January 24, 2018

Case of the Month OCT 2010: Episode #4

Click here for Episode #1

What happens after a positive pregnancy test? There are still some first timers who mistakenly believe that all is safe now. The reality is far from that. Depending on ones age, ones history and ones physical characteristics the risk of a bad outcome (miscarriage, ectopic or abnormality) is usually something like 1 out of 6 or 1 out of 5, but in particularly susceptible high-risk situations, it can be greater than 60%.

So, back to our story. M is happy for her first positive pregnacy of her life and rightfully so. The general estimate for her is that there is better than a 80% estimate that everything will turn out all right and in less than 9 months, she will be holding a baby in her arms. The first step was that initial pregnancy test, know as the beta-hCG test, which came back at 29. Today, we did her blood draw and ran it through the machine in our lab.

What if it came back as a hCG of 60? We would celebrate. That is a classic doubling and most likely signifies good news.

What if it came back as a hCG of 50? That’s not quite doubled but is still in the range where we predict a good outcome as being more likely than a bad outcome.

What if it came back as a hCG of 35? That would be bad news. Not only is a miscarriage likely, there is even the possibility of this being something worse, like an ectopic pregnancy.

The blood test analyzer revealed her result. It was an hCG of 23. Bad news.

One of toughest tasks for my staff is to break this type of news to the patients. If we were to choose to have me, the doctor, call every patient back with her lab results, it would force patients to wait until my work time was freed up. By our current protocol, having the nursing staff or medical assistants call her back, eager patients got their news hot off the presses. Then I would follow up later, usually in 1 or 2 days to discuss things in greater detail.

So M was told of the bad news. Her hCG values were dropping. This meant that this pregnancy would almost for sure not continue. That’s the bad part. The redeeming glimmer of hope on the bright side was that we all know knew for sure that she CAN get pregnant.

Later that day, when I spoke with her, I answered all her questions, including what the next step was. The next step was to follow these values with a repeat test, maybe in a week, just to make sure it was back down to zero. Then we could offer her another cycle under a similar strategy to the one that got this pregnancy.

Continue to Episode #5