Several times a calendar week in my practice, and in my Net roles at the WebMD Fertility Center and the Pregnancy Board at WebMD, I accept the opportunity to deal with early pregnancies and patients who want or demand to know if a pregnancy is progressing normally (or not). In my brusque twenty years in practice, technological advances accept come up about that allow careful monitoring of pregnancies in the get-go half of the first trimester. These modalities have the potential to determine the viability of a gestation before any negative sign or symptom develops, and, if used properly they can prevent dangerous complications or reassure patients during uncertain times. But along with the technology and the good comes misuse and inappropriate interpretation that tin can do a lot of damage and crusade a lot of worry in many instances.

In that location are several reasons to monitor pregnancies during the first few weeks after formulation. These include:

  • bleeding in early pregnancy
  • possible ectopic pregnancy
  • recurrent miscarriage
  • patient anxiety due to previous pregancy loss

It'due south important to note that in that location is no intervention bachelor today to a adult female who is already meaning that will influence the rate of early pregnancy loss. Monitoring pregnancies may reduce anxiety, prevent rupture of ectopic pregnancy, and avoid the unease in waiting for a miscarriage to declare itself, but information technology cannot provide data that will affect the pregnancy'due south prognosis.

The human pregnancy hormone, human chorionic gonadotropin (HCG) is first found in a meaning woman'due south blood as early as 7 to eight days afterwards conception. As a pregnancy grows, HCG increases. Measurements of HCG levels can exist useful during the early weeks before the fetal heartbeat is seen on ultrasound, usually effectually vi-7 weeks after concluding menstrual period, or 4-5 weeks afterwards formulation.

A single HCG value doesn't give enough data about the health or viability of the pregnancy. Inside the first 2-four weeks after fertilization, HCG usually doubles every 48-72 hours. That usually corresponds to HCG levels beneath 1200 IU. From 1200-6000, the HCG usually takes 72-96 hours to double. To a higher place 6000 IU, the hCG often takes over 4 days to double. So, the rate of increase in HCG levels usually varies as a pregnancy progresses. Normal HCG values vary upward to 20 times betwixt dissimilar pregnancies, however, and an HCG that does not double every two to iii days does not necessarily indicate a problem with the pregnancy. Some normal pregnancies will accept quite low levels of HCG, and result in perfect babies.

Pregnancies that will expel and ectopic (tubal) pregnancies are likely to testify lower levels and slower rises, but often have normal levels initially. Sometimes information technology takes three or more HCG levels at least 48 hours autonomously to become an idea how a pregnancy is progressing.

One time the HCG levels are above thou-1500 IU, vaginal sonography ordinarily identifies the presence of an intrauterine pregnancy. At that betoken an ectopic pregnancy is finer ruled out. Once the pregnancy is visible on ultrasound, further HCG testing is less reliable than ultrasound for monitoring a pregnancy, equally the variations in HCG levels are ofttimes misleading and cause unnecessary worry. Since normal levels of HCG can vary tremendously, after 5-6 weeks of pregnancy, sonogram findings are much more predictive of pregnancy issue than are HCG levels. Once the gestational sac is seen, most doctors will monitor with ultrasounds rather than cartoon HCG. Subsequent monitoring with ultrasound should reveal normal growth of the gestational sac, and the evolution of a fetal heartbeat by vi to 7 weeks' gestation (six-seven weeks after LMP). Once fetal action has been detected by ultrasound, the chance of miscarriage is usually less than 10%.

My general recommendations regarding the advisable use of HCG testing are summarized below. By following these guidelines, unnecessary testing that might lead to needless worry might exist avoided, and simply the right information volition be obtained.

  1. If you're hurting-free and you're not bleeding and y'all're at depression-risk for an ectopic pregnancy, try to avoid the temptation to monitor HCG levels. Mostly no bleeding (no news) is good news. The pregnancy is on autopilot, and at that place'due south niggling yous can practise to influence it at this phase. Endeavor to relax and expect and run into.
  2. IF HCG monitoring is indicated, try not to read too much into the absolute numbers and rates of increment of the HCG levels. Trust your dr.'south knowledge and experience to tell you if and when to repeat the tests, when and how to react to the numbers, and when to accept an ultrasound. I can't tell you how many patients I've had who convinced themselves that their pregnancy was doomed based on inappropriate interpretation of HCG levels, only to observe that everything is fine when an appropriately timed ultrasound is performed.
  3. Once an intrauterine pregnancy is visible on ultrasound, do not put any faith in HCG measurements. Ofttimes pregnancies and their HCG levels don't fit the mold, and the numbers don't increment the way they "ought" to. Rely on time, and predictable ultrasound changes to determine pregnancy viability.
  4. Remember that positive thinking and trust in the process are of import in shaping your experience and add good karma to our globe!