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Why is my pregnancy test still positive 2 weeks after an abortion? #1110/11

I had a surgical abortion when I was 7 weeks pregnant.  It is now my second week after the abortion, but still my home pregnancy test (HPT) shows positive. Why?  My doctor says that I could have an ectopic pregnancy, but there are no such symptoms of it.  Also, I had a clear USG of the entire abdomen.  Please explain!


The pregnancy test remains positive for a while after an abortion.

           

The following information is from the NEW 20th edition of Contraceptive Technology:

 

Pregnancy Testing and Assessment of Early Normal

and Abnormal Pregnancy

Mary Fjerstad, NP, MHS

Alison Edelman, MD, MPH

 

hCG LEVELS AFTER PREGNANCY COMPLETION

After a pregnancy ends in delivery or by abortion, hCG levels gradually decrease. Figure 23–3 represents the hCG disappearance curve following uterine aspiration at 7 to 13 weeks (upper curve), miscarriage at 6 to 15 weeks (middle curve), and surgical treatment of ectopic pregnancy (bottom curve).The initial decrease in hCG after full-term delivery is quite rapid, so that a hCG level following the delivery will have dropped to less than 50 mIU within 2 weeks, and hCG will be undetectable after 3 to 4 weeks.


 

Disappearance curves of serum hCG in three groups of women.  Semilogarithmic scale.  Upper curve represents women (n=36) who had elective vacuum abortion at 7-13 weeks LMP.  Middle curve represents women (n=35) with ectopic pregnancies diagnosed 2.5 – 11.0 weeks after LMP and removed surgically.  Source: Steier et al. (1984) with permission

 

Figure 23-3 Disappearance curve of hCG after abortion, miscarriage and surgical treatment of ectopic pregnancy



 

PREGNANCY TESTING AND ASSESSMENT CONTRACEPTIVE TECHNOLOGY

If first-trimester vacuum aspiration or medication abortion successfully ended the pregnancy, hCG clears normally from the bloodstream as expected and the hCG level declines steadily, halving at least every 48 hours after vacuum aspiration and after medication abortion, or halving within 2 to 4 days of taking misoprostol. When patients have medication abortion, hCG continues to increase following mifepristone but then declines precipitously after administration of misoprostol. However, since hCG levels are near their peak at about 10 to 12 weeks LMP, hCG levels may still be high enough 2 weeks following an abortion that pregnancy tests—both blood-based and urine—will still be positive. Sensitive pregnancy tests, including commonly-used office or home use urine test kits are likely to be positive between 16 to 60 days. By the first follow-up visit, 6 to 18 days after taking mifepristone, hCG levels drop to 20% of the initial value (measured on the day of mifepristone intake) in 98.5% of successful medication abortions. However, it is possible for some successful medication abortion patients to have hCG levels decline with a lengthy plateau. Patients who require uterine evacuation intervention less than 15 days after medication abortion due to prolonged bleeding or pain generally have higher absolute and relative hCG values than women with normal courses whose hCG values drop sharply. Unfortunately, due to overlap of hCG levels between those with a successful medication abortion and those who require uterine aspiration, no clinical decisions regarding uterine evacuation can be made based on hCG levels alone. In the case of a continuing pregnancy, hCG levels will demonstrate an upward trend: over 2 days, a mean rise of 124% and a minimum rise of 53%.25 If an ectopic pregnancy continues to evolve after medication or vacuum aspiration abortion, hCG values can behave erratically; these patterns are discussed in more detail in the section, Managing Problems in Early Pregnancy.  Research has demonstrated the expected fall of hCG following successful

medication abortion. The outcome of medication abortion can be followed by quantitative hCG instead of ultrasound, and this may save a woman from returning to the clinic for an in-person examination, especially if she travels great distance to receive mifepristone and plans to self-administer the misoprostol at home. Draw a quantitative hCG on the day the woman receives mifepristone in the clinic; the level is expected to drop by 50% within 4 days of receiving mifepristone if the pregnancy aborted. If hCG is tested 6 to 18 days after receiving mifepristone, a drop of 80% has a very strong predictive value in confirming successful medication abortion.

 

To learn more about the advantages and disadvantages of all available contraceptive methods, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?

 


Key Words:  surgical abortion, pregnant, ectopic pregnancy, symptoms, hCG levels, positive, Mary Fjerstad, NP, MHS, Alison Edelman, MD, MPH, delivery, Contraceptive Technology

 

Reference:

Fjerstad M, Edelman A. Pregnancy testing and assessment of early normal and abnormal pregnancy IN Hatcher RA, Trussell J, Nelson A, Policar MS. et at. Contraceptive Technology 20th edition, pages 660 and 661: Ardent Media Inc. 2011

Posted 11-30-2011,Updated 12-13-2011, Updated 1-3-2012

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2012-01-3


Contraceptive Technology 20th Edition & Managing Contraception
  


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