Foetus death at 2 weeks

Patient

Q: My girlfriend just tested positive on pregnancy the day before. The line on the tester was a blur one. She took the ultrasound for 2 times and there's not foetus. The doctor made her take the test and it was negative. She went through X Ray procedures and took anti-biotics right before the pregnancy. The doctor said the foetus aborted itself due to those things. It will be washed down as menstruation anytime soon. She has to take another test to confirm the foetal death in 10 days. We were going to go through abortion anyway. But is it possible that the fetus is dead? Anything I should be aware of? I just want my girlfriend to be safe. Thanks.

Symptoms:  Foetal Death
Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,

Firstly if the pregnancy test was positive initially, but the ultrasound of the uterus turned out to be negative and a repeat test after few days in form of urine pregnancy test came back as negative, indicates that the pregnancy which had come either have already got aborted by the time when you went for the ultrasound or that the first test showed a false positive result.

Ideally a serum beta hcg test should be done which is more sensitive for pregnancy and if the levels of hcg are more than 1 then pregnancy was there and if the levels are lower then there was none.
The urine pregnancy test can get positive only after 7 days of missed period i.e when the pregnancy is around 3-4 weeks. Serum beta hcg test becomes positive after 7 days of intercourse.

Now if there was a pregnancy but not seen on ultrasound now, then there has been a natural abortion and possibly x-rays and antibiotics could possibly be the reason as radiation in early pregnancy can be detrimental for foetal growth, but to term it as death can only be established only once the heart beat of the foetus has been confirmed, which is not the case.

So it is advisable to get a basal serum beta hcg level now and then repeat after 48 hrs again to reconfirm any rise or decrease in levels. If there is a rise then there is an ongoing pregnancy which was not located on ultrasound, but if there is a decrease then the foetus is not viable and and the gestational sac shall be aborted naturally through natural menstrual bleed. However a repeat ultrasound after 10 days shall confirm or negate abortion with certainty.

I hope i have answered your query in detail,
Wishing you good health,
Regards

Comments / Follow Ups

Patient: My girlfriend had a miscarriage and started bleeding in August and hasn't stopped since. The fetus was only a month old when it happened. It was a natural miscarriage. She didn't take any abortion pills. The fetus didn't survive because she had to take antibiotics and an X Ray test for her vertebrae (without the knowledge of the pregnancy). The urine, ultrasound and transvaginal tests said everything was clear (no ectopic or cyst). Her gynaecologist said there's nothing to worry about but I'm just reassuring. Besides the bleeding has been going on for longer than it is supposed to be.
Doctor: Well if the ultrasound is clear and There are no products of conception still remaining inside uterus , the bleeding should stop naturally but if there are, then they would have to be removed with a dilatation and a curettage.
Regards
Patient: She went through d&c on Saturday morning because she got hcg level 157 in her body. She's been on birth control pills(prescribed by the gynaecologist) 10 days prior to the procedure. And, she's still on pills. She stopped bleeding for a while after the procedure but started bleeding again today. Just a little bit. Dark in colour. And, she's suffering from mild cramps. Is it normal to be like that after the d&c procedure?

And the biopsy result says " the endometrial tissue contains fragments of endometrium on the proliferative phase. There are tubular glands lined by single to a few layers of regular columnar cell. There is no nuclear pleomorphism. Occasional normal mitoses are presented. There are no feature of endometritis, hyperplasia or malignancy."
Doctor: The endometrial biopsy report is normal with proliferative phase endometrium. So the hcg levels which are still high may have tone followed up again after 2 weeks to check for decrease in levels as it takes time for the levels to decrease completely after the abortion. The spotting to bleed is possible after D& C as she has been on pills so there is nothing to worry as of now, just continue her pills and this bleeding shall stop but a repeat hcg level would be necessary after 2 weeks. The level should decrease below the level of 1ng/dl.
Regards

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