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Increased HCG, spotting on DUPHASTON in pregnancy.

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My wife is currently 11 weeks pregnant and the pregnancy has been confirmed with heartbeat detected via an ultrasound. My wife is 29 years old patientold, normal weight, with no identified health issues.

Around May 31,2015 my wife had been spotting for a few days (maybe week 7 of the pregnancy) and my wife's doctor put her on Duphaston (dydrogesterone). Day 1, she took a load of 30mg in one dose followed by 10mg, 3 times a day.

A week later, as her spotting didnt disappear, she was given two shots of 500mg each of Proluton Depot (hydroxyprogesterone), injected 1 week apart. By this time the spotting had started to clear and my wife was asked to phase off Duphaston gradually by reducing the dose to 20mg per day, then 10mg per day to zero.

On the evening of June 23, my wife had one day of heavier bleeding (but no cramps or pain) after a 3-hour shopping spree. As our main doctor was not accessible at the time, we visited another Ob Gyn at another hospotal who then carried out an ultrasound and said all was fine but (based on this new doctor's theory) that the placenta could be sitting low (although this was not visible on the ultrasound) and pressure could have caused the bleeding. She then injected my wife with 5000iu Choriomon (hCG) and asked her to come back for another equal shot a week later which will be this next Monday. The next day we called my wife's main doctor and updated her. The main doctor said that she doesn't recommend another shot of hCG but rather a shot of Proluton Depot on a weekly basis while restarting 30mg of Duphaston per day.

So we are confused and would appreciate your help.

Category: OBGYN

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Category: Infertility Specialist
 29 Doctors Online

Thanks for posting your query at
Can you please upload the ultrasound scan report ?
If the placenta was low lying, it would definitely show on the ultrasound scan.
Actually all the 3 treatment protocols are accepted for bleeding in the first trimester.
Bleeding in the first trimester is equivalent to a threatened miscarriage, and HCG, Duphaston and Proluton Depot are all 3 given to control and prevent it.
SO you can continue with your main doctor and take the Proluton Depot and the Duphaston, but the other doctor was not wrong in offering HCG either.
BUt progesterone is a must in the form of Duphaston and Proluton Deport.
HCG can be added , but if your main doctor omits that, no major harm done.
So please follow the advice of your main treating doctor.
Ask her to take rest.
Avoid intercourse, stress, shopping sprees, standing or walking or straining herself for prolonged periods etc.
And upload the ultrasound if possible.
All the best
Please feel free to discuss further.

Patient replied :

Hi Doctor, thank you for the detailed response. I have uploaded the ultrasound that we have (uploaded twice by mistake).
How long do you think weekly shots of Proluton and Duphaston tablets will be required before my wife can stop them?

I need to look at the scan report please , not just the images.
Can you please upload the typed report ?
She would have to continue them atleast till 14 - 16 weeks, provided the bleeding stops.
Progesterone in the form of Duphaston or natural micronized progesterone ( Susten / Naturogest ) can continue until the third trimester.
Take care.

Dr. Aarti Vazirani
Category: Infertility Specialist
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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