In early pregnancy medical limbo -- advice appreciated

Hi all, 

I'm 6 weeks pregnant, and had a bunch of bleeding last weekend, assuming the worst. Because I'm not yet established with an OB, my primary sent me to get an urgent ultrasound at UCSF, and it came back inconclusive. The doctor who performed it (a radiologist in Mission Bay) told me to come back for another ultrasound in 10 days to confirm viability, but now I'm in a kafkaesque loop where UCSF won't see me again until I'm an established patient, and they won't see me to establish care until the 10 week mark. Sutter wouldn't see me before week 8. Does anyone have any experience with prenatal care in this case? I'm so lost and so anxious, and there's no actual doctors to talk to. Any advice would be greatly appreciated. 

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I’m so sorry this is happening. Can your primary care physician order blood tests for you to check your hcg levels 48 hours apart? This will allow you to understand whether levels are rising, as would suggest an ongoing pregnancy, or falling, which would indicate a pregnancy loss. I’ve been there and my heart goes out to you. I hope you are able to have clarity sooner than later. 

I'm so sorry to hear that. I hope everything turns out OK. I've heard that Millie Clinic (where I go for my prenatal care) in Berkeley will get you an ultrasound early. 

So sorry you're going through this! I had a miscarriage fall of 2021 - I had some bleeding at about 6 weeks, went to Kaiser ER, and was told things were inconclusive. Had more bleeding 2 weeks later and went back to the ER, where I was told that it looked like a likely miscarriage, which was confirmed the following week at my first OB visit. They often don't schedule first OB visits until 9-12 weeks because the risk of early miscarriage is so high and they want to make sure the pregnancy is more established before enrolling you into care. One thing your PCP could maybe do to give you some answers without being seen is order sequential quantitative HCG levels. If your levels are rising, that's a good thing for the health of the pregnancy.

Your PCP should order another ultrasound. Alternatively, the UCSF Betty Irene Moore Women's Hospital (1855 Fourth St., Third Floor) inpatient birth center has a triage area where doctors can do ultrasounds on you in between seeing their patients. Just go up the the 3rd floor and tell the front desk that you're there to be checked out due to bleeding. 

I’m so sorry you’re going through this. I don’t have experience personally with this exact situation- but wanted to offer a suggestion. If you say you have new or worsening symptoms I believe they are legally obligated to get you in. Then once you’re in you could get an ultrasound. Also- for what it’s worth- I had a lot of bleeding with my first pregnancy, and everything ended up being fine. Try not to worry too much yet (although I know it’s impossible.) Good luck! 

I'm sorry you're going through this. It sounds like you are looking for advice about how to get out of the loop and also to understand if this pregnancy is viable or not. My suggestions are to ask your doctor (either primary or see if you can message an OBGYN at Sutter or UCSF) for a standing lab order to take your HCG levels so that you can monitor your HCG level trends. If you feel strongly about an ultrasound, you could follow up with the radiologist in Mission Bay or you could seek out a "boutique" service such as midwifery practice and see if they could offer you an ultrasound and in person appointment earlier than UCSF or Sutter (San Francisco birth center comes to mind). Unfortunately, besides monitoring your HCG levels, there isn't much else that can be done except wait. I would suggest you keep an appointment at both Sutter and UCSF for peace of mind. Sending you compassion and hoping for the best for you. 

I found the Sutter OB practice in Berkeley to have very bad communication between the OBs and staff and simple things like ordering a time sensitive prescription would fall through the cracks. I would assume that whoever you spoke with doesn’t have the final say in whether you get treated and use what others have suggested, even if it’s an exaggeration, that you’re having worsening symptoms. If this is indeed a miscarriage, know that you are not alone and while it is devastating, it is incredibly common. 

It's a bit of a drive, but the prices are decent (as unreimbursed medical expenses go) and you can just go get an ultrasound without a doctor's order at Lance Dursi/Scanbabies in Los Gatos: Be aware that the vast majority of patients are there to get photos of their babies in utero, so it may be a tough place to be if you end up finding out your pregnancy isn't viable, but honestly, it's not any better at Sutter/UCSF etc. etc. where again, most people are getting wonderful news/getting to see their baby. I speak from experience, alas. As someone who found out I was carrying an empty sac at 12 weeks, I'd definitely encourage you to figure out what's going on sooner rather than later. Best of luck and stay strong.

I'm so sorry you are going through this, I've had the same experience and understand what you might be feeling and do I hope things have turned around for you since you posted.  For medical advice - it might be a bit far but Stanford LPCH down in Palo Alto has an early pregnancy clinic that will see people in early pregnancy through their Gyn clinic (rather than ob clinic - where you can't see anyone until 10weeks, which is crazy to me). 

Hello! I am so sorry you are in this situation. I was in the same situation during my pregnancy and the bleeding was scary! Then I was asked to quantify it--like in tablespoons or something. How exactly does one do that? Mine turned out fine when I finally got in to see my OB and I gave birth with no complications--so there is reason to hope! 

I wanted to give one piece of advice: someone else seems to encourage you to say that your symptoms are worsening--even if that isn't true--to force the hand of the provider. I would just like to say (as a medical provider) that patients should never give symptoms they don't have or make up any information they are giving their doctor to try to get the doctor to do one thing or another whether it be see them or prescribe something. It can cause unnecessary testing to be done costing you a lot of money and it could result in an incorrect diagnosis and treatment which could harm you (or your baby). I've had patients say something incorrectly just to get in, and then admit once they were in the door that they had done just that. It isn't a good start to a doctor-patient relationship. And, at this point, it seems so many people are doing it, that I must simply end the urgent appointment once I hear the true history. Doctors are people too. We are doing our best, but we are overburdened right now and lots of our colleagues are leaving the profession--which is making the problem worse. At this point--if you are miscarrying--there isn't a treatment that will make that stop. That is why the system is set up the way it is--even if that system isn't the best for our mental health! But, honestly, more time needs to go by for any doc to know for sure. Hang in there, Mama! 

I am SO sorry you’re in this terrible limbo. I’m aaa at nurse practitioner and I have had so many patients in this predicament, it’s really crazy. You might try Planned Parenthood - all do ultrasounds and some locations do prenatal care, not sure if you have to go to one of the ones that does or not. I wish I had better advice to offer. Best of luck to you 

Some primary care providers will manage things with an ultrasound and/or blood work but some won’t. It’s definitely worth asking.

Hi there, I'm so sorry you are feeling lost.  I hope your primary care provider has been able to order beta HCG tests for you - that should provide some information while waiting for the next ultrasound.  Your primary care provider should also be able to order a radiology ultrasound at UCSF or Sutter for around 8 weeks.  Maybe UCSF just needed a new order?  But if they really could not see you again before 10 weeks, Sutter is a good option (either at Alta Bates or in SF at 1100 Van Ness) - radiology, not OB/Gyn.  Best of luck.  As someone else noted, prenatal care often doesn't start until 8-10 weeks because many pregnancies end naturally before that point.  But knowing it is common doesn't mean it is easy.  

This is a late reply but just in case you are still in limbo — I’m really sorry for both the anguish and the confusion

Your pregnancy symptoms can be a clue in this situation — did you already have them (tender breasts, nausea, food intolerance, sensitivity to smells) and have they gone away? Usually in a an early pregnancy loss, the bleeding starts after the symptoms have already started to resolve.

A small offering re: language. The term “miscarriage” is full of both blame and shame. In reproductive medicine we have shifted towards “early pregnancy loss””.” It’s clunky but takes away the blame and speaks to the emotional experience of loss. 

I have experienced 3 miscarriages and 2 full term births (and 2 abortions): please know that having a miscarriage does not mean you cannot or will not have a full term pregnancy in the future. 
best wishes to you 

I am so sorry this is happening but want to address some repeated claims on these responses, since I didn't see anyone mention they are an actual ObGyn, which I am. There is no role for testing HCG levels once a pregnancy is seen in the uterus, the trend cannot tell you if this is a normal pregnancy or not, the only thing that can is a repeat ultrasound. Trending HCG levels is something people do very early on, if they got fertility  treatments or if there is concern for an ectopic pregnancy, meaning they don't see it in the uterus. I know how scary it is early on to have no idea but the recommendation to wait for a repeat ultrasound is the only one that can be made. once  the ultrasound is done then a plan can be made. Either way this is not your fault and bleeding doesn't mean it won't work out, but I know how scary this time can be.