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Forum Name: Obstetrics

Question: Vanishing Twin Syndrome + High HCG


 Sensi1 - Sun Jan 11, 2009 5:47 pm

I recently went to the ER and discovered I was at least 9 weeks pregnant with what appeared to be twins. Age of gestation was determined only from vaginal exam and vaginal sonogram because at The time I was having an ongoing menstral (the whole month of December) and normal periods for the 3 months prior. Though there was a split sack (with an obvious baby in one and some tissue in the other), there was only one heartbeat detected through vaginal sonogram. My labs were unexplainably abnormal as follows:
HEMATOLOGY
HGB- 10.9L
HCT- 34.2L
MCV- 79.3L
MCH- 25.4L
RDW- 18.1H
MPV- 10.9H
MONOCYTES % AUTO- 10.5H
COAGULATION
PARTIAL THROMBOPLASTIN TIME- 24.2
URINALYSIS
LEUKOCYTE ESTERAS...- SMALL AB
WBC- 5-10
EPITHELIAL CELLS- MODERATE
BACTERIA- MODERATE
URINE PREGNANCY- POSITIVE
ENDO & NUTR
HCG QUANTITATIVE- 214320.0H
CHEMISTRY
BUN (TAKEN 2X)- 6.0L/ 7.0L
CREATININE (TAKEN 2X)- 0.60/ 0.60
CO2 (TAKEN 2X)- 23/ 20L


My concern is I am still pregnant (three weeks later) and there has been no treatment other than a prescription of prenatal vitamins and one bag of sodium chloride through IV at the time of ER. Will the remaining tissue affect me and/or my living fetus? Should I have the remaining tissue removed if it hasn't already came out on it's own? I am still having minor vaginal bleeding from time to time, am I likely to miscarriage the living fetus? And lastly, if all is well and this is a case of Vanishing Twin Syndrome (VTS), why would I have such a high HCG? Should I be concerned?
 Debbie Miller, RN - Mon Jan 12, 2009 1:21 pm

User avatar Hello,
These are good questions. First let me remind you that lab values are important but only part of the whole health/illness picture. Each person has their own curve when it comes to HCG levels so while a pattern can help determine a viable pregnancy vs miscarriage, the values, especially in the case of vanishing twin or other complications can vary greatly. Other lab values vary with the particular lab and their controls so it requires a doctor to explain them, in light of the lab particulars. The values are really only useful as part of the physical exam and other findings from history, symptoms, etc. It is misleading to try to interpret these alone and if labs told the whole story, technicians could do most of our health care. Draw blood, get results and recommend action if needed.

Some experts believe that vanishing twin syndrome may occur in as many as 1/3 of all multiple gestations, often occurring before the woman is aware there were multiple fetuses. In days past, most women did not receive pregnancy confirmation until they had missed a second period. By then, this may have already occurred while she was unaware.

If it happens in the first trimester there is rarely any problem with the remaining fetus and the additional, non-viable one is reabsorbed into the placenta. Later in the pregnancy there is a chance it could cause problems and sometimes the twin is removed surgically, though this is not without risks to the surviving twin.

Without intervention it would be impossible to predict your odds of carrying to term. Minor bleeding happens in healthy pregnancies as well as impending miscarriage. Only time will tell and unfortunately, there is little to be done to intervene if loss is inevitable. Just do what you can to be healthy, eat good foods, take a daily vitamin, get exercise but not too strenuous, avoid bad habits such as smoking, drinking, drugs and use your seatbelt. These are things you CAN do to make a difference. Try not to dwell on the things you can't change. High stress hormones are not so good on you or your pregnancy.

Best wishes

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