<s>[INST] Hello doctor, I have a positive UPT and my LMP is 31st March. I have an irregular period at 13th May and I found some blood spots. After that, I go for a TV ultrasound that shows no definite gestational sac, endometrial echo is central and normal in thickness and measures 0.6 cm. Before TV ultrasound, on 8th May, I checked my beta hCG and it is 178 and after 48 hours it is 247. Is this miscarriage or should I go for another ultrasound because after that I do not have bleeding or cramps or anything? Please guide. [/INST] Hello.   I have gone through the description you mentioned and understand your concern totally. But the details are a little confusing, it would have been good if you could give details with dates when beta hCG (human chorionic gonadotropin) was checked. I understand that scans were performed and the beta hCG test on 8th May is 178 and on 10th May it was 247. On 13th May you got the scan as you had a spotting, right? See, as your previous cycles have been irregular, it is difficult to predict when you would have ovulated exactly. So we cannot go by your dates to calculate the duration of the pregnancy. May I know when did the urine pregnancy test turn positive for the first time? It would be advisable to recheck your urine pregnancy test now again, as you had spotting, if the levels are falling then it would be suggestive of a miscarriage, and mostly this could be like a biochemical pregnancy, where pregnancy is detected only in the blood tests, but on the scan I cannot find the gestational sac development, which has ultimately got aborted. (As levels you mentioned last were pretty low). Another possibility to be ruled out, more importantly, is ectopic pregnancy or pregnancy at some unknown location. To rule out all these, doing a serum beta hCG will clear your doubts. Serum beta hCG level. Repeat ultrasound after checking the beta hCG value. Report to your gynecologist if you have any sharp pain. </s>