Ectopic Pregnancy: Symptoms, Diagnosis, and Surgical Outcomes

Ectopic pregnancy

Last month, my period started on the 7th.
This month, I had my period again from December 8 to December 15.
A week later, on December 22, I experienced abdominal pain and light bleeding.
I initially thought it was ovulation pain since I was still breastfeeding until December 23.
My abdomen continued to have intermittent pain, so I visited a gynecologist.
An ultrasound revealed internal bleeding.
A pregnancy test showed two lines, and the doctor diagnosed me with an ectopic pregnancy, advising me to transfer to a larger hospital.

At the larger hospital, my blood test showed a level of approximately 6600, and I was immediately scheduled for laparoscopic surgery.
After the surgery on December 24, the doctor explained that during the procedure, they removed a blood clot from my abdomen, but there was no embryonic tissue found, suggesting it may have already been expelled.
They also removed a cyst from my ovary.
The doctor checked the fallopian tubes, which appeared clean with no bleeding, and both samples were sent for pathology to check for any embryonic tissue in the blood clot.

Before being discharged on December 25, my blood test showed a level of about 1100.
Could it be possible that I am not experiencing an ectopic pregnancy but rather a miscarriage? Does this mean the surgery was unnecessary? What could be the possible scenarios?

Miss Zhou, 30~39 year old female. Ask Date: 2023/12/29

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, having blood in the abdominal cavity is not normal.
Please follow up with your obstetrics and gynecology specialist for further consultation.
Wishing you good health.

Reply Date: 2023/12/29

More Info

Ectopic pregnancy, particularly cervical ectopic pregnancy, is a serious condition that requires careful diagnosis and management. Based on your description, it seems you experienced symptoms that led to the diagnosis of an ectopic pregnancy, followed by surgical intervention. Let’s break down the key aspects of ectopic pregnancy, including symptoms, diagnosis, and surgical outcomes.

Symptoms of Ectopic Pregnancy
Ectopic pregnancies can present with a variety of symptoms, which may include:
- Abnormal vaginal bleeding, which can be mistaken for a menstrual period.

- Pelvic or abdominal pain, often localized to one side.

- Symptoms of early pregnancy, such as nausea or breast tenderness.

- In severe cases, signs of internal bleeding, such as shoulder pain or fainting, may occur if the ectopic pregnancy ruptures.

In your case, the bleeding and abdominal pain you experienced could be indicative of an ectopic pregnancy or a possible miscarriage. The timing of your symptoms, particularly the bleeding after a recent menstrual period, can complicate the diagnosis.

Diagnosis of Ectopic Pregnancy
Diagnosis typically involves:
- Ultrasound: A transvaginal ultrasound is often the first step to visualize the uterus and surrounding structures. In cases of ectopic pregnancy, the absence of an intrauterine gestational sac, along with the presence of fluid or blood in the pelvic cavity, can suggest an ectopic pregnancy.

- Blood Tests: Measuring serum hCG (human chorionic gonadotropin) levels can help assess the viability of the pregnancy. In a normal early pregnancy, hCG levels should rise significantly. In ectopic pregnancies, the rise may be slower or plateau.

In your situation, the ultrasound indicated bleeding in the abdomen, and the hCG level of 6600 suggested that you were indeed pregnant. However, the absence of identifiable embryonic tissue during surgery raises questions about the nature of the pregnancy.

Surgical Outcomes
The surgical approach for ectopic pregnancy often involves laparoscopic surgery to remove the ectopic tissue and any associated complications, such as blood clots or cysts. In your case, the surgeon noted that there was no embryonic tissue found, which could indicate that the ectopic pregnancy may have resolved on its own, possibly through a process known as "spontaneous resolution." This can happen when the body reabsorbs the ectopic tissue, leading to a decrease in hCG levels.

Post-Surgical Considerations
After surgery, it is crucial to monitor hCG levels to ensure they return to normal, indicating that all pregnancy tissue has been cleared. The drop from 1100 suggests that your body is responding well post-surgery.

Conclusion
While it may feel disheartening to have undergone surgery without a clear diagnosis of ectopic pregnancy, it is essential to recognize that the procedure was likely necessary to rule out serious complications. The presence of blood in the abdomen and elevated hCG levels warranted intervention to prevent potential rupture and internal bleeding.

In summary, your symptoms and the surgical findings suggest that while you may not have had a typical ectopic pregnancy, the situation was serious enough to require surgical intervention. It's important to follow up with your healthcare provider to monitor your recovery and discuss any further concerns you may have regarding future pregnancies or the implications of your recent experience.

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