Urgent Dr Hive - Alternatives to Ectopic? - Update Post 33

[abba12]

I'm on my way to hospital this afternoon, I'm quickly trying to research all I can to be prepared when I see doctors.

 

By dates I am 8 weeks pregnant. Last week I bled and passed uterine tissue in a way that very much looked like a miscarriage, with cramping that stopped as soon as tissue passed.

 

My HCG has continued to rise, and is currently at 2000 (up from 1300 a week before, the day after the tissue passed).

 

I had an ultrasound 24 hours ago which showed nothing in the uterus, and nothing visible in the fallopian tube or around the ovaries.

 

Today I have had mild pain on the right hand side, not cramping and not severe, constant and fairly low down.

 

They want me to take the medication for ectopic pregnancy though there is nothing visible on ultrasound, so we can't prove without doubt that it is ectopic. I am firmly pro-life but I also recognize ectopic is life threatening to me and I will terminate an ectopic pregnancy if that's what this is. I wish, so much, that it had been visible on ultrasound, and I am praying something will be visible on the ultrasound I will inevitably receive at the hospital in a few hours, because it will make what's happening much clearer.

 

Is there anything else this could be but ectopic? I realize 2000 at 8 weeks is too low for there to be much of any chance of the baby being viable even if it isn't ectopic, but, viable or not, this is my third miscarriage in a row, so if there's a chance it's another cause I want to identify that as well. Should a baby be visible in the uterus at a hormone level of 2000? Can you pass uterine tissue and remain pregnant if the baby is in the uterus? Is there any other options here but ectopic that I can bring up to check?

 

And, on a slightly related topic, can an ectopic pregnancy resolve itself without intervention? I had a previous miscarriage follow an almost identical pattern, but the doctor did no follow up. I continued to have pregnancy symptoms but three weeks after the tissue passed I had another round of heavy bleeding, which is when pregnancy symptoms suddenly disappeared. I am now wondering if that could have also been ectopic.

 

 

Edited March 4, 2016 by abba12

[maize]

I don't know, but sending hugs and prayers your way.

[abba12]

A quick search shows me this

 

A transvaginal ultrasound showing no gestational sac with an hCG level above 1,500 is considered fairly certain evidence of an ectopic pregnancy. 

 

 

Edited March 3, 2016 by abba12

[gardenmom5]

was the US external or transvaginal?  big difference in visibility at eight weeks. 

[abba12]

was the US external or transvaginal?  big difference in visibility at eight weeks. 

 

transvaginal

Edited March 3, 2016 by abba12

[LifeLovePassion]

Molar pregnancy?

[Spryte]

No answers, I just wanted to say I'm so very sorry that you're going through this.

[Barb_]

Ectopic is so dangerous and seems so likely given what you've posted. I think I would follow my doctor's advice. I'm so sorry.

[Woodhaven]

I am praying for wisdom for you and your doctors!

[Guest]

I've got nothing, it sounds like an ectopic to me :(. I'm praying for you!

[LibraryLover]

Thinking about you. 

[LMV]

I'm sorry for your losses. Hugs.  :grouphug:

 

A quick search shows me this

 

A transvaginal ultrasound showing no gestational sac with an hCG level above 1,500 is considered fairly certain evidence of an ectopic pregnancy. 

 

Yes, generally if the HCG >1,500 then if there is a viable IUP we should be able to see it with a transvaginal approach. In contrast, it can often be difficult to visualize an ectopic. Careful doppler scanning in the adnexae can be helpful for this, however, ectopics can be hard to visualize so we generally err on the side of caution and presume that these are ectopic and proceed accordingly.  I presume they are recommending you take Methotrexate. 

 

In your case, I suppose given that you had passage of tissue you could have had an incomplete miscarriage. You can use Methotrexate with missed/incomplete miscarriages so that wouldn't necessarily be a bad option. Did your doctor do an internal exam? Is your cervix open?

 

 

[LMV]

Molar pregnancy?

 

Generally with molar pregnancy we will see something in the uterus (sometimes it is called a "snowstorm pattern" because of all of the projections from the mass). Molar pregnancies also generally have high HCG levels. 

[SebastianCat]

I had the exact same thing in 2003 and my doctor was fairly certain it was ectopic. I took the methotrexate and had follow up HCGs drawn to make sure my levels returned to zero.

 

(((((Hugs))))). It is hard to know what to do when they can't clearly see an ectopic on ultrasound, but from what I was told, if it IS ectopic it will not resolve on its own - most likely it will continue until it becomes a life threatening situation. I will pray that you get some answers today.

 

I did go on to conceive my DD after my ectopic, and I hope you are able to do the same.

[Rachel]

No advice but I'm sorry. Hugs and prayers to you!

[Okra]

Hugs.  

 

[Carrie12345]

I am so sorry this is happening to you.

 

Take the methotrexate. (sp?)  And insist on close monitoring afterward.

 

My ectopic wasn't visualized for quite some time.  I can't remember the specifics, but there were multiple scans over a few weeks.  The shot, which I obviously didn't get right away, was not effective for me.  I don't know why, it just wasn't.  I did eventually rupture and require surgery after being sent home by a different hospital and doctors. (I was out of town.)  Monitoring is ESSENTIAL.  Demand close, frequent blood tests.

 

:grouphug:

[Innisfree]

I'm so sorry. No medical advice, but try to take loving care of yourself.

[Katy]

Please take the medication.  Background in nursing (primarily hospital gyne floor), personally pro-life and had a miscarriage again last week. 

 

If you don't take the medication, it might not be fatal, but you will cause permanent damage to your tubes.  Please accept treatment, and know that even Catholic hospitals, the most anti-birth control around, have accepted that treatment is the most moral choice.

[Zoo Keeper]

:grouphug:  :grouphug:  and prayers for your situation.

 

 

[zoobie]

:grouphug: to Katy and abba. 

[GAPeachie]

I went through this in October.  2000 should be able to be seen transvaginally.  I had multiple labs and my HCG count was going up but nothing could be seen.  

 

I'm firmly pro-life but nothing could be found by several different machines and techs/doctors.  I have mourned that loss at a different level than my other miscarriages.  in the quiet of the night, I find myself asking, "What if?"  DH has had to speak Truth over me when that hits.  "We made the best decision we could, with the knowledge we were given, at that time and on a very tight time table."  Feel free to PM me.  

 

Praying for you! 

[Zoo Keeper]

:grouphug: to Katy and Peachie as well.  I'm very sorry for your loss.

Edited March 3, 2016 by Zoo Keeper

[GAPeachie]

:grouphug: to Katy and Peachie as well.  I'm very sorry for your loss.

 

Thanks.  I've lost three, all very different ways. It's hard. 

[moonsong]

I just wanted to offer hugs. This is a hard place to be. :grouphug:

[Tammyla]

:grouphug:  :grouphug:  :grouphug:

[ashfern]

:grouphug:  :grouphug:

[Mom2Five]

I am so sorry. I would have a hard time not having a definite answer as well. If they said yes it is for sure ectopic and in your tubes that would be hard, but this would be harder. I would think at 8 weeks that you would for sure be able to see something in the uterus though, as I have had several ultrasounds with different pregnancies at 5 weeks and they were able to see the baby and even a heart beat. Prayers for you.

[Mom2Five]

I wonder if there has been examples of this happening with twins? One is miscarried, but the other is ectopic so there is still a rise in hcg levels after passing tissue as in a miscarriage. Just thinking out loud. Maybe another avenue to research and give you peace about your decision.

[Lecka]

I don't know much about this, but I have heard anecdotally about women having multiple first-trimester miscarriages and then sometimes there is a shot you can get that will help in the next pregnancy.

 

I have no idea of the details or if it is rare or common, though. I will try to google.

 

I am so sorry.

 

Edit: it is HCG hormone therapy that I have heard about anecdotally.

Edited March 4, 2016 by Lecka

[displace]

Just wanted to send hugs to you.

[MercyA]

http://www.obgynnews.com/trending/complications/single-article/watchful-waiting-is-viable-option-for-unruptured-ectopic-pregnancies/95b0c887bbd20863284a1b662e37e49b.html

 

(((Hugs abba)))

[abba12]

Home from hospital.

 

My country handles ectopic care a lot less aggressively than the US, based on the research I've quickly done these past few days. Surgery or Medication definitely happen, but watch and wait is considered a very valid option in a lot of cases too. Thanks for that link MercyA

 

They found some blood in the pouch of douglas and still no sign of anything in the tubes or anywhere else. The mild pain I had had passed. My hormones had spiked up to 2500 but the lack of visible tissue plus the blood higher up made them fairly confident that it was resolving naturally (it is, apparently, not unusual for ectopic pregnancies to self-resolve, it's just that many never get the chance). The decision was made to watch and wait overnight, so I stayed in the hospital. This morning the hormones were down to 2300, and still no pain and only very light spotting. Three Gyns are all in agreement that it has probably been passed by the body naturally, back up the fallopian tube, and we saw a hormone spike when this happened, but it has now all passed and will absorb safely. I am on strict orders that if I have any pain, lightheadedness or vomiting that I am to call an ambulance, but it looks like I will be fine.

 

We are now seriously considering whether our previous 'strange miscarriage' was a second naturally resolving ectopic.

[abba12]

http://www.obgynnews.com/trending/complications/single-article/watchful-waiting-is-viable-option-for-unruptured-ectopic-pregnancies/95b0c887bbd20863284a1b662e37e49b.html

 

(((Hugs abba)))

 

Just got a chance to read that article properly (I only saw it after I got home)

As it was explained to me, Australia seems to follow an almost identical protocol as the one described here, except that I was given the option to skip the medication and go straight to surgery if the hormone rose, while it seems this protocol considered surgery the last resort.

[Monica_in_Switzerland]

So sorry about the miscarriages. I am glad this situation seems to be resolving itself, but it's still so sad.

[Melissa in Australia]

:grouphug:  :grouphug: :grouphug:  

 

So sorry.

 

 

I have not had an ectopic but a ruptured fallopian tube. I had a tubal ligating and 3 years afterwards the clip ripped through my tube and got imbedded in my ovary. The most painful experience of my life by far. (Natural childbirth became a 1 in pain level after that.) I thought I was going to die. I remember waking DH up and telling him that if l I looked like I was asleep then I would really be dead. scans could find nothing wrong. I then saw a Gynecologist who did some exploratory surgery and had to remove half my ovary. He also did a dye flush through my other  tube. ( I guess to see the clip was working there ) strangely enough I fell pregnant 2 months after with DS12