Ectopic Pregnancy: Symptoms, Diagnosis, and Next Steps

Q: Ectopic Pregnancy: Symptoms, Diagnosis, and Next Steps

Hello Miss Mingming： I have understood your situation in detail. <br>My assessment may indicate an ectopic pregnancy; however, it seems that the embryo did not continue to develop, leading to rupture and bleeding, which is a fortunate outcome in an unfortunate situation. <br>For

Ectopic pregnancy

Hello Doctor: On July 28, I took a home pregnancy test and saw two lines.
That day, I visited a gynecologist at a clinic, where I had another urine test and an ultrasound, but no embryo was detected.
The doctor asked us to return on August 6.
On August 6, the ultrasound still did not show an embryo, so a transvaginal ultrasound was performed, which also did not reveal an embryo.
The doctor ordered a blood test, and my hCG level was over 1700.
On August 10, I experienced a significant amount of brown discharge, and that evening I returned for a follow-up.
Another transvaginal ultrasound was performed, but still no embryo was seen.
However, there was a shadow near the fallopian tube close to the uterus, and the doctor mentioned the possibility of an ectopic pregnancy.
Due to concerns about potential danger, I went to a teaching hospital the next day.
The doctor performed another transvaginal ultrasound, which showed no internal bleeding, and drew blood.
When asked if I felt any discomfort, I mentioned that my abdomen felt tight and uncomfortable.
The doctor suggested I return the following week for another blood test and transvaginal ultrasound.
However, on August 12, I experienced a large amount of bright red bleeding, along with blood clots, similar to a regular menstrual period, and I had significant abdominal pain.
After passing the blood clots, I felt much better.
That afternoon, I returned to the teaching hospital for a follow-up with another doctor, who performed an abdominal ultrasound, which also showed no internal bleeding, and my hCG level was reported to be over 900.
The doctor noted that I did not appear to be in discomfort and advised me to return to my original doctor for the next visit.
On August 17, I returned for a detailed transvaginal ultrasound and blood test, which showed my hCG had decreased to over 700.
The transvaginal ultrasound indicated a shadow near the left fallopian tube close to the uterus, but the doctor did not provide any treatment options, only suggesting I return on August 24 for another blood test.
On August 24, my hCG had dropped to over 300, and the doctor still did not indicate any course of action, just scheduling another appointment for August 31 for a blood test and transvaginal ultrasound.
I would like to ask the doctor if I am experiencing an ectopic pregnancy.
Thank you, Doctor.

Mingming, 30~39 year old female. Ask Date: 2016/08/25

Dr. Huang Yiwen reply Obstetrics and Gynecology

Hello Miss Mingming: I have understood your situation in detail.
My assessment may indicate an ectopic pregnancy; however, it seems that the embryo did not continue to develop, leading to rupture and bleeding, which is a fortunate outcome in an unfortunate situation.
For now, we can only continue to monitor the levels of pregnancy hormones.
If the levels keep declining, the risk will decrease significantly.
Congratulations, you may have escaped a serious complication this time.

Reply Date: 2016/08/25

More Info

Ectopic pregnancy, or a pregnancy that occurs outside the uterus, typically in the fallopian tubes, can present significant challenges both in terms of diagnosis and management. Based on your description, it appears that you have been experiencing symptoms and diagnostic evaluations that are consistent with a potential ectopic pregnancy. Here’s a comprehensive understanding of the situation, including symptoms, diagnosis, and next steps.

Symptoms of Ectopic Pregnancy
Common symptoms of ectopic pregnancy can include:
1. Abdominal Pain: This pain may be sharp or dull and is often localized to one side of the abdomen. In your case, you mentioned feeling a "tight" sensation in your abdomen, which can be indicative of ectopic pregnancy.

2. Vaginal Bleeding: The presence of brown or red discharge, as you described, can be a sign of ectopic pregnancy. The bleeding may vary in amount and can sometimes be accompanied by blood clots.

3. Shoulder Pain: This can occur if there is internal bleeding that irritates the diaphragm.

4. Weakness or Dizziness: These symptoms may indicate internal bleeding and should be taken seriously.

Diagnosis of Ectopic Pregnancy
The diagnosis of ectopic pregnancy typically involves:
1. Ultrasound: Transvaginal ultrasound is the most effective method for visualizing the location of the pregnancy. In your case, the absence of an embryo in the uterus and the presence of a "shadow" near the fallopian tube raises suspicion for ectopic pregnancy.

2. hCG Levels: The measurement of human chorionic gonadotropin (hCG) levels is crucial. In a normal intrauterine pregnancy, hCG levels typically double every 48 hours. In ectopic pregnancies, hCG levels may rise more slowly or plateau, as you have experienced with your hCG levels decreasing from 1700 to 300.

3. Clinical Symptoms: The combination of ultrasound findings, hCG levels, and clinical symptoms helps in making a diagnosis.

Next Steps
Given your situation, here are some recommended next steps:
1. Follow-Up Appointments: It is essential to continue with your scheduled follow-ups. Monitoring hCG levels and ultrasound findings will provide more information about the status of the pregnancy.

2. Emergency Care: If you experience severe abdominal pain, dizziness, or heavy bleeding, seek immediate medical attention. These could be signs of a ruptured ectopic pregnancy, which is a medical emergency.

3. Treatment Options: If an ectopic pregnancy is confirmed, treatment options may include:
- Medication: Methotrexate can be used to terminate an ectopic pregnancy if it is detected early and there are no signs of rupture.

- Surgery: In cases where there is a rupture or if the ectopic pregnancy is not responding to medication, surgical intervention may be necessary.

4. Emotional Support: Experiencing an ectopic pregnancy can be emotionally challenging. Consider seeking support from healthcare professionals or support groups.

Conclusion
While your symptoms and diagnostic findings are concerning for an ectopic pregnancy, it is crucial to continue working closely with your healthcare provider. They will guide you through the necessary evaluations and treatment options based on your specific situation. Remember, early detection and management are key to ensuring your health and well-being. If you have any further questions or concerns, do not hesitate to reach out to your healthcare provider for clarification and support.

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