HCG Information Leaflet

Transcription

1 HCG Information Leaflet Department of Gynaecology Elective Division

2 We understand that this can be an emotionally difficult time whilst you are waiting to find out what is happening with your pregnancy. Until we have these answers please be reassured that you can ring the numbers at the end of this leaflet if you need more information or if you are worried. We hope this will provide the answers to some of the questions you may have. What is an HCG level and why is it necessary? This stands for Human Chorionic Gonadotrophin. This is a blood test that measures the amount of pregnancy hormone in your body. It is the same pregnancy hormone that can be present in your urine. However a urine result will only give a positive or negative result. The blood test is more accurate providing the doctors with more specific information and therefore will assist them in planning your treatment and care. It adds to the information that a scan can give and is especially useful in very early pregnancy when the scan findings are sometimes not beneficial. An HCG level is requested by doctors primarily if there is concern about an ectopic pregnancy or if there is concern about the accuracy of a urine pregnancy test. An ectopic pregnancy is a pregnancy outside the womb usually in a fallopian tube. Blood levels are monitored to help diagnose an ectopic from an ongoing pregnancy or a miscarriage. How does this help exactly? A pregnancy that is developing in the uterus (womb) where it should be will result in the levels of hormone in the blood approximately doubling every 48hrs. A level that is continually decreasing by approximately 50% (or half) generally indicates that a pregnancy is miscarrying or failing to develop. However, close follow up is still important, so that an ectopic pregnancy is not missed.

3 s that remain static can indicate an ectopic pregnancy or an early pregnancy in the womb that is no longer developing normally. What is a normal HCG level? A urine pregnancy test will turn positive generally when the pregnancy hormone circulating is above 50. Hospital pregnancy tests are generally more sensitive and can turn positive from 25. Women have to be individually assessed as levels will range greatly from pregnancy to pregnancy. For example, if 10 women had a HCG level at 8 weeks there would be a huge range of results. There are other factors that cause high levels, such as multiple pregnancies or a molar pregnancy. It is essential that diagnosis and planning of care is based on a combination of blood tests, scan results, history and your individual signs and symptoms. All are important in helping doctors understand what is happening with the pregnancy. A hormone count of below 2 means a negative pregnancy test. How often will I need blood tests taking? The HCG levels should be taken 48hrs apart. It is often necessary to take 3 sequential blood tests 48hrs apart to establish the pattern of results. The doctors will plan this individually for each woman. When are my results available to me? The blood tests are normally processed mid afternoon and then results are available to doctors or nurses by approximately 4-5pm. A senior doctor reviews these and individual follow up is then planned before you are contacted.

4 The staff from the early pregnancy assessment unit (EPAU) will contact you around 6pm 7pm. This is important even it is the first level to ensure that you have not had any physical changes since being seen at the hospital. It may also be necessary to organise a scan if you have not already had one. Please note results will not be left on answer phones or with any relatives. We respectively ask that you contact the EPAU or the gynaecology ward on the numbers provided at the end of this leaflet if you have not heard from us by 7pm. On occasions we have difficulty contacting patient s mobile phones (out of credit) or land-lines that are barred from taking anonymous calls (such as the hospital switchboard system). Results are not available at the weekend. What happens if you tell me my levels are high? A pregnancy should be visible on ultrasound scan with a level of above If a scan has not been carried out then this would be the next step. This is often an internal vaginal scan which helps provide more information in early pregnancy. A scan would be arranged as a matter of priority. What if you have scanned me already and my levels are high? If a scan has not detected your pregnancy you will be closely monitored with possibly further blood tests and scans as well as being monitored for pain and bleeding. If we are concerned you may have an ectopic pregnancy, you will usually require an operation called a laparoscopy. What happens if you have seen a pregnancy sac? A further scan will be organised as it is not until a yolk sac or a fetus with a heart beat has been seen within the pregnancy sac, that we can be sure the pregnancy is in the right place. Until then, caution will remain and you should inform us if your symptoms change. A repeat HCG level is sometimes required.

5 What happens if my blood tests are doubling every 48hrs? This is reassuring but further scans will be done until a fetus with a heart beat can been seen. The doctor thinks I have miscarried so why do I need these blood tests? Because ectopic pregnancy can be difficult to confirm, at times it is important you are monitored until we are 100% sure that the pregnancy has ended. This is particularly important if we have seen no sign of a pregnancy on ultrasound scan. This can be because you have already miscarried or it may be because you are miscarrying an ectopic pregnancy. The doctors will recommend a follow up with blood tests or sometimes a urine pregnancy test. I have already had an operation (laparoscopy) for an ectopic pregnancy so why do I need more blood tests? The doctor may advise a further blood test just simply to ensure your levels are returning to normal, that all pregnancy tissue has been removed and that you make a safe recovery from your operation (laparoscopy). I have had an operation for my miscarriage (ERPC) so why do I need a blood test? Sometimes the doctors will re-call you back for a blood test after your operation (ERPC). If the laboratory examination of the tissue removed shows no evidence of pregnancy tissue, it may be that the pregnancy still remains in the womb (failed ERPC) or that you had an ectopic pregnancy. You may have gone on to miscarry completely, but we need to be sure that the pregnancy is completely over.

6 Why do I need to return to EPAU to have a pregnancy test? This is so that we can safely follow your care though and discharge you when we are satisfied with your results. It also provides you the opportunity to ask any questions you may have. Signs and symptoms of an ectopic pregnancy. Light bleeding / spotting from the vagina (front passage) Stabbing pain in your lower abdomen / side Dizziness / fainting Pain in your shoulders this can indicate bleeding in your stomach Please contact the EPAU if any of this happens. Contact Numbers Early Pregnancy Assessment Unit (EPAU) Mon Fri, 9am 7pm Gynaecology Ward hrs EPAU Bleep (Trained nurse) ask for bleep 1238 EPAU and the gynaecology ward are on 1 st Floor, Sherborne Building, Basingstoke and North Hampshire Hospital

7 Record of your results

8 Basingstoke and North Hampshire Hospital Aldermaston Road Basingstoke Hampshire RG24 9NA EPAU Sister Pauline Bawden Dr Catherine Pappin, MRCOG Dr K Ramalingam, MRCOG March 2010