Pregnancy of unknown location - expectant management

[MusicIsMedicine]

I'm currently still dealing with my pregnancy of unknown location. It is thought to be ectopic but very small/early on. Was offered Methotrexate but I declined this as I don't want to take it unless absolutely necessary. Has anyone else been in this "wait and see" situation and if so how did it pan out? I am sure the pregnancy is non-viable and will end naturally hopefully without the need for drugs or surgery, but just curious if anyone else experienced this and what happened next? Also how did it affect periods/fertility and what did you use for contraception afterwards?

I was told this at an early scan, they suspected ectopic but it was all inconclusive. I opted to wait and see and after (I think, it was a good few years ago now) about 10 days (maybe 14?) and a couple more scans it was found to be a intra-uterine pregnancy, but further on it was recognised as non-viable (slow growing and eventually stopped growing) resulting in an ERPC at about 10 weeks (could have opted for natural m/c but I'd done that before and prefer ERPC)

It didn't in any known way affect periods/fertility but it was no4 of 5 pregnancies that did not result in a live birth.

Sorry not to be reassuring, but each and every one is different. Best of luck with it.

Hi Winter and thanks for the reply. What is ERPC? Sorry not up to speed on all the acronyms. Sorry to hear of all you've been through, cannot imagine going through this 5 times.

its evacuation of retained products of conception, what they used to call a d&c (dilation and curretage I think?). It's a quick op under anaesthetic. If it comes to that point you can usually choose between the erpc, medical management (which is tablets to encourage everything to come out, sorry for bluntness) or natural m/c. Occasionally one way or another will be medically indicated and you would be pointed in one direction.

If it helps, I've known others in the exact same situation who had a good outcome (viable uterine pregnancy discovered after all). It's all a bit random, I'm afraid.

I hope thats not TMI, feel free to ask questions if it helps.

Sorry, to be clear, those options are only for a non viable uterine pregnancy. If it is non-uterine, so ectopic, you will be presented with another set of options. Expectant management is appropriate at this stage, if its really early it can even literally just disappear, although a recommendation of methotrexate is likely if and when the location is discovered.

Hiya. I also had a v early ectopic. I opted for methotrexate over surgery because I knew my tube, at that point was saveable but was advised almost all surgery's they remove the tube regardless as it lessens risk of another. Leaving it to ride out wasn't an option. My hcg was still rising albeit slowly, and I just knew I'd end up vvvv poorly.

The methotrexate was no fun admittedly. The first round failed for me (20% chance of that happening apparently but my dr had never had it fail previously so was surprised) which meant I had another shot. (I deliberated just going for surgery at that point but I was terrified) which worked.

We were told to wait 3 months minimum to ttc again. It had taken us 16 long months to get pregnant with ectopic. . . We caught first month after (my cycles instantly hit 28 days) and I was scanned immediately at 6 weeks. I'm now 16 weeks with a (touch wood) healthy baby who we cannot wait to meet.

I'd urge you to take methotrexate or surgery. The heartache of dragging it out isn't worth it. It took over a month for anyone to take me seriously from my first v heavy bleed. No one would listen. I honestly think the likely hood for natural resolve of an ectopic is very small and the risk of becoming extremely sick is too high. After the 2nd round of methotrexate my hcg was 0 within a month. It was a relief to have it over. Good luck and I'm very sorry that things aren't going as hoped for you x

Yes, scan (atfter pain and a strange period prompted pregnancy test) was inconclusive. Regular blood tests for two weeks showed hormone levels falling, looked like it was miscarrying wherever it was. Then hormone levels started to climb back up, proving ectopic. Treated with methotrexate but took about 6 weeks from there for hormone levels to finally drop to non pregnant levels. Was a horrendous 2 months. However conceived dc2 6 months later with no problems.

Look at the ectopic pregnancy trust website for contraceptive advice, loads of good advice and supportive message boards.

OP, how far along are you? I started bleeding lightly 1.5 days after I found out I was pregnant (which was day 27 of my cycle). The scan didn't show anything as it wasn't so early on, but since my HCG levels were increasing slowly rather than doubling every 24h I had the same (unknown location preg). I was too nervous to just sit and wait for another week and to wait for signs of ruptured tube (shoulder tip pain, etc), so decided to go for another scan privately on Harley st. There they've found the tiny ectopic in my tube but said I have nothing bad to expect from this as the "foetus" was no longer alive and wouldn't go any further, and thus, not give me any problems. They recommended to have an other scan a couple of weeks later just to see that it was re-absorbed by the body. So I didn't need any medication or intervention. If we weren't TTC at that time I would've probably just thought that my period has arrived (although I was lightly bleeding for ca. 10 days in total).

We had to stop TTC for a while after that due to another health issue I had, but they recommended to wait for max 3 months before trying again.

Fast forward 1.5 years and I'm 31 weeks preggo and everything seems fine! :) Good luck to you OP, keep us posted. x

I had methotrexate in 2005, very sadly for us the embryo turned out to be in the right place after all, so I would definitely suggest waiting as long as it is deemed safe to do so as it destroyed what could have been a healthy pregnancy.

P.S.: I'm really glad I went for that private scan, it was worth every penny to get a peace of mind and to know I was no longer in danger and could relax rather than freaking out about every twinge in my stomach. I certainly wouldn't take the medication unless it is confirmed that it is medically necessary.

Very sorry to hear you are going through this OP. I had expectant management for two weeks after a scan showed an empty uterus. I had blood tests every other day and my HCG levels rose very, very slowly so it was obvious after the two weeks that it was a non viable pregnancy and a further scan showed there was still nothing in the uterus. The methotrexate worked, my HCG levels dropped quickly and it was a relief to have a resolution. I had a second ectopic which ruptured a few years later and it was very touch and go so would advise you to make sure you are being regularly monitored and not too far from medical facilities.

I had a diagnosis of Pregnancy of Unknown Location after a slight bleed, with very slowly rising HCG and no visible embryo on a scan. I waited for as long as they would allow because I wanted to miscarry naturally and didn't like the idea of the methotrexate or the delay in ttc following. But HCG was still rising and I was asked to choose between methotrexate or investigative surgery to try to locate the pregnancy, with the understanding that if a pregnancy was found in my tube, they would either remove the tube or possibly open and sow it up again. I opted for surgery as I was really not keen on the drugs, and they couldn't find anything. They would have then wanted me to take methotrexate, but I miscarried naturally a day after the surgery.

So, in answer to your questions, it is entirely possible that it may end naturally in its own time, but of course you do need to be very aware and keep getting monitored in case it ruptures in the meantime.

I don't think it affected my fertility or periods at all. I did have a second miscarriage (straightforward uterine pregnancy but that just didn't develop) 6 months later, but another 6 months on and I'm now 31 weeks pregnant.

OK I looked it up. Wondering if I will need one of those.

Hi, I had an ectopic/PUL in June last year. I did the wait and see approach and it sorted itself out so didn't need medical intervention (though this involved lots if blood tests and being monitored). It took quite a while for my hcg to go back down to 0 but for me I am glad I had this approach and that it worked itself out. Sorry to hear you are in this position and wishing you all the good luck and strength xxx