Ectopic Pregnancy: Symptoms, HCG Levels, and Treatment

Ectopic pregnancy

Hello Dr.
Lin: My last menstrual period was on December 6.
I usually have regular periods, but I didn't get my period in January.
On January 8, I started bleeding at noon, and on January 9, I took a home pregnancy test and found out I was pregnant.
On January 11, I went to a nearby obstetrics and gynecology clinic for a pregnancy test, which confirmed the pregnancy, but an ultrasound did not show anything.
On January 13, during a follow-up visit, the ultrasound still did not show anything, and the doctor suggested a blood test to check my HCG levels.
That evening, the result came back at over 1700.
On January 14, during another follow-up, the ultrasound still did not show anything, and I had another blood test.
On January 15, the result was over 2800.
The ultrasound still did not show anything in the uterus, but there was a suspected area near the fallopian tube.
The doctor immediately diagnosed it as an ectopic pregnancy and urgently referred me to a larger hospital.
On January 16, the hospital ultrasound finally confirmed the presence of a gestational sac (but not in the location mentioned the day before), and I had another blood test to determine if I could receive MTX.
On January 18, the report showed that the HCG level from January 16 was 5800, so I received MTX that day.
After the first week, I had no significant discomfort, the bleeding was minimal, and I did not experience abdominal pain or bloating.
Following the doctor's instructions, I returned for a blood test on January 23, and the report showed a dramatic increase to over 18,000.
The doctor suggested I return for another blood test on January 25 to determine if surgery was necessary.
The day before my follow-up, on January 24, I felt unwell (but it was manageable), and the bleeding increased (though not more than during my heaviest menstrual flow).
On January 25, the blood test showed a slight decrease to over 17,000.
The doctor recommended monitoring for another week and asked me to return on February 1.
However, this week, I have been experiencing noticeable discomfort in my uterus, along with rectal pain, and the bleeding has increased, with two large blood clots passed.
After passing the clots, I felt somewhat better, but I am very worried about the possibility of sudden heavy bleeding (as I am unsure what constitutes heavy bleeding).
During my time at the larger hospital, I only had an ultrasound on January 16, and none afterward.
I would like to ask Dr.
Lin: 1.
Is the fluctuation in my HCG levels normal? 2.
Is the bleeding situation normal? When is it likely to improve? Is passing blood clots normal? 3.
Is the rectal pain a condition that could be triggered by this treatment? 4.
Is it necessary to have another ultrasound, or is it sufficient to determine based on the HCG levels from blood tests? I apologize for the many questions, and I appreciate your assistance in answering them.
Thank you very much!

Niming, 30~39 year old female. Ask Date: 2016/01/27

Dr. Lin Wenbin reply Obstetrics and Gynecology

1.
HCG levels may rise due to MTX (methotrexate).
2.
Improvement of bleeding needs to be monitored; if there is significant bleeding, surgical intervention should still be considered.
3.
Rectal pain is caused by internal bleeding from an ectopic pregnancy.
4.
Both are necessary.

Reply Date: 2016/01/27

More Info

Ectopic pregnancy is a serious condition that occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. Understanding the symptoms, HCG levels, and treatment options is crucial for managing this condition effectively.

1. HCG Levels: In a normal pregnancy, human chorionic gonadotropin (HCG) levels should rise steadily, typically doubling every 48 to 72 hours in the early stages. In your case, the initial HCG levels were 1700, which is a significant number indicating pregnancy. However, the subsequent rise to 2800 and then to 5800, followed by a spike to 18,000, raises concerns. While HCG levels can fluctuate in ectopic pregnancies, a consistent increase is expected. The fact that your levels increased dramatically after receiving methotrexate (MTX) treatment is concerning, as it suggests that the ectopic tissue may still be producing HCG, indicating that the treatment may not be effective. Close monitoring of HCG levels is essential to determine the progression of the pregnancy and the effectiveness of the treatment.

2. Bleeding and Clots: Light bleeding can occur in early pregnancy, but in the context of an ectopic pregnancy, it can be a sign of complications. The presence of blood clots, especially if they are large, can indicate that the body is trying to expel the ectopic tissue. While some bleeding can be normal, significant changes in bleeding patterns, especially if accompanied by pain, should be reported to your healthcare provider immediately. The increase in bleeding you described, along with the passage of clots, is concerning and warrants further evaluation.

3. Pelvic Pain: The pain you are experiencing, particularly if it is localized to one side, can be associated with ectopic pregnancy. The pain may result from the growing ectopic tissue or from internal bleeding. The presence of rectal pain could also indicate irritation or pressure from the ectopic mass or bleeding. It is essential to communicate these symptoms to your doctor, as they may require immediate intervention.

4. Need for Ultrasound: While HCG levels provide valuable information, ultrasound imaging is crucial in diagnosing ectopic pregnancy. It helps visualize the location of the pregnancy and assess for any complications, such as internal bleeding. Given your symptoms and the fluctuations in HCG levels, a follow-up ultrasound is necessary to evaluate the situation more thoroughly. Your healthcare provider may recommend additional imaging to monitor the condition and determine the best course of action.

In summary, the fluctuations in your HCG levels, the bleeding, and the pelvic pain are significant indicators that require close monitoring and possibly further intervention. It is vital to maintain open communication with your healthcare provider, report any changes in symptoms, and follow their recommendations for further testing and treatment. Ectopic pregnancy can lead to severe complications if not managed promptly, so timely medical attention is crucial.

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