Patient: I am six weeks pregnant. My HCG levels dropped and I have fluid pockets in my uterus along with severe back pain and abdominal swelling. I know I am going to miscarry, but what does all of this mean?
Symptoms: Abdominal swelling, back pain, low HCG levels, shoulder pain, fluid pockets in uterus
Doctor: You seem to be having all the symptoms of a miscarriage. Dropping HCG levels are not a good sign and is generally an ind icator of an impending miscarriage.The most common cause for a first trimester miscarriage is a chromosomal abnormality in the fetus. In early pregnancy the body acts in an ‘all or none’ fashion rejecting abnormal fetuses with low potential for growth. Sometimes the fertilized egg is chromosomally abnormal and may develop as an empty egg called as blighted ovum which is seen on ultrasound as an empty fluid sac.What is usually described as a fluid pocket on a scan is called retroplacental collection/ blood clot in medical terms. This is an area of separation between the baby’s sac and the maternal uterus leading to an area of bleeding. Depending upon the relative size of the same and the causative factor the presence of a retroplacental clot could mean poor survival chances for the baby.The causes for a retroplacental clot are many and cannot be conclusively tested for. In case you do miscarry it is best that you discuss your risk factors with your doctor and identify any correctable risks such as smoking, folic acid deficiency, coagulapthies, infections etc. so that you may avoid the same in your next pregnancy. I must state that statistically only 15 percent of women with one miscarriage have a second miscarriage and hence you must keep hope and try again a second time as soon as you are ready.