Ectopic or Normal pregnancy ? Spotting, no pain, nothing on US...

[graycat17]

I'm freaking out.
I had a miscarriage in February, and on May 17 I had a positive pregnancy test.  I started spotting on the 20th and went to ER.  They said it was a miscarriage.  Hcg was 260.
Well, 4 days later, Hcg was 640.  Went back to OB 4 days after that, and HCG was 1800.   HOWEVER, transvag US showed NOTHING - no sac, nothing.
Now they are saying it's ectopic.  They saw something near my ovary, but not conclusive that it's ectopic.  In the meantime, I'm still spotting, but have no heavy bleeding and no pain..

I'm worried that it's still too early and they might give me the ectopic drug and kill a viable pregnancy.
But I'm also worried that it is ectopic and want to make sure it's caught in time.

Has anyone had hcg of 1800+ and seen nothing on US?  Can it possibly still be a normal pregnancy?  

I don't know what to do if OB wants to give me the injection for ectopic...

[Elaine Brown, MD]

Hi!
Your situation definitely requires very close follow up.  If you were my patient, the first thing I would do is to repeat the ultrasound in my office.  A good quality transvaginal scan should be able to detect a pregnancy when the hcg has increased over 1000.  If the ultrasound showed the pregnancy, then the answer would be clear.  If not, and if you were low risk, and if you had no symptoms or discomfort, I would be willing to wait 48 hours to see what another hcg level would be. By this point the answer should be clear.
If the pregnancy is normal, the hcg should be well over 3000 and definitely visible to ultrasound.  If the hcg doesn't increase enough, that is a sign that the pregnancy isn't viable anyway.

One more test to consider is a progesterone level, that can sometimes help determine viability of the pregnancy.

Laparoscopy is also an option, but I would encourage waiting.
Methotrexate is much easier cheaper, and less likely to cause more damage to the fallopian tubes.
Hope this helps!
Dr B

[hperske]

Get a second opinion first, that way you'll feel better about the decision and you'll have several options or opinions instead of just one. Hate for something bad to happen but also hate to eliminate a possible baby. Good luck to you.