Re: Ectopic questions (Long)
From: Jane (anonymous@obgyn.net)
Sun, 30 Jul 2000 06:27:35 -0500 (CDT)
I am not a doctor or anything, but I think I'm going through something
very similar to you, but here in the UK.
I found out I was pregnant on July 8th, after thinking I was going to
have a period because I had very slight spotting on my due date. Because
I had an ectopic pregnancy and tube removed in January, I went straight
to the doctors for an HCG test. This was 56 (already not good news as
when you miss a period is should be aroun 100). I then had some mild
bleeding the next day and my hormone level when checked the next day was
30. The doctors were going to leave it at that because they thought it
was an ordinary implantation failure.
However, on the Friday, by breast were increasingly sore and larger, so
I did an ordinary urine test which was positive after being negative
when I had the bleeding a couple of days earlier.
I went for another blood test on the following Monday 17th which was 75.
On 19th it was 65, 21st it was 60 and then I started to bleed (a bit
like a normal period but the heavy days were only 2 instead of my usual
3/4). On the Monday 24th my levels had gone up to 80 and this Thursday
27th they were up to 153!! I had a scan when my levels were 65 and they
couldn't see anything untoward apart from some cysts on/near my right
ovary (right tube being the only one left).
I think I have an ectopic pregnancy, but no-one is open enough to give
me an idea of exactly what they think this is - they are all (doctors
etc) keeping an open mind and want to wait until it gets bigger. They
won't give me a D&C because they say that they might miss the small
speck that it producing the HCG and we will be noe the wiser for doing
it. They are giving me another scan on Tuesday when they think my
hormone levels will be nearer 350 (not sure whether at those hormone
levels they'll see anything either) and then who knows what they'll
suggest.
I have had a laparoscopy with my last ectopic and as I had no
pre-disposing conditions which could have led to that ectopic (aside
from age) I can't help but wonder if this is an ectopic and caused by
adhesions from the first operation. I have had heavier periods since
the first and tenderness on the offending side ever since. My scars are
above the bikini line and I feel like I have been mutilated (I scar
badly - keyloids - and one of the scars has attached itself to my muscle
wall and it doesn't look pleasant). I am not saying this to scare you
off a laparoscopy, merely to warn you to request that they are careful
where they cut you. I am trying to avoid this procedure again and would
like Methotrexate, because that I think will leave me fitter more
quickly so that I can look after my 2 year old. Actually it is her
birthday this coming Friday and I desperately don't want to find that
I'm not able to share it with her on the day. She's here and I've lost
2 babies this year and I feel that she's the most important person in my
life and I want to be there for her.
I can understand all the things you're feeling at the moment - loss,
despair, frustration, confusion, anger (well, I am anyway) and am
completely distracted, totally preoccupied, on the verge of tears most
of the time and yet trying to get on with as normal a life as possible
for the sake of husband and child.
I am thinking of you, and hope that your blood result tomorrow is a good
one for you. If they are worried about ectopic, they should follow you
back down to 0.
Good luck.
At Sat, 29 Jul 2000, geo_gal wrote:
>
>I am a 35 y.o. mother of one. I found out I was pregnant June 20th,
>after my expected period began with only light brown spotting (which
>lasted for almost 2 weeks). My BhCG levels were 379 on June 26 and 463
>on June 28. I went to the ER on June 26, because I was spotting, knew I
>was pregnant and awoke around 2 a.m. with strong pain just above my
>pubic bone. I was assessed by a triage nurse and shown into a room
>where I waited for 2 hours, alone. Not ONE person came to check in on
>me. The pain subsided somewhat and I felt that if no one at the
>hospital was concerned, perhaps I shouldn't be. So, I got dressed and
>went to tell a nurse I was leaving. It was a seemingly quiet night,
>only one patient visible in the ER, a sleeping elderly woman. I found
>the nurses chatting at the station. I didn't have to sign a release and
>I left to go home and get some sleep. I had an appointment at 7 a.m.
>with my doctor (a family practitioner). She felt I didn't have any
>predisposing factors for EP, and sent me for the 2 serial hCGs. I began
>to bleed (heavier than my normal mp) on July 6 and the bleeding ended
>July 13. It resumed on July 17th, and I went to the ER again. There, I
>had a repeat hCG (690) and an US and TV US. The ER doc told my husband
>and I that he suspected EP and called gyn for consult. Gyn came in
>short time later, and said something was detected in left fallopian tube
>(complex mass?). Gave option of D&C and laparoscopy that day (actually,
>as he was the ONLY ob/gyn in our community of 46,000, he said he could
>get to my surgery at around 2 a.m.). I asked what other options I might
>have. He said methotrexate was one. I asked him, based on the history
>of this situation, was there a hurry? He said no, I could get my hCG
>levels checked a couple more times and then see him with the results. My
>BhCG on July 19 was 586 and on July 21 was 405. Bleeding stopped on
>July 21. I have no symptoms of the pregnancy any more (no breast
>tenderness, no nausea, etc.). I saw the ob/gyn on July 24, where he did
>an internal to check for any tenderness. There was none. He said my
>pelvis was "clinically normal". I have not had any pelvic pain since
>June 26 episode (which seemed to be relieved after passing gas).
>However, he said that my hCG levels were still high, and that chorionic
>villi must still be producing hCG. I wondered how my levels could be
>dropping steadily, but I supposedly have villi that are still producing
>hCG? I asked him how this could be and he did not have an answer. He
>said he wanted to see my hCG levels declining by 50% every 48 hours. Why
>would he be comfortable with this, when any methotrexate protocol I have
>seen accepts a 15% decline weekly? When I asked him this, he said "Good
>question" and did not have an answer. Also, when I pressed him for a
>description of what was seen on US, he said the resolution is not that
>clear (ie. as to size and location of mass supposedly seen on July 17
>ER visit). He then went on to tell me that he had a patient who had an
>EP which ruptured with an hCG of 32. Not to alarm me, he said, but just
>so that I know. I told him that I am not comfortable with the idea of
>the methotrexate therapy for a multitude of reasons. I would rather
>face surgery. I am still breastfeeding my son, and am not ready to stop
>that relationship (and neither is he). I know that "expectant
>management" of EP is rare. But, it seems to me that my body is taking
>care of this on its own. But, how does one know for sure? It seems that
>they don't. I have been very stressed for the past 7.5 weeks, since the
>pregnancy began. With my first pregnancy, I had no such abnormalities
>or complications. No spotting, etc. So, we ended the appointment with
>him telling me that he will have my hCG tested once more (that happened
>July 28) and, if he is not comfortable with the level, he wants to do
>something. I asked him what value would he be comfortable with, and he
>evaded answering by saying, "We'll see on Monday". So, I have an
>appointment to see him July 31 and discuss the result. If he is not
>happy with it, he wants to do the D&C and laparoscopy/laparotomy. If I
>still want to wait, he will no longer see me, as I will be out of his
>"comfort zone". I am confused! I feel very unclear about how I should
>know what is the right decision. Wait some more, or opt for surgical
>management. How can I know if it is safe to wait? Is there no way of
>knowing? I have read that rupture can occur when hCG levels are below
>50. What I am wondering, in those women who had a rupture with an hCG
>below 50, did they have any other clinical indicators? Pelvic pain?
>Progesterone level? Creatine kinase level? Adnexal mass resolved on TV
>US? Anything else to indicate that a rupture might be imminent? I wish I
>could talk to another doctor, but I don't know if I would hear anything
>different from him/her. I understand that the doctor would be much more
>comfortable doing something with me, because he would then have handled
>the potential problem. But, how do I know if "doing something" is
>necessary, or warranted? I am beginning to feel backed into a
>corner-with no way out but some intervention. Strangely, before the
>birth of my son, I probably wouldn't have asked so many questions. Now,
>I worry a lot more about things. I want to be around to watch him grow
>up. I am so bummed out by this whole thing and just wish it would be
>resolved-or, that I would have a definite answer. Right now, the best
>guess is that I have an EP. No one seems to know for sure. He also
>mentioned that there is a danger of the uterus involuting over retained
>placental materials and forming a pre-malignancy. Sure does scare me! I
>guess I am also wondering that will an hCG value of <5 be the value that
>means no intervention is necessary? Has anyone studied how hCG values
>decline in cases managed expectantly? I know that ultimately I will have
>to place my trust in this doctor, but, I need to be sure in my own mind
>that I am making the choice only after knowing all the facts. I am just
>concerned that this doc seems evasive at times, when I ask for details
>about the findings so far. Does anyone have any suggestions that might
>help ease my mind? He has also not suggested that it could be anything
>else but an EP, are there any other possibilities, based on the
>information I have shared with you? Thank you very much, in advance, for
>any thoughts/expertise shared.
>
>Sincerely,
>
>Lisa
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