Possible second ectopic? What are options :(

[Abbie2222]

hi all, just after some advice please. I have already had one ectopic pregnancy and had my right tube removed. I am only four weeks pregnant again now so too small to tell the location of the pregnancy, and my HCG was only 20 yesterday which was 12 DPO. I’ve had only mild cramping (whereas the cramping with my previous ectopic was more severe) but I have had pretty severe pain in my left trapezius muscle on the top of my shoulder, which is the side where I have the only remaining tube. The early pregnancy unit said we just have to monitor but I am so anxious. I cannot risk it rupturing because then I‘ve lost both tubes. I’m a bad candidate for IVF (if I have to have the remaining tube removed) because I have rock bottom AMH and follicles so it’s incredibly important that I can fall pregnant naturally. The previous ectopic was removed via taking the whole tube on the NHS in the UK as they said this is the most common option.

what else can I do, other than waiting until the pregnancy grows so they can determine the location? I am so anxious about rupturing and losing this. I don’t necessarily want to take the methotrexate if it is ectopic and have to wait three months to try again because my follicles are already so low and I have been told my chances of conception are declining very quickly (if the methotrexwte is even successful, which I’ve heard it often isn’t). Is the only option then to try and remove the pregnancy but save the Tube? and how likely is it that this trapezius pain could be related to an ectopic despite having no real major abdominal cramps?

thanks so much, so anxious 💔

You need to get medical advice, but thought I would post to say removal of the tube is actually old fashioned and not preferred. Try to get a female surgeon as they understand the damage complete removal causes to early menopause etc. You should be able to have the tube cleared instead.

I was told by my female consultant that removal of the tube entirely is preferable to leaving you with a scarred tube when you still have another healthy tube left. I imagine if you had another ectopic they’d try to preserve the remaining tube a bit more than they did the first to avoid taking both. Otherwise it’s expectant management or methotrexate from what I remember.

My first pregnancy after ectopic ended up being a very early loss/chemical pregnancy but I was in an absolute state for a week or so as the symptoms were pretty much the same as the first time and I was convinced it’d be ectopic. EPU should be able to scan from 5 weeks (two different ones have for me in subsequent pregnancies) to check you out.

ETA I’ve also had two healthy pregnancy post ectopic and the first weeks wait was agonising then as well so all may be well for you!

I'm sorry to hear you're going through this. Try and take one day at a time, hopefully its not a second ectopic.
I had two ectopics with the first one having my right tube removed. The second one was detected early and I chose to have conservative management which entailed getting my bloods taken every 48hours and also a hospital stay after they failed to drop. The hopsital recommended I take methotrexate but I declined so it was a lot of monitoring and waiting, however in the end it did resolve itself without needing surgery.
Every situation is different so of course take the hospitals advise but I just wanted to share am experience that didn't end in the tub being removed. 💐

@Abbie2222I don’t have too much advice for this, however was hoping I can offer you a tiny bit of comfort or hope.

I had an ectopic pregnancy this time last year, however mine was treated with the methotrexate. At the start of this month I found out I was pregnant at 9dpo, I am currently 6 weeks + 3 days. Like yourself, I was absolutely petrified that I was having another ectopic and from my positive test I was getting an almost pulsating ache that would come and go on my left side where my past ectopic was. I was obsessively googling about it and had was also keeping an eye out for shoulder pain - I did read however that the shoulder pain during an ectopic is caused by the free fluid if it ruptures, which at 4 weeks would be very very unlikely. I think our bodies have an amazing but very unfortunate way of remembering pain and when we’re in an anxious state it can feel heightened as we are almost looking out for the familiar pains so much.

Obviously if the pain is really bad and continuous it would definitely be worth going to A&E at any point, as you know your own body and sometimes the reassurance helps. Has your cramping been different this time round?

I got booked in for a scan at 6 weeks by the EPU, the wait for the scan was genuinely the most anxious I’ve ever been. I was absolutely convinced that it was another ectopic but to my surprise, the pregnancy is exactly where it needs to be. Obviously it’s still early days, but I wanted to offer you a positive story ❤️

is your early scan booked? Perhaps you could request a slightly earlier one, at 5 and a half weeks, instead of 6. As they may be able see a gestational sac atleast (still can be too early to see the yolk sac/embryo). For me I wanted to wait until 6, as I wanted to ensure they could see something so it didn’t cause me any more anxiety

Unfortunately it’s a very unpleasant waiting game OP 😔 but there is much higher chance that everything will be ok this time x

Thank you for this! And I’m so sorry that you’ve been through this experience too, so horrible the things we have to go through. I really hope things are looking up for you.

That’s good to know that’s an option. The nurse I spoke to on the phone did say if it was ectopic they would generally try to do conservative management given I only have one tube left but I wasn’t sure how this would go. When you say it resolved itself, did it eventually just pass without any further management? I guess I just worry with this that I would potentially scar the only remaining fallopian tube from the pregnancy growing bigger, if this is even a thing? I know that they say removing it from the tube could scar the tubes, so wouldn’t leave it there to grow do the same?

I just had such a rushed and intense experience the last time this happened, it was all done from the early pregnancy unit and then acute Gynacology and I didn’t have any service in the basement of the hospital to even be googling other options because it was all such a rush. I even felt like the doctors didn’t have much time to explain all the options, they just repeatedly said that they would always remove the tube and that’s the safest and best.

i’m obviously praying that it is not an ectopic and that the healthy pregnancy continues, but I want to be more prepared this time and know what my options are.

Generally tubes are removed now due to the scarring left by trying to remove the embryo which leads to further ectopic pregnancy. I’ve had four. The first two resulted in my tubes being left but both were scarred which resulted in two more ectopics and I eventually had both tubes removed. Sorry you are going through this - it’s totally heartbreaking- I had 12 years of it.

Hey. I can hear the anxiety in your posts and I want to send you some calm! I've had three ectopics myself, I understand how you feel.

Firstly, a tube that functions and only gives ectopics is not a tube worth keeping. If this tube needs to be removed, it is truly no loss. To keep it would be to keep a tube likely to keep repeating ectopic hell. You don't want that.

Secondly, you do not know that this pregnancy is ectopic. HCG 20 at 14dpo is lower, but still in the totally normal range. Please do not worry without due cause. One day at a time. Today, things are in the normal category.

Thirdly, shoulder pain from ectopic happens due to internal bleeding - this causes pressure and comes out as shoulder pain. At a HCG of 20 your chances of rupture - even with a confirmed ectopic - are EXTREMELY low. Not completely impossible, but medically very very notable. You would be in a medical paper, trust me. It is extremely unlikely that you have ruptured and have internal bleeding with a HCG so low, only two weeks after conception. One day at a time, today the risk is really really low.

Finally, if this pregnancy is indeed ectopic you will be presented with three options.

• The first is expectant management - this is where you will have repeat bloods over and over to see if the levels rise or fall, left alone. Some ectopics can manage themselves and HCG will fall to zero without intervention. This has just happened to me - I've had two ectopics that resolved naturally, and one that did not.

• The second option is methotrexate. Yes, you cannot try for 3 months if you have it. But, if you don't have it, you may end up with surgery and not be able to try naturally ever. So it's worth considering. However, it didn't work for me. And it makes you feel like shit. So, if your HCG gets to a level where it is very high, and it's borderline whether methotrexate will work, you might be best skipping it and going straight for surgery.

• Surgery is of course option 3. When you have only one tube the surgeon will attempt to remove a pregnancy and leave a tube. But often this will cause scarring. Most likely the tube will be removed.

Tubes are not required for IVF. I was told my AMH was low, and not to expect much. I got 9 embryos. IF (and it is quite a big if!) you lose this tube and need IVF, there is still hope.

I hope this helps. For me, I find playing out worst case scenarios actually soothes me. Whatever happens, you can cope with this. Here if you want to talk more. I've literally just been through this for the third time so I really do get it.

Hi thanks for your response, much appreciated. My 48 hour hcg was still only 20 today so they’ve advised it’s either a miscarriage or ectopic so need to monitor. I hear your point about keeping a tube that’s had an ectopic, but I only have one left currently so if it is another ectopic I don’t want to be tubeless. With such low AMH I’m a bad candidate for ivf which i would then need if i lost the remaining tube :(