Q&A: Should I get a second opinion before getting a D&C?

by Dr. Gerard M. DiLeo

I just had an ultrasound on January 5th. The radiologist said there were some concerns about blood flow and that it may be a "non-viable" pregnancy, then advised me to go see my doctor with the results and get my Human Growth Hormone levels checked. I went to my doctor the very day he received the ultrasound results, and he wanted to schedule a D&C! I was horrified! I have had no cramping, no spotting, bleeding, or any other reason to believe that I will miscarry. He did not even mention getting an hCG level test!

I told the doctor that I will get a second opinion. He responded that he thinks I could start hemorrhaging and dosen't want to delay the D&C. I told him if I hemmorage I will go to an ER. I am definately going to see another physician.

Until then what should I do? I have so many questions that my current doctor did not answer. My further concern is that the conception date may be miscalculated because my periods are so irregular. Could the baby be a lot smaller than they think and not be readable on the ultrasound yet? If the baby is dead or "non-viable" then won't I naturally miscarry? Will my body hang on to something that is dead? I don't feel sick at all, other than a little upset stomach that I have been experiencing for about four weeks. I am 34 and this is my first pregnancy so I am concerned and inexperienced. Most of my friends believe I should get a second opinion.

I am living on the Big Island in Hawaii and I am in the middle of moving to Honolulu where I will get a doctor's appointment within a couple of weeks.

I am not planning to give up yet! Please answer my letter, I need to get some answers (or advice) to my concerns, I am losing sleep! Thank you for your time and consideration of my concerns, I look forward to your reply.

The only way I would plan a D&C in my own practice would be to document a fetal demise by the following criteria:

  • A fetus on ultrasound with no heartbeat
  • OR
  • An empty sac AND two declining HCG titers in a row.

Yes, your dates can always be off, which can falsely make the ultrasound look bad, but the HCG levels tell no lies! (Although it's normal for HCG levles to start declining or plateau-ing around ten weeks.)

Definitely get another opinion. I'm not saying there's anything wrong with your doctor other than just a communication problem, but you can't go wrong getting a second opinion. If you're moving to Honolulu, since it's a large city, you can seek the opinion of a maternal-fetal specialist at the university--the top of the line for your information. And you can wait, since hemorrhaging so severely as to put you at risk is rare. But I would say the benefit of not writing off your baby far outweighs this small risk.

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