Many Women with Viable Pregnancies have non-Doubling hCG Levels

On the Misdiagnosed Miscarriage site, many women are worried because their hCG levels are not doubling in 48 hours.  For the life of me, I don't know why some physicians are bound and determined to scare women when non-doubling hCG levels can be quite normal.

Taken from WebMD:

"Within the first 2-4 weeks after fertilization, HCG usually doubles every 48-72 hours. That usually corresponds to HCG levels below 1200 IU. From 1200-6000, the HCG usually takes 72-96 hours to double. Above 6000 IU, the hCG often takes over four days to double."

And as the pregnancy progresses through the first trimester, those numbers are going to slow quite a bit.  They will then plateau and begin dropping.  This is normal.  I've talked to women with numbers around 30,000 to 40,000 and their doctors are worrying them because the levels are not going up.  They've been fine.  In fact, according to Healthline, these are normal levels for women:

• Six weeks LMP: 1,080 to 56,500 mIU /ml
• Seven to eight weeks LMP: 7,650 to 229,000 mIU /ml
• 9 to 12 weeks LMP: 25,700 to 288,000 mIU /ml

and according the American Pregnancy Association:

 "The level will reach its peak in the first 8 – 11 weeks of pregnancy and then will decline and level off for the remainder of the pregnancy."

Really, hCG levels are useful in determining that you do not have ectopic pregnancy.  After they find the gestational sac, most doctors will stop taking hCG levels because your numbers can rise and be normal.  They can plateau and be normal.  They can drop and be normal.  

If I Could Have Just One Study Done on Misdiagnosed Miscarriages, This Would Be It

Flashing back to the year 2002.  There was NOTHING on the internet about misdiagnosed miscarriages.  A search yielded plenty of 'miscarriages of justice' but nothing on wrongly-diagnosed miscarriages.  Indeed, the only information I found was that miscarriages were not misdiagnosed and any suggestion otherwise just seemed to be an irritant to whomever was asked.

Thankfully, my miscarriage was indeed misdiagnosed.  I shared my story online and women found it.  They started emailing me so thankful to find some hope.  Some of those women ended up being misdiagnosed as well.  From those stories, The Misdiagnosed Miscarriage was born and many babies' lives have been saved as a result.

I've seen wonderful changes in the last ten-plus years.  The medical community is starting to take note.  Sure, there are *still* doctors who claim miscarriages are never misdiagnosed but there are many more who recognize that some babies just appear later.  It has nothing to do with the actual baby being too small.  It's all about the ultrasound equipment.

During the last decade, I've hoped for one study and it hasn't happened...yet...

I would like a study that examines the relationship between the transvaginal ultrasound and the retroverted uterus during the first trimester and I'll tell you why.

It didn't take too many emails for me to realize that many of us had something in common:  The majority of us had a tilted uterus.

I searched for any studies on the tilted uterus and found this one:

Transrectal Ultrasonography for Problem Solving After Transvaginal Ultrasonography of the Female Internal Reproductive Tract

This study discovered that transvaginal measurements were not as  accurate as transrectal measurements in the retroverted uterus.  Of course, they weren't measuring babies but the results were intriguing.

Of course, not many women are going to want a transrectal ultrasound during pregnancy but, this study does demonstrate that measurements may just not be as accurate as your doctor would like to believe if you have a tilted uterus. 

If we could get a study done that followed a large group of women during the first trimester, I already know what they would find.  They would find that when women have a tilted uterus, she looks one to two weeks behind during the first trimester.  Later, when the baby is large enough to be seen, the measurement dating tends to be more accurate.  We've seen this over and over on the site.  

Now, if somebody would just do this study, perhaps physicians would be a bit more patient and not in quite as much of a rush to end a pregnancy that might still be viable. 

Created a 'Ten Reasons Miscarriages are Misdiagnosed' Page

I decided to write a page today on the top reasons why miscarriages are misdiagnosed.

Ten Reasons Miscarriages are Misdiagnosed

The top reasons I've seen on The Misdiagnosed Miscarriage site are:

1. A Tilted Uterus
2.  Empty-Looking Gestational Sac with High hCG Levels
3.  Diagnosed in the Emergency Room
4.  Gestational Sac Looking One to Two Weeks Behind
5.  Non-Doubling hCG Levels
6.  Unexplained Bleeding
7.  IVF
8.  A Doctor or Nurse Did Your Ultrasound
9.  Enlarged Yolk Sac
10.  Missing Gestational Sac

Looking at that list and there are just too many reasons miscarriages are misdiagnosed.  I've read that if doctors would just take a wait-and-see approach (and not scare women by bringing up the 'M' word), we could do away with the vast majority of misdiagnosed miscarriages.

No matter what, unless there is an urgent need to end the pregnancy, be certain you are indeed miscarrying before having your pregnancy ended.  Often, that means waiting until nine or ten weeks. 

Blighted Ovum Diagnosis? Ask About the Size of the Gestational Sac.

I know, I've said it before but I just have to say it again.

If your doctor is diagnosing a blighted ovum (empty gestational sac), the most important question you need to ask is:

What are the measurements of the gestational sac?

• It doesn't matter how many weeks you are.
• It doesn't matter how high your hCG numbers are.
• It doesn't matter that your doctor has the latest and greatest ultrasound equipment.

What matters most is the size of the gestational sac and whether it is growing.  If that gestational sac is under 25mm, one ultrasound cannot diagnose a blighted ovum.

I've blogged about the UK's new guidelines. If the gestational sac is growing and, if there are no complications, you should wait until the gestational sac is 25mm and then wait one week to verify.

Taken from the  National Institute for Health and Care Excellence's page:

Ectopic pregnancy and miscarriage: Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage

1.4.9 If the mean gestational sac diameter is less than 25.0 mm with a transvaginal ultrasound scan and there is no visible fetal pole, perform a second scan a minimum of 7 days after the first before making a diagnosis. Further scans may be needed before a diagnosis can be made.

1.4.10 If the mean gestational sac diameter is 25.0 mm or more using a transvaginal ultrasound scan and there is no visible fetal pole:

• seek a second opinion on the viability of the pregnancy and/or
• perform a second scan a minimum of 7 days after the first before making a diagnosis.

1.4.11 If there is no visible fetal pole and the mean gestational sac diameter is measured using a transabdominal ultrasound scan:

• record the size of the mean gestational sac diameter and
• perform a second scan a minimum of 14 days after the first before making a diagnosis.

1.4.12 Do not use gestational age from the last menstrual period alone to determine whether a fetal heartbeat should be visible.

1.4.13 Inform women that the date of their last menstrual period may not give an accurate representation of gestational age because of variability in the menstrual cycle.

Without a doubt, these are the best guidelines I've seen.  If doctors around the world would adopt these guidelines, the number of misdiagnosed miscarriages would plummet.

Generally speaking, the gestational sac will measure at least 25mm by about nine weeks or so for the vast majority of women.


Too many women have shared stories of being misdiagnosed because their hCG levels were really high with no baby seen or their doctor didn't believe there was hope because they were eight weeks.  Don't focus on these things.  Focus on the size of the gestational sac and whether it is growing.  Yes, it still may end up as a blighted ovum but, if you end your pregnancy before the sac reaches 25mm and it is still growing, you may be ending a viable pregnancy.

Misdiagnosed Conditions During Pregnancy

Although I tend to blog on misdiagnosed miscarriages, far too many women are misdiagnosed in other ways during pregnancy.

I've shared my story about how my son was misdiagnosed as having Down Syndrome.  We refused to terminate.  You can read that story here: 

My First Misdiagnosed Miscarriage at 12 Weeks!

I hear stories like this quite a bit and, indeed, here is yet another story of a family who was given the option to terminate:

 Misdiagnosis or divine intervention? Baby given no hope to live, born completely healthy

I do wonder how many women terminate their pregnancies when everything really was fine.  I know, with my own ultrasound, our son showed the markers of Down Syndrome.  Really, though, even had he had it, we wouldn't have minded.  He was our son and like any parents, we were going to adore him to the moon and back.  We were surprised when he was born without Down Syndrome though.

If you are going through a diagnosis of this nature, I urge you to seek non-medical counseling as well.  All too often the medical community just sees the diagnosis and you need to talk to somebody who sees the bigger picture. 

When Good Pregnancies are Misdiagnosed as Molar Pregnancies

Every so often on The Misdiagnosed Miscarriage, women share that their doctors have diagnosed a molar pregnancy and are pushing for a quick D&C.

Now, a molar or partial molar pregnancy is quite serious.   A molar pregnancy is when the mother's chromosomes are somehow 'lost' and the father's chromosomes are duplicated.  In a partial molar pregnancy, the father's chromosomes are duplicated again but the mother's remain as well.  This can happen with duplication or if two sperm fertilize the egg.

According to the Mayo Clinic, about 20% of women who have had a molar pregnancy will develop gestational trophoblastic disease.  This happens when the tissue remains and continues to grow.  You'll see hCG levels rise as well.  When this happens, chemotherapy may be needed.  Very rarely this will turn into cancer.  Generally, a complete molar pregnancy can be detected by about nine weeks. 

As you can see, you should take a molar pregnancy but I was reminded today of how frequently good miscarriages are misdiagnosed as being molar as in Gabrielly's story.  We've been emailing back and forth.  She was being misdiagnosed too soon with a molar pregnancy.  We've had other similar stories as well, such as Heather's story and Dani's story. 

I have a suspicion that some doctors *may* use the molar diagnosis to pressure women into having a quick D&C.   Very few pregnancies have ended up being molar in my years on the site.  Those women seemed to have really high hCG levels (over 100,000) or other signs (i.e. grapelike clusters, pain, bleeding, etc...).  Reading through online literature and it sounds like partial molar and molar pregnancies are often caught at the end of the first trimester and into the second trimester. 

How early can a molar pregnancy be caught?  This is what I've really been wondering since so many women who are being misdiagnosed with a molar pregnancy seem to be between 6-8 weeks.

I found this study:

A prospective study of ultrasound screening for molar pregnancies in missed miscarriages.

"The diagnosis of both complete (CHM) and partial (PHM) hydatidiform moles in first-trimester miscarriages is difficult. hCG is significantly higher in both CHM and PHM and, in conjunction with transvaginal ultrasound, could provide the screening test required to enable clinicians to counsel women more confidently towards non-surgical methods of management of their miscarriage, where histopathological examination is not available."

For this reason, if there is any reason to suspect your doctor is wrong in their diagnosis, you really might want to consider a second opinion especially during the first trimester.  Stay monitored though.

As always (((hugs))) if you are going through this scare.
 

Misdiagnosed Miscarriages in the ER - A Real Problem

According to RightDiagnosis.com, misdiagnosed cases in the ER or ICU range from 20% to 40%.  These numbers are huge.

I have been very thankful for ER doctors in the past but, please remember, they are treating everybody no matter what their specialties might be.  They don't have a lot of time with each patient either.  They are going from one room with a car accident victim to the next were somebody has cut his finger with a saw to the room with the toddler with a 104 temperature to the room where a pregnant women is bleeding.

Is it any wonder they don't get it all correct?

A woman just shared her daughter in law's experience.  At just shy of seven weeks, she went to the Emergency Room due to serious cramping.  No baby was visible.  They diagnosed a miscarriage.  Thankfully her DIL did not give up and they insisted on another appointment to verify.  At that appointment, they found the baby.

You may read her story here: 

Gmvallejo's DIL Story: Misdiagnosed in the ER

 I am sharing her story today because we have been seeing these stories for years.  Indeed, I was misdiagnosed in the ER as well and have shared that story.

Misdiagnosed at 12 Weeks

Our site is filled with stories of women misdiagnosed in the ER.  This doesn't mean that every woman that goes in there is misdiagnosed but it could mean that, at the very least, 1 in 4 may be.  This is important because you need to know there may be hope and you may need a second opinion.

I know I keep going on about the new UK guidelines:

Misdiagnosed Miscarriage? The UK Has Changed their Guidelines. Your Doctor Needs to Take Note.

but if your gestational sac is not yet 25mm, you should not be diagnosed with a blighted ovum.  The new guidelines are good ones and would prevent the vast majority of misdiagnosed miscarriages.  If there are no complications, wait until the sac is 25mm (if it is growing) and then wait one week to verify.  For most women, this will bring them to at least the nine week range before they can be diagnosed.  My gestational sac with my daughter was 28.5mm before my daughter could be seen and at only 21.5mm, it still looked empty.

As always, if you are going through this scare right now (((hugs)))  Feel free to visit the Misdiagnosed site or leave me a message here.