Hcg Levels Go Down Then Up Again
By: Kelly Gleason, PhD, RN
The Sunday after I received a very faint, simply positive pregnancy test, I excitedly cleaned out the room that my hubby and I dreamed of every bit our nursery when we bought our house. I called him upstairs to ask if he idea a crib could fit in the room with the queen size bed, and if he was okay with painting the furniture white and the room mint light-green. I was and then happy, he was going to be a great dad. Then suddenly I felt farthermost abdominal hurting.
I laid down and texted my best friend and my mom "Is this normal? This hurts so bad."
"Yes, pregnancy is uncomfortable. Take it easy," my mom wrote back.
But my married man fabricated me go to the emergency department, and several tests later, the nurse practitioner attention teared up when she told me the results. My hCG level (the hormone that indicates a pregnancy) was on the low terminate for someone 4 to 5 weeks along and the ultrasound showed no evidence of a baby. It was possible I was having a miscarriage, and I would need more than tests to confirm it.
Simply hither's the thing about pregnancy: every symptom can be interpreted in different ways.
My pregnancy was detected, just there was no evidence of a baby on the ultrasound. That could be worrisome, but then there isn't usually evidence of a baby at 4 to five weeks or at my hCG level, 200. My hCG level was on the lower cease for someone 4 to 5 weeks along, but it was still within the ridiculously large "normal" range of 5 (the depression terminate) at 4 weeks to 7,340 (the high end) for 5 weeks. Abdominal cramps could mean that I was experiencing a dangerous complication, or that my uterus is expanding. There was something funny going on with my pregnancy, then I held on to the chance that I could still exist pregnant.
On Tuesday I did a follow up hCG exam and my level tripled to 600. Your hCG level should at to the lowest degree double in a healthy pregnancy—a triple hCG could be twins! I called my husband to tell him the intestinal hurting was probably just my body preparing for twins!
On Thursday I excitedly shared the news at my follow-up OBGYN engagement, but my provider was more reserved. "Sometimes it triples as your body's concluding ditch attempt," she said. "I want one more hCG test on you."
It'southward 590. I remain hopeful that it could be vanishing twins—a long shot but still possible! Just by Sat I have that I'm having a miscarriage; I've had intestinal pain and spotting, and my Saturday examination shows the same hCG level, right around 600.
I thought I was having twins two days agone, at present I'm crying hysterically over my miscarriage, and suddenly an on-call OBGYN that I've never met before calls and tells me to come in to the emergency department immediately. I demand a "D & C and methotrexate" correct now because my "symptoms scream ectopic." I'grand a nurse but maternal health isn't my specialty. What does that mean?!
By way of explanation, she said, "Oh information technology just takes 5 minutes once nosotros get a room and a nurse, information technology's just so I can get a tissue sample to ostend." She said more but at present I'm afraid too as emotional. What the provider is communicating, and I'm non understanding, is that I'm most to accept several serious decisions to make.
I'k not processing or accepting that she's telling me:
- That I probably have an ectopic pregnancy, a life-threatening condition where my babe is growing in the fallopian tube outside of my uterus.
- That she wants me to have a dilation & curettage (D & C), a surgical process often performed later a miscarriage to remove the contents of the uterus (what if the infant was actually in there?!), as a test to confirm that I have an ectopic pregnancy. Or
- That she wants me to take methotrexate, a chemotherapeutic agent with horrid side furnishings, equally a treatment to destroy the ectopic pregnancy that she is 95 percent sure exists.
I didn't process what she told me until I met her in person while she took my informed consent and I was already dressed for a surgery I didn't know I was having. I'm a nurse with high wellness literacy, merely until that point I was so clueless about what a "D & C" was that I texted my friend I'd just be a piffling late to her 1 p.m. birthday party.
I consented to the D & C, simply there'due south another subconscious decision to brand when I wake up later on the operation. They can't confirm that my pregnancy was ectopic until the tissue result comes back in a few days, only the OBGYN wants me to accept methotrexate, the chemotherapy drug, now. The very warm, professional nurse in recovery is visibly worried nearly giving me the methotrexate; she is wearing three pairs of gloves, explaining all the side furnishings… and I decide to (politely) turn down the treatment until my ectopic pregnancy is confirmed.
They couldn't stop me from leaving, but 2 different OBGYNs called on their own fourth dimension to encourage me to take the methotrexate and reiterate the dangerous nature of my still untreated (and still unconfirmed) ectopic pregnancy. What the on-phone call OBGYN explained in a manner I finally understood was that if I filibuster treatment for my ectopic pregnancy, the unviable fertilized egg tin can grow larger in the wrong identify, which could cause a life-threatening hemorrhage or cause my fallopian tube to rupture, threatening my chances of children in the future.
I couldn't fall asleep Sunday dark, the irksome anguish in my right side was a reminder that I may have put myself at risk for a tubal rupture by stubbornly refusing medication. On Monday I go back to the emergency department in hurting and receive the methotrexate, and my ectopic pregnancy is confirmed the next day.
Looking back, I received textbook treatment: my pain wasn't ignored, my ectopic pregnancy was caught as early as possible, and my provider prescribed methotrexate and performed a D & C to confirm that I had an ectopic pregnancy since it wasn't visible on the ultrasound.
But in ane week I was pregnant, I might accept miscarried, I thought I was having twins, I accepted that I had a miscarriage, then I was diagnosed with an unconfirmed but life-threatening complication. And in my vulnerable, emotional state, I had to brand so many serious decisions nearly treatments that I wasn't familiar with and didn't conspicuously understand. I called my mom to confirm my decisions were okay and aligned with our Catholic faith at every point. I was unsure of how open up I could be about what was happening to me since people don't talk about miscarriages. And I'm still not sure that I would accept consented to the D & C if I realized the surgery was just a test, and that the results wouldn't be back in time to inform my determination on methotrexate either mode.
I have more than nigh people do. An amazing, supportive husband, high health literacy (though not in child-bearing), health insurance, great OBGYNs who followed up persistently, a job where I can work from habitation, and more than luncheon and dinner plans than ever because my endless, fantastic support system doesn't want me to be alone. And it yet stunk. And it still hurts.
In the virtually urgent situations, patients do not wait to have to make a decision most treatment when the diagnosis is not confirmed. Patients exercise not perfectly understand all of the risks and benefits, or why clinicians make the decisions they exercise. It is so, so scary to get to the operating room and so be prescribed a medication with dangerous side furnishings just based on the provider's intuition. Patients must fully understand their options, regardless of if they are an experienced nurse practitioner or have less than a grade school education. "Shared controlling" is non some fad, it'due south vital.
Read more by Dr. Kelly Gleason:
- On Pi Day, Nursing Meets Applied science
- Diverse Perspectives, Innovative Solutions
- What Nurses Need to Know: Diagnostic Error
- Patient-Provider Teamwork Makes a Departure in Diagnostic Research
ABOUT THE Writer:
Kelly Gleason, PhD, RN, Assistant Professor at the Schoolhouse of Nursing, teaches informatics. In her research, she aims to develop methods of reducing diagnostic fault through patient-facing wellness information technology tools.
Source: https://magazine.nursing.jhu.edu/2019/03/in-one-week-i-was-pregnant-i-miscarried-and-i-was-diagnosed-with-a-life-threatening-complication-i-didnt-understand/
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