Ectopic pregnancy - how to know detect it early?

[eventide13]

Hi all,

I wonder if anyone with a history of ectopic pregnancy can help.

I'm currently 4 weeks pregnant and have experienced a lot of abnormal bleeding. My GP referred me to the Early Pregnancy Unit, fearing it could be ectopic pregnancy. She marked it as urgent, thinking they would see me within days, but they gave me an appointment for 2 weeks from now (when I'll be 6 weeks 3 days pregnant).

I'm of coursed concerned because I know from week 6 the risk of rupture increases and that could lead to infertility or even death. However, I've been trying to get a private scan and have learnt that it's very difficult to detect ectopic pregnancy before 6 weeks anyway?

I've been told that if I experience abdominal pain I should go to A&E, but won't it be too late by then, because it will already have ruptured?

I feel like I can't win. What am I supposed to do? I feel so powerless not being able to detect this early in order to avoid something terrible happening. Of course, it's possible that it's not actually ectopic pregnancy, but I feel so anxious not being able to rule it out.

Does anyone have any experience detecting ectopic pregnancy before 6 weeks?

Thank you so much

I am so sorry you are going through this. I have no input unfortunately but I couldn’t just read and go, I wanted to acknowledge you and wish you well 💐

They won't be able to detect by scan because they won't be able to see where the fetus has implanted. Having had a ruptured ectopic pregnancy I would suggest just going straight to a&e if you have severe abdominal pain.

I had a scan around 6wks and they still couldn’t see it. Took weeks after to find it in the tube. There was the option still to wait to see if it gets reabsorbed as it was so small and the blood levels were low. I’m no expert, but I think it’s down to the size of it. At 4wks it will be a speck, so I don’t think they will be too worried about it. I had the same advice as you, go in if I am experiencing pain. I had the injection in the end, but wished I just had the tube removed as it ended up being blocked and useless!

I would see if you can get a blood test to check your HCG levels. At around 2,500 you should be able to see something and where it’s located.
when I had an ectopic it took ages to get to that point but I did end up having a tube removed at around 8 weeks which was luckily before it ruptured

I had extreme pains at 4 weeks but they didn't see anything on the scan.
It all calmed down with no pain for a few days.
I had a couple scans after that - they eventually saw the pregnancy in my tube 5 weeks 5 days and did emergency surgery before it ruptured.
I hope it all goes ok for you 🙏🏽

I had an ectopic. I knew I was pregnant but it couldn’t be seen on the scan at all. My hcg was rising so it was classed as a pregnancy of unknown location. After weeks of back and forth I went to a and e with pain. I was left for three days in a bed because it was over the weekend. By the Monday it had ruptured. I would just be very vigilant to ANY pain and go up to an and e. They’ll likely track your bloods and take it from there. At least you’re on top of it now I would say the highest risk factor is for people who are further along. For what it’s worth I had abnormal bleeding very similar to my ectopic with other pregnancies and she is now twelve so hoping it all works xxx

First of all, thanks so much to everyone who's replied to my thread. You've really made me feel less alone ❤ It's my first pregnancy so everything is new and scary and I've been feeling so emotional.

I'm going to take all your advice and go to A&E the moment I experience any pain (if I do). So far, I've not quite had pain, but sort of a pins and needles sensation, which I imagine is normal for pregnancy? But what level of pain on a scale of 1-10 were you all experiencing when you went to A&E? And was it lower abdominal pain?

Also, I was relieved to read in your replies that abdominal pain doesn't always mean there has already been a rupture. I'm definitely going to run to A&E the moment I feel any pain that concerns me. @uselesseuphless I was so shocked to read that you were left in bed for 3 days and ended up rupturing. That is absolutely awful and I'm so sorry that happened to you. And of course, I'm so sorry for all the rest of you who experienced ectopic pregnancies and emergency surgeries.

I think I might also talk to a private gynaecologist. Even if they can't see it on a scan yet, I'd like to ask about HCG tests as was suggested.

Thanks again, everyone!

I would also add that I had a private scan at 6 weeks expecting to confirm a miscarriage because of bleeding and light tests.
how have your tests looked? Mine were positive but never progressed to dark
At the private scan they couldn’t find anything so diagnosed a pregnancy of unknown location.
My EPU didn’t have appointments so I went to A&E because I was soo stressed.
they tracked my HCG but never found the pregnancy on multiple scans. By 8 weeks they did exploratory surgery and found it hidden at the fold of my uterus. They said If it had ruptured I’d of needed a hysterectomy.
A year later I’m now 25 weeks pregnant x

I would also add that I had a private scan at 6 weeks expecting to confirm a miscarriage because of bleeding and light tests.
how have your tests looked? Mine were positive but never progressed to dark
At the private scan they couldn’t find anything so diagnosed a pregnancy of unknown location.
My EPU didn’t have appointments so I went to A&E because I was soo stressed.
they tracked my HCG but never found the pregnancy on multiple scans. By 8 weeks they did exploratory surgery and found it hidden at the fold of my uterus. They said If it had ruptured I’d of needed a hysterectomy.
A year later I’m now 25 weeks pregnant x

For me, I think I felt the moment it ruptured (as I was in A and E and I felt I couldn’t walk…maybe completely medically wrong though!) But after that it was a really dull stabbing pain. I remember as I was going down for surgery I couldn’t straighten my legs when lying down type pain. Some people were amazing (the nurse on shift/ sonographer/ dr on shift who admitted me) but some were clueless (a doctor the day before said she’d schedule an mri in a month to check!?) just keep speaking to the hospital if you’re worried…in my experience different shifts = different outcomes xx take care

My latest pregnancy test (a couple days ago) came out with quite a strong line (bottom one in pic). I wonder if every woman either an ectopic pregnancy experiences a lighter line like you.

THANK GOODNESS you went to A&E and they did exploratory surgery. Having a hysterectomy would have been devastating. I'm so happy you're pregnant now.

Thanks for your reply! So you didn't have any pain before it ruptured? Did you suspect ectopic pregnancy because of the scan? When did the scan take place? What were your pregnancy tests like?

I can't even rate it 1-10.
I have had 2 babies, Labour without pain relief and I can tell you the ectopic pain was worse than labour without pain relief.
If you have any kind of persistent pain that is painful I would go straight away to A&E.
I would also push EPU to see you earlier and ask for bloods - that's very bad that have not seen you earlier.

I didn't know I was pregnant with my ectopic so unfortunately it ruptured just after I had gotten to A&E, having had waves of pain for nearly 24 hours because I was used to extreme ovulation pain and thought that's what it was. I was between 7-8 weeks pregnant though.
If you experience any pain not just your stomach but even in your lower back or bum/tail bone go to A&E and say you have a suspected ectopic, but it's impossible to see a pregnancy on a scan at 4 weeks unfortunately. They can do bloods so do ask why they haven't or if they can.
I hope all turns out well for you and you can enjoy your pregnancy x

Bleeding can be common early pregnancy.

Repeat blood tests every 48 hours to check hcg levels were rising properly - this is a good indicator of viability. Difficulty is you're unlikely to see anything on a scan before 6 weeks, they could be doing blood tests at this point though.

For me I went for a private scan at 6 weeks and was told "pregnancy unknown location" and was sent to EPU. Initially still still couldn't locate and then confirmed ectopic.

Agreed to methotrexate injection with EPU. Unfortunately ruptured a week later - no bleeding (initially) or pain in shoulder etc. honestly felt like extreme trapped wind.

Sorry you're going through this.

I’ve had four ectopic pregnancies.

The first ruptured and the pain was so bad I passed out in Morrisons. I knew I was pregnant but thought I was having a threatened miscarriage as there was a brown smeary discharge on the toilet paper when I went to the loo.

The second one, I was more aware of the fact that it could again be ectopic as the chances are higher if you’ve already had one so as soon as I saw the positive test I went to the EPU and they did bloods every three days.

HCG Levels should double every couple of days or so with a normal pregnancy so it was clear after a week that it was again ectopic as mine were only crawling up. More surgery but it hadn’t ruptured.

I then went on to have two more.

One if the big signs for me was the brown discharge when first pregnant. I had it with every one and knew straight away.

Hopevthings work out for you OP.

I was fine, even at 6+ weeks. Second trip to EPAU for bloods, and was back at work with no concerns other than dark, globby, bleeding. Got called to return ASAP due to HGC levels, still no pain. Sat in hospital, waiting for a place in theatre, and then I quite quickly went down hill. Within a couple of hours, I went from totally normal to morphine, curled in a ball, and only DH able to understand what I was saying (he was literally translating my words). An hour later I was in theatre, and they still got to me before my tube ruptured.

So, if you do get masses of pain, get to A&E and be very clear have an upcomming appointment for a suspected ectopic. Otherwise, it really is a waiting game. Sorry.

Yes I had pain but not unbearable. I knew it was ectopic because my scans were empty but hcg going up. I can’t carry in my uterus because I’ve had an ablation so I suspected it was. My tests were about 1500 when it ruptured. I hope you’re okay xx

Thank you 💙 dark brown discharge has been my main symptom. How early in pregnancy did it start for you?

Pretty early. In fact, after the first one - it was the sign I dreaded… as soon as I knew I was pregnant and saw that muddy smear on the toilet paper I knew.

My first pregnancy was ectopic. I remember I was driving home from work and had a sudden intense lower abdominal pain. I went to bed and had a nap with paracetamol and then went out for dinner with friends later that evening as it had subsided (enough to mask being fine but not totally disappeared). I then woke in the night with more pain and by about 5am knew something was wrong so called 111 who sent me to out of hours. It happened to be a Sunday so I was then sent home and booked into an EPAU the next morning where a scan confirmed the pregnancy was not in my uterus. On a pain scale (I think I am quite good at dealing with pain) by then it was more of a dull continuous crampy stabby pain. I didn’t have any of the other symptoms like shoulder tip pain and the drs were surprised at how ‘well’ I seemed considering.
I had emergency surgery that day and had a tube removed.
I have since gone on to easily and quickly fall pregnant 4 more times despite only having one tube. One was sadly an early miscarriage for unknown reasons but I have two healthy boys and am awaiting the arrival of my 3rd. So whilst the ectopic was heartbreaking, very stressful and resulted in the loss of a tube, fertility wise I have still been extremely lucky. I hope that’s helpful and reassuring and I’ll be thinking positive thoughts for you.

My first pregnancy was ectopic. I remember I was driving home from work and had a sudden intense lower abdominal pain. I went to bed and had a nap with paracetamol and then went out for dinner with friends later that evening as it had subsided (enough to mask being fine but not totally disappeared). I then woke in the night with more pain and by about 5am knew something was wrong so called 111 who sent me to out of hours. It happened to be a Sunday so I was then sent home and booked into an EPAU the next morning where a scan confirmed the pregnancy was not in my uterus. On a pain scale (I think I am quite good at dealing with pain) by then it was more of a dull continuous crampy stabby pain. I didn’t have any of the other symptoms like shoulder tip pain and the drs were surprised at how ‘well’ I seemed considering.
I had emergency surgery that day and had a tube removed.
I have since gone on to easily and quickly fall pregnant 4 more times despite only having one tube. One was sadly an early miscarriage for unknown reasons but I have two healthy boys and am awaiting the arrival of my 3rd. So whilst the ectopic was heartbreaking, very stressful and resulted in the loss of a tube, fertility wise I have still been extremely lucky. I hope that’s helpful and reassuring and I’ll be thinking positive thoughts for you.

You need your HCG bloods done. Once every 48 hours and it will need repeated 3-4 times. In a no ectopic pregnancy they should double every 48 hours. Ectopic always follows a strange pattern where they rise slowly. Honestly I would go to A&E as they should do those bloods and get you seen urgently .

Hi everyone,

Thanks for all your help and advice. You've encouraged me to seek further help from the EPAU and I've just gone in for a blood test. They've asked me to come back on Wednesday so they can compare the HCG levels. Hopefully this will shed some light on what's going on.

Thanks again for your support!

hey! Was there any update here? Did everything turn out ok? Having similar symptoms, v worried, waiting call back from epu & hoping they book scan (6 weeks on saturday)