Expert: Lawrence Jay Rappaport <B>M.D.</B> - 10/11/2005

Question
I am 27 and have one 8 year old daughter.  I found out I was pregnant on Sept 19th and my last menstrual cycle was around Aug 15th.  However, when I went to my first OB on Oct 6th, the ultrasound only showed a gestational sac.  The Dr. ran labs and my HCG was 4053 and progesterone 13.7.  He said that I was definitely only 4 weeks pregnant (menstrual cycle was irrelevant) but my progesterone was too low.  He has said that a miscarriage might occur, but has put me on progesterone injections.  I will go for another ultrasound on Oct 24th and will redo labs Oct 13th.  I am concerned because I have no real symptoms of pregnancy (but it was the same way with my first child), and I don't understand how I can only be 5 weeks pregnant (as of now) and my last cycle was Aug 15th.  Is there any chance that this is still a good pregnancy?  

Answer
If your last period stgarted on August 15, on October 6 you should have been 7 weeks 2 days. If the sonogram only showed an empty gestational sac, that would mean that you were less than 5 weeks pregnant at the time. I would repeat the sonogram on October 24 to see if there is any further growth. If there is no change, I'm afraid it is a missed abortion. While the progesterone levels are a bit low, they are not severely decreased. It would definitely help to take some progesteronee supplementation, either injections, suppositories, or orally.