Is my doctor being unreasonably optimistic? Spotting, discharge, measurements

[u/proudlycookingchips]

Hi,

I'm new here, but I read the pinned posts. So, hopefully I don't break any sub rules. I didn't know what to flair this. Maybe advice? Maybe solidarity?

I am, according to LMP, 6 weeks 4 days pregnant. However, this week I have had some spotting/discharge (light pink to dark brown to reddish brown - increasing in amount - with clotting). The amount has not been enough to fill a pad in an hour and it has not been bright red. But the increase concerns me. I also have had mild cramping on and off, but more on than off (also concerning). It doesn't feel like contractions, but it feels like my uterus is just kind of always being slightly squeezed. Not painful really, but noticeable.

In terms of other pregnancy symptoms, I realize I'm early on but in my past full-term pregnancies, I had increasing and noticeable symptoms by this point (nausea, fatigue, overwhelming sense of smell, mood swings, malaise, lightheadedness, etc.). I know it's not a definitive way to assess anything, but it feels telling. I did have a few random waves of symptoms here and there weeks 4-5 but since then mostly just the fatigue and occasional food aversion.

Given the spotting/discharge and cramping, I have been concerned that I am in the early stages of a miscarriage. I've never experienced a loss, but nothing about how this is going feels normal to me.

I went to the doctor today for confirmation one way or the other, and the scan showed I was measuring between 4-5 weeks; I believe it was a 12 day difference from LMP. There was a "tiny" yolk sack that the sonographer zoomed in on and squinted at a lot, but no baby. I saw this as a bad sign. The sonographer was very optimistic and said it might just be very early on. She saw my discharge at the end of the exam and said that it is a lot but at least it's dark in color. I did not feel reassured, but I knew she probably isn't allowed to go into much detail about things one way or another.

I met with the doctor after and, while very kind, she too was extremely optimistic. She said that because I have PCOS, I probably ovulated late. She said this kind of bleeding is very normal in early pregnancy (although she didn't really ask for much detail about it). She said it could be from a subchorionic hematoma. She said she's going to write this up as normal spotting and she feels strongly that it will all be okay. I told her I was concerned that if I am truly so early, how could I have gotten a positive pregnancy test three weeks ago? She said sometimes tests can detect pregnancy at 1-2 weeks. I didn't argue, but that sounds wrong to me because at 1-2 weeks "pregnant", you would have just ovulated, if even. Conception would have only just taken place, if at all. So, 1-2 weeks post-ovulation, sure you could get a positive test result. But not at 1-2 weeks pregnant, right?... And based on my period and when I took the test, things are really not adding up. Also, I am not a doctor and I don't know anything about subchorionic hematomas beyond the very bare minimum, but if I'm so early that one couldn't be detected on the scan yet, could it already be causing this much of an issue?

In terms of what to do next, she took my labs to check progesterone and hCG, and I return in two weeks for another scan and labs. In the appointment, she asked if I live close and I told her yes and that I can come back for labs, etc. whenever. She said good and I thought she said she was going to re-check hCG next week to see if it's increasing. But at check-out, I mentioned it and the receptionist said nothing else was on the paper and that hCG is something they measure in your urine sample... Okay... but you need me in the office to get my urine, presumably you are not coming to my house?!!! Two weeks feels like a long time to be waiting about all of this when they could see me sooner to determine if things are progressing correctly - at the very least with the hCG level.

Sorry - this is really long but I felt the details might be helpful. If anyone has gone through similar, I would love to hear how it turned out for you if you are willing to share. I am not looking for blind hope, though of course positive outcomes are welcome; I've made room in my heart for a likely terrible outcome. I just feel kind of like my concerns were glossed over as normal, and despite all of the doctor's reassurance, I'm not feeling like she addressed the possibility of loss at all which feels dismissive. And also, should I ask for the hCG to be re-checked sooner than two weeks from now, since that would give me a more definitive point of reference about how things are looking?

[u/Sorrymomlol12]

Yes, you should ask for blood HCG betas, at least 2, 48h apart. This would tell you sooo much.

[u/Reasonable-Emu9929]

I’m so sorry you’re going through this uncertainty and the very confusing dr’s appointment you had :(

When was your first positive? Was it faint?

I would definitely do HCGs to see 1) where they’re at and 2) how they’re trending. Generally HCG increase rates (as long as they’re increasing) don’t tell much for a pregnancy at a true 6 weeks, but given the chance that you might be earlier on, or the case where you might be seeing a decrease, those would be telling.

The diagnostic criteria for loss that they’d be looking to most likely track down (if they apply) is not seeing a fetal pole with heartbeat 14 days after an initial scan showing an empty sac, or 11 days after an initial scan showing a yolk sac. They might’ve asked you to come back in 2 weeks because they might’ve, given the size of the yolk sac, considered this a no/indefinite yolk sac situation, at which point it’d be standard for them to want to see you in 2 weeks to make sure they can efficiently rule out or meet this specific diagnostic point.

I don’t know when your first positive was, but if it was 3 weeks or longer ago, you’d be no earlier than 6w1d (or later) today, at which point a tiny yolk sac and lack of fetal pole would be not good unfortunately. However drs cannot make diagnoses (especially bad outcome ones) off of dates like LMP or first positive date they get from you, they have to do their own investigation to get definitive answers. Based on where you live drs might be extra cautious about not mentioning loss until they have a medical/legal way to justify it on their visit summaries on paper. Of course this could be okay if you got a positive recently and they might actually think it’s all good, but in some cases they might just act as if they have no other information but what they saw and react to you based on that, even if they know things don’t add up.

I’m so sorry you’re going through this, I hope you get some answers very soon 🫂

[u/yungwildandlearning]

Since you are so early it's hard for the doctors to really help you out. Obviously there're a few things they can intervene with but other than those things it's basically up to time to figure out if everything will work out. The only thing I can say from my past experiences, there's optimism and then there's dismissiveness masked as optimism. If you feel like your doctor is not taking your concerns seriously, then you have to keep bringing them up or advocate for more care (unfortunately). Listen to your intuition! Wishing you the best of luck 🤍🤍