Gynaecology - HCG level monitoring in Early Pregnancy

Introduction

Your ultrasound today has not given a clear answer as to what is happening in your pregnancy. In order to get a better understanding of what is happening, we intend to measure the concentration of HCG (Human Chorionic Gonado-trophin) in your blood over a period of time.

We understand waiting to be given clear answers about what is happening in your pregnancy is emotionally difficult. This leaflet aims to give you a better understanding about what is happening and we hope this will provide answers to some of your questions

Why is it necessary to check HCG levels?

HCG is a blood test that monitors the hormones in pregnancy. It is the same pregnancy hormone that is in urine. However, a urine result will only give a positive or negative result. The blood test is more accurate telling us how much hormone is present and is especially useful in very early pregnancy when scan findings are sometimes inconclusive.

The test is performed by taking a sample of blood and measuring the level of HCG in it. It may be repeated several times over a period of days/weeks to monitor whether the hormone level rises or falls with time, helping us to give you a clearer picture of what is happening in your pregnancy.

What is HCG?

HCG is a hormone produced in increasingly larger quantities during early pregnancy. By monitoring the level of this hormone in the blood, we can help determine whether your pregnancy is still ongoing. The test is performed by taking a sample of blood and measuring the level of HCG in it. The HCG levels should be taken 48 hours apart. It is often necessary to take several blood tests 48hrs apart to establish the pattern of results and monitor whether the hormone level rises or falls with time.

What are the possible outcomes?

There are 3 possible outcomes in this situation:

1. If the concentration of the HCG in your blood rises quickly, approximately doubling every 48hrs, then this usually signifies a continuing pregnancy. Another scan will be arranged when we will hope to see more clearly how the pregnancy is progressing.
2. If the concentration of the HCG is already low, or goes down quickly then, regrettably, you have seemingly suffered a miscarriage or the pregnancy is failing to develop. If this happens, the staff will explain this to you and give you further information. However, follow-up is still important, so that an ectopic pregnancy is not missed, particularly if we have seen no signs of a pregnancy on an ultrasound scan.
3.  If the scan shows an empty uterus and a HCG level that remains static or rises very slowly, this could indicate an ‘Ectopic’ pregnancy or a pregnancy of unknown location (PUL) and further investigations will be required. You may be asked to return to hospital and may need to stay overnight.

What is an ‘ectopic pregnancy’?

When you become pregnant the egg and sperm meet in the fallopian tube, (this is the tube which carries the egg from the ovary to the womb). Typically, the fertilised egg then moves to the womb and the pregnancy will mature. If the fertilised egg does not move and stays in the fallopian tube, an ectopic pregnancy could begin to develop. Ectopic pregnancies can also occur in other areas, such as the abdomen or ovary, but this is rare. Ectopic pregnancy affects around one in ninety pregnancies.

What is a pregnancy of unknown location?

In this condition, there is a positive pregnancy test with no sign of pregnancy either inside or outside of the womb.

What happens now?

After your blood test you can go home. Individual follow-up will be discussed with the doctor and a member of staff will advise you if and when to return for more blood tests, and/or a repeat scan. Please note; results will not be left on answer phones or with any relatives. We ask that you contact the Early Pregnancy Assessment Unit (EPAU) or the Gynaecology Assessment Ward on the numbers provided at the end of this leaflet if you have not heard from us by 7pm.

What should I do over the next few days?

Please try to observe the following until we are able to give you a better idea of what is happening to your pregnancy:

• You must remain easily contactable and within easy reach of the hospital at all times
• Contact the hospital at once if there is any change in your condition

What symptoms do I need to look out for?

If you feel unwell in any way or there is a change in your condition you must get in touch with the Early Pregnancy Assessment Unit (EPAU) at once. You should report if any of the following symptoms occur:

• New or increasing abdominal pain
• If the bleeding increases
• Feelings of dizziness, light-headedness, pain in the rectum (your bottom) or pain in the top of the shoulder

You must get someone to bring you into hospital immediately if you faint or pass out.

Who should I contact?

Gynaecology Assessment Unit: 0161 627 8855/0161 778 5536 between 8am – 8pm