Ectopic Pregnancy: Symptoms, Diagnosis, and Recovery

Ectopic pregnancy

The first day of the last menstrual period was February 3, and pregnancy was confirmed on March 5.
From March 11 to March 25, a transvaginal ultrasound could not detect the embryo, and the doctor diagnosed it as an ectopic pregnancy.
During this period, blood tests were conducted to check the beta-hCG levels: on March 13: 970.53, March 16: 1168.23, March 23: 2509.13, and March 25: 3168.0 (MTX was administered on March 25).
On March 31, the level was 4859.7 (the value increased, and a second dose of MTX was given on March 31).
On April 1, the doctor scheduled a dilation and curettage (D&C) procedure.
On April 2, the level was 4158.8 (showing a decrease).
On April 6, it was 2930.64, and on April 13, it was 681.3 (the doctor mentioned a follow-up appointment in May).

On the same day, I asked the doctor if it was normal to still have bleeding.
The doctor said it was normal.
Bleeding started on March 10 and continued until the surgery on April 1, with ongoing bleeding after the procedure from April 1 to now.
There is no abdominal pain, and the bleeding is less than a menstrual period, initially light pink and later bright red.
Is this bleeding situation normal? Since the beta-hCG level is still at 681.3, does it need to be completely zero for the bleeding to stop?

Fang, 30~39 year old female. Ask Date: 2023/04/16

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the BHCG levels have not yet returned to normal, which may cause bleeding.
Please continue to follow up with your original obstetrician-gynecologist for further management.
Wishing you good health.

Reply Date: 2023/04/16

More Info

Ectopic pregnancy, also known as tubal pregnancy, occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. Understanding the symptoms, diagnosis, and recovery process is crucial for anyone who suspects they may be experiencing this condition.

Symptoms of Ectopic Pregnancy
The symptoms of ectopic pregnancy can vary, but common signs include:
1. Abdominal Pain: This may start as mild cramping and can become severe. The pain may be localized to one side of the abdomen, depending on where the ectopic pregnancy is located.

2. Vaginal Bleeding: Light spotting may occur, but it can also be heavier than a normal period. In some cases, the bleeding may be accompanied by tissue that resembles a menstrual flow.

3. Shoulder Pain: This can occur due to internal bleeding that irritates the diaphragm, leading to referred pain in the shoulder.

4. Weakness or Dizziness: If the ectopic pregnancy ruptures, it can lead to significant internal bleeding, causing symptoms of shock such as fainting, weakness, or dizziness.

5. Positive Pregnancy Test: Despite the abnormal location of the pregnancy, a home pregnancy test will still show positive due to the presence of the hormone hCG (human chorionic gonadotropin).

Diagnosis of Ectopic Pregnancy
Diagnosis typically involves:
1. Blood Tests: Measuring hCG levels can help determine if the pregnancy is progressing normally. In a healthy intrauterine pregnancy, hCG levels should double approximately every 48 hours. In ectopic pregnancies, this increase may be slower or plateau.

2. Ultrasound: A transvaginal ultrasound is often used to visualize the uterus and check for the presence of an embryo. In cases of ectopic pregnancy, the embryo may not be visible in the uterus.

3. Physical Examination: A healthcare provider may perform a pelvic exam to check for tenderness or masses.

Treatment and Recovery
Treatment for ectopic pregnancy depends on several factors, including the size and location of the ectopic tissue, the patient's health, and whether the ectopic pregnancy has ruptured. Common treatment options include:
1. Methotrexate (MTX): This medication is used to stop the growth of the ectopic tissue. It is most effective when the ectopic pregnancy is detected early and has not ruptured.

2. Surgery: If the ectopic pregnancy is larger or has ruptured, surgical intervention may be necessary. This can involve laparoscopic surgery to remove the ectopic tissue or, in severe cases, a salpingectomy (removal of the affected fallopian tube).

3. Monitoring: After treatment, hCG levels will be monitored to ensure they return to zero, indicating that the ectopic tissue has been completely removed or absorbed.

Recovery and Follow-Up
Post-treatment, it is normal to experience some vaginal bleeding, which may last for several days to weeks. The bleeding may change in color and intensity, similar to a menstrual cycle. However, if the bleeding becomes heavy or is accompanied by severe pain, it is essential to seek medical attention.

Regarding your specific situation, the continued presence of hCG levels at 681.3 suggests that your body is still processing the ectopic pregnancy. It is common to have some bleeding after a surgical procedure, but the amount and duration can vary. If the bleeding is less than a normal period and you are not experiencing significant pain, it may be within the realm of normal recovery. However, it is crucial to keep in close contact with your healthcare provider, especially regarding the hCG levels and any changes in your symptoms.

In summary, ectopic pregnancy is a serious condition that requires prompt diagnosis and treatment. Understanding the symptoms, diagnostic methods, and recovery process can help you navigate this challenging experience. Always consult with your healthcare provider for personalized medical advice and follow-up care.

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