harvard University. Press
from The New Harvard Guide to Women’s Health
by Karen J. Carlson, Stephanie A. Eisenstat, et. al.
Harvard University Press, 2004

The patient with an ectopic pregnancy has elevated hCG levels signifying the presence of a pregnancy; however, the hCG level does not double in 48 hours as in most normal early uterine pregnancies.

“Crush Step 1 E-Book: The Ultimate USMLE Step 1 Review” by Theodore X. O'Connell, Ryan Pedigo, Thomas Blair
from Crush Step 1 E-Book: The Ultimate USMLE Step 1 Review
by Theodore X. O’Connell, Ryan Pedigo, Thomas Blair
Elsevier Health Sciences, 2017

When the hCG level is falling, it should fall at a minimum of 21% over 48 hours, and if it falls at a rate less than this, again, a D&C should be performed to accurately make the diagnosis.

“Management of Common Problems in Obstetrics and Gynecology” by T. Murphy Goodwin, Martin N. Montoro, Laila Muderspach, Richard Paulson, Subir Roy
from Management of Common Problems in Obstetrics and Gynecology
by T. Murphy Goodwin, Martin N. Montoro, et. al.
Wiley, 2010

An ectopic pregnancy, or pregnancy with implantation outside of the uterus, should be suspected with slowly rising or continued positive β-hCG levels after no intrauterine pregnancy is seen on an ultrasound.10 The ultrasound should be repeated in 2 to 7 days to confirm.

“Primary Care E-Book: A Collaborative Practice” by Terry Mahan Buttaro, Patricia Polgar-Bailey, Joanne Sandberg-Cook, JoAnn Trybulski
from Primary Care E-Book: A Collaborative Practice
by Terry Mahan Buttaro, Patricia Polgar-Bailey, et. al.
Elsevier Health Sciences, 2019

Higher than normal levels of hCG may indicate ectopic pregnancy, abnormal gestation (e.g., fetus with Down syndrome), or multiple gestation; an abnormally slow increase or a decrease in hCG levels may indicate impending miscarriage (Cunningham et al., 2014).

“Maternal Child Nursing Care in Canada E-Book” by Shannon E. Perry, Marilyn J. Hockenberry, Deitra Leonard Lowdermilk, Lisa Keenan-Lindsay, David Wilson, Cheryl A. Sams
from Maternal Child Nursing Care in Canada E-Book
by Shannon E. Perry, Marilyn J. Hockenberry, et. al.
Elsevier Health Sciences, 2016

Missed abortion is a possible explanation for her low β-hCG level but should not be diagnosed in this case until a repeated βhCG level fails to double in 48 to 72 hours to avoid misdiagnosing twins or a normal (but inaccurately dated) singleton pregnancy.

“Swanson's Family Medicine Review E-Book” by Alfred F. Tallia, Joseph E. Scherger, Nancy Dickey
from Swanson’s Family Medicine Review E-Book
by Alfred F. Tallia, Joseph E. Scherger, Nancy Dickey
Elsevier Health Sciences, 2012

The hCG levels are generally low in those cases in which the pregnancy will be lost and normal in those which proceed satisfactorily.

“The Immunoassay Handbook” by David Wild
from The Immunoassay Handbook
by David Wild
Elsevier Science, 2005

Up to 15% of normal pregnancies will have an abnormal serum hCG doubling time, and as many as 35% of ectopic pregnancies will have what is considered to be a normal serum hCG doubling time.

“Clinical Manual of Emergency Pediatrics” by Ellen F. Crain, Jeffrey C. Gershel, Sandra J. Cunningham
from Clinical Manual of Emergency Pediatrics
by Ellen F. Crain, Jeffrey C. Gershel, Sandra J. Cunningham
Cambridge University Press, 2010

Early pregnancy loss (positive human chorionic gonadotropin [hCG] finding but less than 6 weeks after last normal menstrual period) occurs in approximately one fourth of pregnancies.1,2 The overall embryonic and fetal loss rate after implantation ranges up to one third of detectable pregnancies.

“Rosen's Emergency Medicine Concepts and Clinical Practice, 2-Volume Set,Expert Consult Premium Edition Enhanced Online Features and Print,7: Rosen's Emergency Medicine Concepts and Clinical Practice, 2-Volume Set” by John A. Marx, Robert S. Hockberger, Ron M. Walls, James Adams
from Rosen’s Emergency Medicine Concepts and Clinical Practice, 2-Volume Set,Expert Consult Premium Edition Enhanced Online Features and Print,7: Rosen’s Emergency Medicine Concepts and Clinical Practice, 2-Volume Set
by John A. Marx, Robert S. Hockberger, et. al.
Mosby/Elsevier, 2010

The levels of hCG (the diagnostic hormone of pregnancy) double in early normal pregnancies every 3 days but are reduced in abnormal or ectopic pregnancies.

“Brunner & Suddarth's Textbook of Medical-surgical Nursing” by Lillian Sholtis Brunner, Suzanne C. O'Connell Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever
from Brunner & Suddarth’s Textbook of Medical-surgical Nursing
by Lillian Sholtis Brunner, Suzanne C. O’Connell Smeltzer, et. al.
Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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12 comments

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  • Dr Roex, my reading suggests that the most common cause of early spontaneous pregnancy loss is due to trisomies rather than XO. I can imagine this being an MCQ, so I wonder if you can clarify?

    http://www.medscape.com/viewarticle/722321_2?pa=ZlxQG3pm8mmElG%2BaHjQlXC86%2BN1i5aVVUkFcvuO%2FkJZyAqoKBg5kI7KaT35DgIiacFrqow%2Bf2%2F37XuRaZT6JAA%3D%3D

  • hello mam,my last 4 months periods dates are
    8 nov 2019
    6 dec 2019
    6 jan 2020
    10 feb 2020
    And i was test beta hcg test on 16 mar 2020 which is
    53.4 mIU/mL.then i was test urine test on 19 afternoon in which its negative.
    My question is.Am i pregrant or not? If yes its normal limit of hcg….plz reply thanku

  • Mera period miss hue aaj 12 days ho chuke h or kal Maine beta HCG ka blood test karayi hi toh report me 307.3 aya h level toh kya Mai pregnant hi ya nahi plzz reply me hume 4 yrs se conceive nhi ho rha h baby plzz reply

  • Mam u r god plz reply ki maine pregnancy kit se test kiya but negative result came two times then mujhe beta hcg test doctor ki advice par krna chaye plz reply mam

  • hlw mam I’m pregnant…maine apna hcg test 4 week me karwaya tha,jiska result 1200 kuch aaya tha…to mam mera baby tHik h vo kamjor to nhi….plzzzzz mam reply me����

  • i got a very faint second line in the morning, in evening i went to doctor and after having urine and ultrasound test doctor said that you are not pregnant. again i went to home and took a home pregnancy test and again a faint line appeared.
    my LMP date was 23rd August, still 2 days left in my next period. what should i do i am really confused and worried, Please advise.

  • I’m around 4 or 5 weeks and my first one was 11. The nurse acted like there is no hope. This is my first pregnancy and I’ve been trying for years. I’m going for a 2nd beta tomorrow so I should know more after those results come in. The weird thing is I’m registering positive on home tests and they say they require a hcg of 25 for positive result. Confused. I know this is an old video and I just came across your story. If you see this, please let me know how your pregnancy went.

  • Mam my LMP is 1/12/ 2018…i check UPT on 10/ 1/2019 it is negative i had a regular menstrual cycle…can check beta hcg in blood

  • mam i have 28 days cycle. im on fertility treatment and had missed period. 4 days later i got bleeding for a day. i went to doctor said 2nd day of bleeding for check up. she did per vagina scan and said i have some heavy bleeding not come out. but after that i have no bleeding at all. now i have doubt whether im pregnant or not. plz answer me. is there any possibility of being pregnant plz answer me

  • Hi Dr Madhuri, I have had my beta test taken today 15dpo and my hcg level was 200. Is this good and if so what’s the percentage of having a healthy pregnancy?

    Thanks!

  • I have done my beta hcg after 10 day of iui andvalue is 2.80 is it right value m i pregnant or not or i can wait for some more day

  • hey girl. i hope that all worked out for you as i just got my blood works done yesterday and my doctor said my hcG levels were at 44. I have to get retested again next week. So nervous:(