Advice about management of a possible miscarriage or ectopic pregnancy

[Chilliross]

Hi all, looking for a bit of help. I'm currently 5w+5 pregnant and due to some very early bleeding (since stopped) and slowly rising hcg levels my doctors have been monitoring me closely.

Today I had an early scan on which they couldn't see anything. My hcg levels so far have been: Mon - 350, Wed - 380, Fri (today) - 560, so are definitely not looking too good either...

My doctor has suggested I get the methotrexate shot for a suspected ectopic but this feels a little too soon given that nothings yet been confirmed either way. I'm also wary of the injection side effects and a bit upset about the prospect of not being able to try again for another 3-6 months!

Does anyone have any experience of making a decision in similar circumstances or advice? Really not sure whether to wait it out any longer or hold onto any hope, thanks!

They kept me in hospital for a week monitoring and I did miscarry my ectopic naturally. I didn't feel that my care was particularly good or that anyone really knew what they were doing though and all in all was incredibly traumatic.

@Honoraryuce ah I'm sorry, that's such a long time to be admitted and to receive bad care at such a stressful time! Do you mind me asking what your symptoms were that made monitoring you at the hospital an option?

It was mostly just really bad pain at first down one side and then after I was admitted some spotting. I had an ultrasound at the end of scanning list in EPAU but then was sent home but then was called by a slightly panicky oncall Dr a few hours later telling me I needed to come back to the hospital. I don't really know why they decided monitoring me was ok but I was in A&E for a while then on postnatal then transferred to another hospital because they were better equipped to deal with rupture if it happened. I had an ultrasound each day. I guess they were happy that I was in the right place if it ruptured and maybe the pain made them think the pregnancy was ending on its own? I wasn't particularly well informed at any point during my stay though, it was pretty much just this is an ectopic pregnancy, the safest place for you is in hospital.

Hello
I believe i am 6w+2 today. I am under the EPU due to a previous ectopic pregnancy and surgical removal.
This pregnancy has been 'off' 'different'. I do not feel pregnant. I feel tired but that's it. I got in contact with EPU because i was initially having abdo pains and sharp left sided pain which resulted in an A&E attendance, however the left side is where i had a tube removal last year. No bleeding. As time has gone on I've had constant pelvic pain, cramps and the odd shooting pain on the right side. I've 2 scans now and HCGs every 48 hours for 10-14 days. My HCG was initially very low but doubling, however now there is only a slow rise. The scans have shown a 5cm cyst on my left ovary. However they are uncertain as to whether there is a pregnancy in my uterus. They said they spotted something in my uterus but it was so small they can't call it a sac (this was on Thursday). Doctors are saying different things. Some are saying it is a pregnancy in a uterus, others are worrying that it may be ectopic but they can't see anything on the ultrasound. The doctor on Saturday said he's unsure as to whether the pregnancy is viable. I am going for more HCG bloods today. The specialist nurse phoned me today and asked what was going on. I updated her. She said that after the bloods today we need a consultant led plan/decision as its being drawn out.

On top of this i don't want to be at work right now. I work with babies and families. I've had to cancel visits which the families have been annoyed about. I appreciate why, as i would be as a parent if my visit was cancelled twice. I told work i don't know when I will be in. They have cancelled my visits however i will have a big list of families to catch up with on my return. I feel guilty about work and how i have let me down. I just feel like i would probably cry if i went in to a visit though.

I don't know what i am asking in this mesaage. I understand that this pregnancy will most likely end. However has anyone been in a any similar situations? Thanks 😊

@Butterfurlong1 I'm sorry to hear your going through this. Please don't worry about work, you need to take care of yourself at this time.

I'm afraid I don't have a situation that was quite the same as yours, I went into a and e in pain and was told they weren't sure if the pregnancy was ectopic or not. Eventually after a few days of scans and blood tests eventually an ectopic was found in my tube.

I would say you seem slightly unsure as to your exact dates. With slow rising hcg it's unlikely to be viable, but I'd say it's not impossible that it's ok, just slow to get started and you're just too early to see in your womb. Personally I'd want to wait a little longer (perhaps up to a week) to confirm if the pregnancy is ectopic, in your uterus but not viable or if there's any chance it's just too early and actually it's fine it's just your cyst causing the pain.

Weighing you the best, let us know how you get on xx

@Chilliross I was in a similar situation last year: 4-5 weeks pregnant, hcg rising but I was bleeding like a period and had abdominal cramps. They couldn't see anything on ultrasound except for some "free fluid in the cul de sac" that made them suspect an ectopic. Still, they said that without imaging confirmation, given it was a "desired" pregnancy, they recommended a watch and wait approach with hcg and ultrasound monitoring every 2 days. It was scary to be at home knowing all the risks of an ectopic, and I did go back to the ER once due to worsening pain but they still could not see signs of a pregnancy. They did discuss methotrexate and even the possibility of laparoscopic surgery to assess the fallopian tubes, but they still recommended observation only. My hcg went up to 1700 before it eventually started going down in about a week and became negative in another 10 days or so. So we never knew if it had been an ectopic or just a spontaneous miscarriage. I got pregnant again 7 months later, and I'm now 37 weeks. I live in the US though, so the guidelines may be different...

I don't know if there's a reason in your case to suspect an ectopic. A spontaneous miscarriage would be much more likely, and it could even still be a very early viable pregnancy. I know it's hard to make a decision with so much uncertainty. If you do decide to wait, just be aware of the symptoms that should make you go to the ER (bleeding, worsening pain, etc). I hope everything goes well for you.

Btw my docs did say that even if it was an ectopic, the fact that I was bleeding and the hcg not rising as fast as expected could be an indication that it was miscarrying on its own so methotrexate would not be necessary... Maybe something else to bring up with your doctor.

Hello.
Apologies for not responding sooner. I have been seem by a few people. I had enough scan yesterday which showed a 6mm empty sac. My HCG levels have been rising but recent was only by 17%-20% I was seen by a consultant who i know and he gave me two options to watch and wait. To return next week for bloods and a scan or to perform an ERCP. He is pretty sure that the pregnancy is in my uterus but he cannot rule it out. If he did the ERCP and got nothing from the uterus he would then do a laparoscopy to look at my remaining tube. Pros and cons with both. Due to consultant strikes and a bank holiday, i wouldn't be able to opt for thr ERCP until next week anyway. So i am watching and waiting until i am seen next Wednesday. I am feeling incredibly crampy and cannot shift a migraine. So maybe a sign of something happening? I've decided that if nothing has started by next Wednesday i will go for the ERCP route.
I feel incredibly lonely. We have a 14 month old and my partner is away a sea for work. My mum is busy looking after my nephews and my in-laws are unwell. Does anyone have any tips of how to look after a little one if i start miscarrying at home?
Thank you for your replies :)