Molar Pregnancy and Ectopic Pregnancy: A Patient's Journey

Q: Molar Pregnancy and Ectopic Pregnancy: A Patient's Journey

Hello： Ectopic pregnancy rarely presents with such high initial beta-HCG levels of 6000, followed by 12000 in 72 hours, especially without internal bleeding (ruptured fallopian tube); therefore, the first physician could reasonably suspect a molar pregnancy and perform a dilation

Molar pregnancy? Ectopic pregnancy as well!

Hello Dr.
Cheng: At the end of last month (June 23), I visited your clinic due to an abnormal pregnancy.
At that time, I was nearly 7 weeks pregnant.
A blood test in Zhongli on June 20 showed a B-HCG level of 6000, and the doctor diagnosed it as a molar pregnancy.
Since I had finally achieved pregnancy after much effort, I was filled with doubts about undergoing a medical abortion.
I requested another B-HCG test (which was 72 hours after the last test), and it had risen to nearly 12000.
You recommended that I undergo a dilation and curettage (D&C) in Zhongli for further monitoring and treatment (the procedure was performed on June 25).

A week later (at 8 weeks of pregnancy), I returned to the hospital in Zhongli for a follow-up, and my B-HCG level had not decreased but instead increased to 40320 (on July 3).
I was administered methotrexate (MTX); after another 72 hours, my B-HCG level rose to 48800, and I received another MTX injection (on July 6).
The doctor suspected a possible molar pregnancy with metastasis, as an abdominal ultrasound revealed an unknown mass.
Between the two MTX injections, I experienced severe abdominal pain and went to the emergency room at midnight (on July 5).
I asked the doctor if it could be an ectopic pregnancy, but he deemed it unlikely, stating that the chances of a molar pregnancy combined with an ectopic pregnancy are very low.
After an internal examination, he diagnosed me with uterine inflammation and prescribed anti-inflammatory medication and painkillers (I had not yet received the pathology report from the previous D&C).
My next appointment was scheduled for July 8, but I started running a fever (ear temperature of 38 degrees) on July 7, so I went directly to Chang Gung Memorial Hospital on July 8.
They diagnosed me with an ectopic pregnancy, and my left fallopian tube had ruptured, necessitating an emergency surgery to remove it (the pathology report a week later confirmed this).

Dr.
Cheng, if I had a simple ectopic pregnancy, why would my B-HCG levels be so high? The doctor in Zhongli mentioned on June 20 that my uterine wall was 3.4 cm thick on ultrasound, which led him to believe it was a molar pregnancy (but the pathology report later revealed otherwise).
If it was a misdiagnosis, there's nothing I can do about it, but I am more concerned about being the rare case! Therefore, I would like to ask Dr.
Cheng: what should I pay attention to moving forward? What kind of examinations should I undergo? I really want to get pregnant (I have been undergoing infertility treatment this year, taking prolactin-lowering medication in January and February, ovulation induction medication and trigger shots from March to May, a normal hysterosalpingogram in April, and artificial insemination in May, followed by traditional Chinese medicine in June, which led to my pregnancy).

Please provide me with your insights.
Thank you very much!

pinggu, 30~39 year old female. Ask Date: 2005/07/22

Dr. Li Guanghan reply Obstetrics and Gynecology

Hello: Ectopic pregnancy rarely presents with such high initial beta-HCG levels of 6000, followed by 12000 in 72 hours, especially without internal bleeding (ruptured fallopian tube); therefore, the first physician could reasonably suspect a molar pregnancy and perform a dilation and curettage for testing.
Of course, if the pathology results had been available earlier, there might have been an earlier suspicion of ectopic pregnancy, but the treatment process would likely remain the same—removal of the left fallopian tube.
The first physician cannot be considered to have made a misdiagnosis, as ectopic pregnancy is indeed difficult to diagnose before rupture, and your B-HCG levels have shown some abnormal increases.

I recommend that if you want to rule out a molar pregnancy combined with an ectopic pregnancy, you can check your pregnancy test again two weeks after surgery.
If it remains positive, you will need to continue monitoring your B-HCG levels, as the B-HCG from a molar pregnancy does not decrease immediately.
If you wish to conceive again soon, it would be safer to undergo a hysterosalpingography after your next menstrual period to ensure that the other fallopian tube is patent before attempting to get pregnant.
Additionally, you mentioned that you have been using medication to lower prolactin levels, indicating that your prolactin may be too high, which can hinder ovulation.
Therefore, it is also advisable to measure your prolactin levels again before adding ovulation-inducing medications to facilitate pregnancy.

Dr.
Cheng Jin-He, Department of Obstetrics and Gynecology, Hsinchu Hospital

Reply Date: 2005/07/22

More Info

Molar pregnancy and ectopic pregnancy are two distinct conditions that can occur during early pregnancy, and understanding their implications is crucial for any patient experiencing abnormal pregnancy symptoms. Based on your detailed account, it seems you have gone through a challenging and complex journey, and it’s understandable to have many questions and concerns about your health and future pregnancies.

Molar Pregnancy: This condition occurs when there is an abnormal growth of trophoblastic tissue, which normally would develop into the placenta. In a complete molar pregnancy, there is no normal fetal tissue, and the placenta forms a mass of cysts. In a partial molar pregnancy, there may be some normal fetal tissue, but it is often not viable. The high levels of beta-HCG (human chorionic gonadotropin) that you experienced are characteristic of molar pregnancies, as the abnormal tissue produces this hormone at elevated levels. The fact that your B-HCG levels were rising significantly indicated that there was an abnormality, which led to the recommendation for a dilation and curettage (D&C) procedure.

Ectopic Pregnancy: This occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. The symptoms can be similar to those of a normal pregnancy initially, but as the pregnancy progresses, it can lead to severe complications, including rupture of the fallopian tube, which can be life-threatening. The fact that your B-HCG levels were very high, along with the ultrasound findings, initially led to the suspicion of a molar pregnancy. However, the subsequent diagnosis of an ectopic pregnancy suggests that there was a misinterpretation of the ultrasound findings or that the ectopic pregnancy was developing alongside the molar tissue.

The confusion between these two conditions can arise because both can present with elevated B-HCG levels and abnormal ultrasound findings. The presence of a thickened uterine lining can be seen in both conditions, which complicates the diagnosis. It is important to note that while the occurrence of a molar pregnancy and an ectopic pregnancy together is rare, it is not impossible.

Post-Operative Considerations: After the surgical intervention for your ectopic pregnancy, it is essential to monitor your recovery closely. You should be aware of the signs of complications, such as severe abdominal pain, heavy bleeding, or signs of infection (fever, chills, etc.). Follow-up appointments are crucial to ensure that your B-HCG levels return to normal, which indicates that all pregnancy tissue has been removed.

Future Pregnancies: Given your history of infertility treatments and the recent complications, it is advisable to consult with a reproductive endocrinologist or a fertility specialist. They can provide personalized guidance based on your medical history and help you understand the risks and considerations for future pregnancies. It may also be beneficial to undergo genetic counseling, especially if there are concerns about the potential for recurrent molar pregnancies or other complications.

In summary, while your experience has been fraught with challenges, it is important to focus on your recovery and future health. Regular follow-ups with your healthcare provider, monitoring your B-HCG levels, and discussing your desire for future pregnancies with a specialist will be key steps in your journey. Remember, it is normal to feel anxious and uncertain after such experiences, and seeking support from healthcare professionals and possibly counseling can be beneficial.

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