Miscarriage or ectopic?

[lou95]

Please help!

I am 30 and had been trying for my 2nd child for 8 weeks. My LMP 08/29 (6 weekly cycle) I suspected I was pregnant on 09/25, however started bleeding on 09/29, It was the same flow as a period (medium/heavy) but more brown/red in colour with an elastic consistancy no pain.

Bleeding ended 10/03. Then on 10/11 started brown spotting, posative preg test.

Went to hospital 10/13 for transvagianl US nothing found also for HCG which was repeated 48 hours later results:

10/13 207
10/15 109

because of this was told having a miscarriage.

Next HCG 10/22 and rebounded to 317.

Transvaginal US 10/24 still nothing seen tubes clear.

Was told to come back in 2 wks however sever lower abdominal pain on left started on 10/26, HCG 10/27 407 and diagnosed with ectopic in unknown location. on 10/28 I had 1 injection of Methotrexate, my levels are now going down:

11/01   328
11/09   78

I have had 5 episodes of  sever lower abdominal pain on left like labour pain and each time bleeding increases but still light-medium however now steady.

Could it have been a incomplete miscarriage which caused HCG to drop and go up again when cells started to divide rather than ectopic?

Do you know what the pain is I know its not the injection as has happened before and after.

When Is it safe for me to try to get pregnant again after Methotrexate.

Many Thanks

  

[lou95]

Hi Just to keep you updated,

I have had had more bloodwork and my HCG is now at 21 so looks like its on the way out at last.

I will be trying to arrange to have have some tests done as pain continues, not too bad though but would like to check for potential damage to tube.

I spoke to specalist and he as said that I should wait 6 months to allow for time to get methotrexate out of my system as it can lead to birth defects if its still in me, although I am disapointed with the need to wait I would rather be safe.

Thank you for you kind thoughts.  

[Elaine Brown, MD]

Hi!
Yes, it could have been a miscarriage instead of an ectopic pregnancy.  It sounds likely though that you had a left tubal ectopic.  There is frequently pain on the side of the pregnancy when the tissue starts to dissolve and detach from the tube wall.  This happens a lot, and as long as they don't see any free fluid (that would mean internal bleeding) and your HCG levels continue to drop, you should be OK.

Prior to trying again--you might want to have a HSG (hysterosalpingogram). That is a dye study of the tubes to check to see if they are open.  If they are badly scarred, invitro is an excellent option to avoid another ectopic and to speed up the time to conception.

Good luck!

Dr B

[lou95]

Hi thanks, I am having stabbing pains today but not sever labour like pains.

My next appointment is tomorrow to see if my HCG is down to 0 however it was only 78 last week so it is not that high.

I have mentioned the pain to the doctors however their response is as long as the HCG goes down there is nothing to worry about, have some more pain killers!!!

The methotrexate was given as I was diagnosed with a pregnancy in an unknown location and therefore this would stop the division on cells and clear the mass. I also heard it was 3 months for 1 jab but 1 doctor has told me 3 months and 1 has told me 6 months which has added to my confusion.  

I am starting to think it was not a pregnancy of unknow location but an early incomplete miscarriage and therefore tissue too small to see on transvaginal US?

I really dont know what is happening, all appears a bit strange.

I will let you know what the result is tomorrow.

[waiting21]

If you are still having pain I would call your doctor.  What are your HCG levels now?  Did you get back down to 0?  If not, they could do an X-ray (an HSG) to see if there is anything left in the uterus or in the tubes.  I am not sure how long you need to wait after methotrexate.  I think it varys depending on why you had the shot.  I would think they would say at least 3 months?  I am sorry you have to go through this.  Good luck.