Ectopic Pregnancy

Finally Arrived: Ectopic Pregnancy - Lessons Learned

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I have now been pregnant twice. Both pregnancies were tubal ectopics, both ruptured, and both required emergency surgery and shots of Methotrexate. In both cases, I was lucky to escape with my life. (You can find the gory, bloody details here: 1st Ectopic, 2nd Ectopic.)

I feel like an idiot for letting this happen to me twice. If I had known more and been more alert, I might have caught and resolved these ectopics before emergency intervention was required. Perhaps I would still have my tubes. Hell, perhaps I would have a baby in my arms.

Since a lot of people end up here via Google searches on ectopic pregnancy, I thought I'd do a post on lessons learned about ectopic pregnancy based on my own personal experience. Ectopic pregnancies can be very hard to detect and even harder to end.

1) Home pregnancy tests might not detect an ectopic pregnancy. During my first ectopic, I had a negative home pregnancy test on cycle day 3, only to discover a 6.5 week ectopic pregnancy 2 weeks later.

2) A low Beta HCG ( 1) might indicate an ectopic pregnancy. During my second ectopic, I had a Beta HCG of 5.9 after an IVF cycle (10 days past day-3 transfer). At the time, the nurses told me 5.9 was a negative pregnancy test, but I now know that anything above 1 is slightly positive. If I had a a follow-up Beta HCG blood test, my ectopic pregnancy would have been detected a full 5 weeks earlier and I would not have required emergency surgery.

3) You can get your period and still have an ectopic pregnancy. During both of my ectopic pregnancies, I received my period right on schedule and had no idea I was pregnant.

4) Getting a shot of Methotrexate does not remove the risk of an ectopic pregnancy rupturing. My second ectopic ruptured 8 days after a Methotrexate shot.

5) Surgery might not resolve the ectopic; you might need a shot of Methotrexate anyway. The opposite of #4 holds as well; you might get surgery but still need Methotrexate. My first ectopic was treated surgically with salpingostomy - they carefully cut open the tube and tried to scoop the ectopic out. It did not work and the ectopic pregnancy persisted; HCG levels continued to rise. I required a shot of Methotrexate 9 days after surgery to finally resolve the ectopic.

It is more common for ectopics to persist after a tube-sparing salpingostomy than after a tube-removal operation, such as a salpingectomy.

6) Ruptured ectopics can have very different symptoms. A ruptured ectopic can seem like a heavy period, with a slow bleed over several days and minimal pain (like my first one). Or it may be a massive internal bleed with an acute onset of pain and no vaginal bleeding (like my second). Prior to the rupture, you might have pregnancy symptoms or you might not, and you might feel great or you might feel like crap.

7) Your chances of subsequent ectopic increase the more ectopics you have. About 2% of pregnancies are ectopic, however once you've had one your chances of a second are increased 10-fold, to a 20-30% chance per pregnancy. Once you've had 2 ectopic pregnancies, the chance of a third pregnancy being ectopic is 50%.

8) If you've already had one ectopic, please be extra-extra cautious. Because ectopic pregnancy can go undetected for so long and can kill you within hours of a rupture, please be extra careful if you have already had a prior ectopic.

If you are having unprotected sex, consider taking home pregnancy tests several days into your cycle or after your period stops, to increase the chances of catching an ectopic pregnancy.

If you are completing an IUI or IVF cycle, demand follow-up Beta HCG blood tests until either the results are definitively negative (HCG less than 1) or you have an ultrasound confirming an intrauterine pregnancy.

If you are not planning to conceive, go on birth control, or consider a vasectomy for your partner. Tubal ligation is another possibility, but there is still a small chance you'd get pregnant with a TL and an even higher chance that the pregnancy would be ectopic.

9) If you have a nagging feeling something is really wrong, get it checked out. With my first ectopic, I did not have many physical symptoms. Instead, I had a feeling that something was very wrong and I even had a suspicion it was an ectopic pregnancy. That feeling turned out to be right.

A few weeks earlier I had read a book by Dr. Marie Savard, How to Save Your Own Life, that convinced me to listen to the something is really wrong feeling. She said patients very often intuitively know how serious their medical condition is, and that if a little voice is telling you something is really wrong, something probably is. Listen and get checked out. Posted on Apr 19, 2005 at 08:24 PM in News & Facts for the Infertile | Permalink Comments

Please don t beat yourself up about feeling like you should have known better. Who would honestly think that you would have another ectopic pregnancy? I kind of know how you feel because during the very early stages of my pregnancy, the doctors suspected an ectopic, although it turned out not to be. My early warning signs of a pregnancy in trouble were irregular HCG doubling times. It was hell, to say the least, and just when I thought everything was going to be OK after seeing a heartbeat, all was not well. I have heard of success stories after having tubes removed because an ectopic is impossible, so I have a strong feeling things will be OK for you. Best of luck, I am crossing my fingers for you! Posted by: Lisa | Apr 20, 2005 at 01:27 PM

Very informative, thanks. Can you point me to the into on the HCG 1 being negative? Everything I read says 5 is negative. Posted by: Jenn | Apr 21, 2005 at 09:37 AM

I didn t realise how difficult ectopics were to spot. How awful for you to have gone through this twice. NB my email address was wrong - I ve updated it now. Posted by: Thalia | Apr 21, 2005 at 10:51 AM

As an ectopic survivor, I d like to thank you for this list. Especially the part about low beta numbers. With my ectopic, my first beta was 4.9. The nurse at my OB s office told me I didn t need to repeat the beta because, its not a real pregnancy, your numbers should be in the 1000s by now I know that I saved my tube and perhaps my life by insisting on repeat betas. Which, by the way, doubled appropriately for about 10 days, until they dropped then rose again. Thanks again for writing this, and I m very very sorry for your losses. Posted by: Megan | Apr 29, 2005 at 08:55 AM

Thank you so much for providing this information. I have some questions and I will email you about them. My internet access is very limited here in S.C. but my email seems to be more reliable. Posted by: Julianna | May 04, 2005 at 03:15 PM

I just sent you a very paranoid and neurotic email. Thank you for helping. Posted by: Julianna | May 04, 2005 at 06:09 PM

I just wanted to say hi. I have also had two ectopic pregnancies in a row. My situation is different than yours, as we are using known donor sperm and inseminating at home. My first ectopic was in my left cornua and was treated with methotrexate successfully, the second was in my right tube, and although my beta dropped swiftly, I developed a large blood clot in my tube and needed surgery anyway. We can add that to your very good list: Just because you get methotrexate to treat an ectopic at 5wks 1day, and your beta was only 800, and drops to 68 in 5 days, doesn t mean you won t need surgery. If you have pain (I was cramping in a weird way and still bleeding), make them do an ultrasound no matter how many insurance folks you have to harrass. It probably saved my life. OH - and normal doubling doesn t mean you don t have an ectopic. Both mine had normal doubling and I never had particularly low beta levels. Anyway - it was actually a good thing that they ended up doing a laparoscopy, because they found mild endometriosis (which I had zero symptoms for) and removed it. Hopefully that was the cause of my ectopics, but I am seeing an RE in a couple weeks before we try again.

I m 2 for 2 right now: two inseminations, two ectopics. If you read back through my livejournal you ll get more of the gory details, along with plenty of whining. I personally find it ridiculous that I conceive so easily, only to have them end up in the wrong spot. Since I am a lesbian, these were literally the only two times in my entire life that my body has encountered sperm. Totally ironic.

Best wishes and thanks for the great post. I linked here from your comment on Hardscrabble, just so you know. Posted by: jenny | Jun 23, 2005 at 07:25 PM

I ve also had two ectopics. In both cases after being a week late I had something that looked like a period or early miscarriage. Later I found out that I just lost the lining of the uturus. When HCG is 100 levels are to low to sustain the lining, so it comes out.

First time I thought it was a normal early miscarriage although I didn t see a sac or embryo, but how should I know I am not a biologist!

I have been very lucky compared to Susan. #1 was treated with Meth succesfully and the other died of by itself before treatment. I ve never managed to get a real pregnancy. The big difference between my ectopics and Susan s is I felt both my pregnancies at a very early stage. I ve felt them hatch (around day 8 after ovulation) into parts that are not designed for that; a scratchy crampy feeling.

My HCG levels were only 25 at the day my period was expected. My doctors said there is no way you can feel pregnant with levels like that, but I did. And I looked very pregnant too at 1 day late.

For everybody it s different. Important is not to trust too much on HPT s because they detect HCG levels from 50. And it can take quite a while before your ectopic develops to the size where it produces those levels. Posted by: heleen | Aug 22, 2005 at 02:38 PM


2 weeks ago I had laproscopic surgery to remove what was thought to be a corpus leteum cyst that was bleeding into my abdomen and a D C for a 5 week intra uterine pregnancy that was starting to Miscarry.... Well I came out of surgery having a hetertopic Pregnancy which is the existence of both an ectopic and uterine pregnancy at the same time. The bleeding was not from the normal corpus leteum cysts but in fact from the tubal baby. In the end I lost my right tube and both babies. This is MS # 4 or baby #4 5 lost. I had normal HCG levels, no bleeding until I was admitted, just sharp pain in the right side, very tender abdomen (blood), right shoulder pain, and lots of rectal pressure. Thank you for this site in helping woman to listen to there bodies. Posted by: Rashelle | Aug 03, 2006 at 11:41 PM

I am a 38 year old mother of 2 remarried to a 45 year old father of 3. We both wanted desperately to have a child of our own, but after the birth of my last child I had laproscopic surgery to sever my tubes. 3 years ago we found ourselves living in Chile and found a wonderful Specialist that promised he could reunite one of my tubes. This cost about $2100 canadian. During surgery he and his son, also an obgyn decided to do both tubes. This was Jan 6, 2006. June 28th was the first day of my last period. The doctor then gave me pills to release more than one egg. He did not speak english and I very little spanish, hence my husband translated. Still a very nice doctor who assured us that this was standard procedure and nothing to be concerned about. 13th of July he injected me with 10000 of Pregnyl to stimulate ovulation. In 36 hours I would be ready for sex.I asked the doctor about the pregnyl and the posssibilities of tubal pregnancy. He said not to worry as it is only a hormone shot ansd absolutely safe. I had hesitations but because this was such a large fertility clinic with such a great reputation, took the advice of the doctor. July 22 had brown spotting all day and the next. Saw the doctor who confirmed that this was absolutely normal and is known as implantation bleeding. I had not experienced this with my other pregnancies. I also complained of cramping and numbness in my right leg. I forgot to mention that the right tube was the only tube that was successfuly operated. I continued to have pain nausea, and vomitting and was assured that this was absolutely normal and beginning to feel absolutely stupid for the number of visits tothis specialist. The doc prescribed on two separate occasions, pain killers for the pain on my right side. I found this unusual. I had two hcg tests done the first indicated that my level was 79. I was unable to get excited as I knew that something was wrong. The second three days later read 185. The doctor told me that this was absolutely normal and everyhting would be fine. Slightly implying to my husband that the hormones were working on me and I should try and relax. August 6th I began bleeding and again went to the doctor who told my husband and me that this was normal implantation bleeding as the sac gets adjusted to its new position in the uterus. I did not believe him. He ordered me on strict bed rest which I followed until the 16th when an interuterine ultra was preformed in the am showing no bleeding and no gestational sac. I also had one preformed the week prior but the doctor said that it was too early to see anything and that the tubes looked good. This time 2 docs looked at the ultra and one commented that there was a gestational sac forming and that the uterus was enlarging but he couldn t see my baby as I was just under 5 weeks or 7 weeks depending on the calculation method. Another blood test was done which revealed a level of 601. The doctors finally agreed that this was not a normal pregnancy. I think the doc belived that I was miscarrying and said not to worry, that I could always have another in 3 to 4 months. They sent me home to try and misscarry on my own. I f not a d and c would be performed. Finally The late afternoon of the 16th my husband telephoned the clinic which also has a 24hr emergency and asked if I could see the doctor. My left leg was completely numb as well as the back of my head and I couldn t retain my balance.I was in a lot of pain and thought I was going to die. We drove the 45 min to the clinic where the doctor and his son both performed another interuterine ultra. This time I was bleeding quite heavily. They decided to keep me in the hospital for observation if it made me feel better. As I was getting dressed, the father and son seemed confused amongst themselves with one wanting to do exploratory surgery. He then left the room to consult with his father. We were then escorted by an unsympathetic and unfriendly matrona who talked nothing but money and how we were going to pay and what method we would be using etc. She took us to the emergency room where I was to fill out paers for payment. $1000000 pesos or about $2400 Canadian. Who at the time of emergency carries that kind of money in their pockets. First they made us wait in the waiting room, in agony for approx. 30 min. We had no idea what was going on. Some personal of the hospital came to get us and took us to the maternity ward where I asked not to be and put me in a room with 3 other women with babies. My husband was furious at the lack of sympathy as we had asked for a double room with not babies. They then made me walk down 2 flights of stairs to the floor below and started preping me for surgery. At this point we had never been told that I was having surgery only that I was coming in for observation. The doctors still had not to mine nor my husbands knowledge diagnosed an ectopic pregnancy. My husband went in search for the doctor and he then said that I required emergency surgery. My husband was allowed to attend the surgery where the elder doctor commented, Looks like the Gringa was right after all. I have to say as I have not mentioned so far, that from the earliest on I had insisted to the doctor that I had a tubal preganancy, even before the blood test confirmed that I was indeed pregnant. I contantly insisted this and was ignored. Maybe things would have turned out differently in terms of the surgery if the doctors wouldn´t have treated me like a foolish, dare I say woman. I now require an additional surgery for a n umbilical heria formed during the operation. Please comment on this incredible injustice. I have benn severely depressed since this and spend most of the day crying at how horribly I was treated. I have refused to pay the hospital bill. Stephanie. I might add that my husband attened every apointment, exam ect. and he also feels that an incredible injustice was done me. I have 5 children at home that need their mother well emotionally and physically and I am, with my hernia limited again. Stephanie Posted by: stephanie | Aug 27, 2006 at 08:08 AM

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