This experience understandably resulted in an emotional roller coaster for my patient, who graciously but decidedly transferred her care to another physician. At 10 weeks, 6 days EGA, ultrasound scans revealed a viable 11-week pregnancy. Finally, I referred her for treatment to suppress the immune response, in light of her Rh-negative status.īefore receiving treatment the following week, a confirming ultrasound was obtained. The patient opted to wait for spontaneous completion of her miscarriage. We discussed management options, including chemical induction, dilation and curettage, and watchful waiting. As usual in these circumstances, I addressed the issues of guilt, blame, and grief associated with miscarriage. I discussed the progressive decline in HCG as representing, in all likelihood, a nonviable pregnancy. Prenatal laboratory workup also determined that she was Rh-negative.īased on the 3 consecutive HCG drops, I initiated a difficult discussion with the patient. Results of a follow-up HCG test, however, showed her levels had dropped yet again to 104 177 IU/L. She was seen in our clinic several days later (EGA 9 weeks, 5 days) with no further bleeding or pain. Results showed a further drop to 115 104 IU/L.
While awaiting her appointment, her HCG test was repeated again, 48 hours after the second test (EGA 9 weeks, 1 day). She was asked to come to our clinic for further evaluation. She was asked to repeat the test the next day results showed a level of 131 681 IU/L. Quantitative HCG test results showed her HCG level was 167 343 IU/L. Her examination revealed blood in the vaginal vault, but was otherwise normal with no cervical dilation or pathology. Her estimated gestational age (EGA) by confident dates was 8 weeks, 5 days. Several weeks later, however, she returned to the walk-in clinic because of postcoital spotting that had lasted 1 day. She was referred to our clinic for prenatal care, and an appointment was made for about 12 weeks’ gestation. Mrs S.C., a 28-year-old primiparous woman, was diagnosed at a walk-in clinic with a 6-week pregnancy.
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