Light early pregnancy bleeding with rising beta hCG

Question: I am about six or seven weeks pregnant and started bleeding slightly last Saturday. There is no blood on the sanitary towel, but every time I go to the toilet there is blood when I wipe my self. The blood started off brownish and then turned to pink with the occasional spot of bright red blood. I have had a blood test and the hcg levels were over 1200 and had previously been 364. Does this mean that the baby is ok and if so, how long is the bleeding going to last and what could be causing it. Many thanks for your help. J. (UK)

Answer: On the face of it, this is threatened miscarriage. However, in my view, it is crucial and urgent that you have a scan to confirm location of the pregnancy, number of fetuses and viability. The rise in levels of the pregnancy hormone hCG is good as far as viability is concerned but it does not rule out ectopic pregnancy absolutely. It simply means that diagnosis is less likely. The significance of the rise in hCG levels is also dependent on the interval between the two tests. The results you quoted will be reassuring if the interval was no more than 4 days. From the information you have supplied I can cautiously state that the baby is most probably OK but, without knowing the underlying cause of the vaginal spotting, it is not possible for me to say how long this will continue for. Most cases of non-specific threatened miscarriage resolve well before the end of the first trimester.

Abdominal pain in pregnancy

Question: I am in the 16th week of pregnancy. I get stomach pain at least twice a day but once I go to the bathroom, the pain vanishes from the stomach. Is this due to some kind of gas? I went for an intravaginal scan a week ago and this was normal. Please let me know what should be done. A.K. (india)

Answer: A normal ultrasound scan is reassuring in the sense that this pain is unlikely to be directly related to the pregnancy. It is important that common causes of pain in pregnancy such as a urinary tract infection are ruled out. A urine test will therefore be useful. You may also wish to know that many episodes of abdominal pain in pregnancy remain unexplained.

Chromosomal disorders

Question: What does chromosomal abnormalities mean? And, is it my fault I’ve reduced amniotic fluid? S.H.(UK)

Answer: The most well known chromosomal abnormality is Down’s syndrome. There are many other types of chromosomal disorders. To understand these you need to know the basic information about chromosomes. These are the strands on which all the genes are. Each of the human cell is made up of 46 chromosomes.The chromosomes come in pairs and therefore, for humans, there are 23 pairs. On each chromosomes, there are specific genes responsible for specific activities or attributes. When the number of chromosomes is altered, increased or decreased, there will be problems. With Down’s syndrome, there is an extra chromosome on set No. 21. There is therefore a total of 47 instead of 46 chromosome. For each specific chromosomal disorder, a different pair is affected. Some chromosomal disorders are so lethal that they are incompatible with life outside the womb. Affected pregnancies will tend to end in miscarriage or stillbirth. Down’s syndrome and other chromosomal disorders are discussed in more detail here:

You have asked whether it is your fault you have reduced amniotic fluid. It is not possible for me to answer this about your specific situation as I do not know any facts about your pregnancy. In general, however, reduced amniotic fluid tends to have nothing to do with what the mother has done or not done. A lot of times, the underlying cause of reduced amniotic fluid is difficult to establish. Occasionally, this can be attributed to the abuse of illicit drugs like cocaine or heavy smoking during pregnancy. Such cases are exceptions.

No heartbeat on scan in early pregnancy

Question: i was pregnant after scanning doctor said that there is no heartbeat present in the embryo. so i underwent abortion. This already happened for 2 times. what is the main reason behind this. Anything serious? Thanks. J.J. (India)

Answer: It sounds like you have suffered two consecutive missed miscarriages. A missed miscarriage is where the fetus dies with no apparent cause, usually in the first trimester or early second trimester. There are usually no warning signs or symptoms and often, the first time the mother discovers something has gone wrong with the pregnancy is when she has her scan which shows absence of fetal heartbeat, just like in your case. In many cases of missed miscarriage, a specific cause is never identified.

In some cases, fetal demise occurs because there was something wrong with the baby, either a genetic or chromosomal disorder. In other cases, the mother might have an underlying problem such as antiphospholipid syndrome. There are tests for this latter condition and such tests are offered usually after two or three consecutive miscarriages. We have discussed antiphospholipid syndrome in more detail here:

Discrepancy with scan dates

Question: Hello, I am currently 29 weeks pregnant. I had an early scan at 7 weeks and again at 11 weeks and the dates was the same but when i had my dating scan at 12 weeks my date was different by a couple of days. I was wondering what date should i best to go on? C. (UK)

Answer: As a rule of thumb, the earlier the scan, the more accurate it is in dating a pregnancy. In any case, for practical purposes, you are probably going to see that the two day difference does not make any material difference. Whilst the dates from the ‘official’ dating scan at 12 weeks are going to be used, in the end it won’t matter as the baby will arrive when ready. As you would probably know, only around 1 in 100 babies arrive on their calculated due date. If you happen to go over your due date, the dating scan dates will be used to determine when induction of labour should be done, typically 10 - 14 days after that due date.

Preventing a sickling crisis

Question: Name a drug that can prevent sickling crisis. N.S. (India)

Answer: In sickle cell disease and related conditions, sickling crisis is a dreaded complication not least because of the extreme pain that can be associated with such a development. There is no drug that can prevent a sickling crisis. Sickling crises are usually triggered by identifiable conditions such as infections, extremes of temperature, dehydration, high altitude, smoking etc. To minimise risk of a sickling crisis, steps need to be taken to avoid as much as practicable those triggering conditions. In some sickling crisis episodes, blood transfusion may be necessary.

A drug called Hydroxyurea has been shown to be of benefit in reducing the frequency of painful sickling crises for some patients. It does not work for everybody nor for every type of sickling crisis. There appears to be benefit particularly for the ‘Acute Chest syndrome’ and ‘vaso-occlusive pain’ type of crises.