Ectopic Awareness Raising – Part 2

Warning:  This post may well contain TMI.

Just over a year after my first positive pregnancy test, I conceived again, but this time it took the help of a fertility specialist.

I had a strong, early, positive pregnancy test.  I had traditional pregnancy symptoms – fatigue, even nausea.  How I relished that nausea.  With a history of one ectopic pregnancy, my doctor wanted me to get blood tests and an early scan (at about 6 weeks pregnant).  In fact, she’d given me the forms for blood tests even before I got pregnant, and just said – use them.  The tests would tell if my hCG levels were rising appropriately.  They’re supposed to double every 2-3 days.  If they don’t, then the pregnancy is possibly an ectopic.  But I got my positive close to the end of the year, and I couldn’t get the tests done as we were travelling south for Christmas.  I figured I could wait and get that scan after the New Year.  After my experience a year earlier, I knew the symptoms of an ectopic, and I knew to get to the doctor if things weren’t right.  So I relaxed, we both relaxed, and enjoyed it. 

Until things started going wrong.  Bleeding.  Lots of it.  Too much.  None of the classic ectopic symptoms, though.  Pain, for example.  Any woman of child-bearing age who has abdominal pain should be tested for pregnancy, and an ectopic should be ruled out.  It saves lives.  But we don’t all get pain.  I hadn’t had any pain with my ectopic the previous year, so I knew that pain – whilst it is a common symptom – didn’t have to be present for my pregnancy to be ectopic. 

At the end of December, after I returned home, and things deteriorated, I began an interminable process of hospital visits, and blood tests.  This time though my hormone levels were high. The doctors treated me for a miscarriage, then an incomplete miscarriage.  But my levels continued to rise.  I ended up in hospital, having emergency exploratory surgery and a D&C.  “You’ve miscarried,” I was told.  “There was no sign of an ectopic.”  I went home, looking forward to recovering, then trying again.  But once again, the quality of the health care I received probably saved my life.  They continued to check my blood levels, and waited for histology results.  My levels continued to rise.  Obviously this was no miscarriage.  But it wasn’t a viable pregnancy either. Finally, after many more days, more scans, and many more long, boring, worrying hours waiting at the Women’s Health Assessment Unit, I was diagnosed with a second ectopic pregnancy.

To be more accurate, this one was a cornual ectopic pregnancy (now more accurately called an interstitial pregnancy).  Only about 1-2% of all ectopic pregnancies (themselves about 1-2% of all pregnancies) are cornual.  So they are rare.  This type of pregnancy almost makes it to the right place, but not quite, implanting in the area where the blood supply enters the uterus.  This was probably why my hormone levels were so high – compared to a fallopian tube, there was room (and a blood supply) here for the pregnancy to grow.  It is as a result one of the most dangerous types of ectopic pregnancy; if it ruptures, the outcome is potentially catastrophic, as you can bleed out within a very short time. 

Normal protocol for an ectopic pregnancy is to treat with surgery if your hCG levels are over 3-5,000.  Mine were at 14,000.  But surgery itself was too risky.  It could result in too much bleeding, and potential loss of some or all of my uterus.  So again I was treated with methotrexate.  But this time I wasn’t allowed to go home.  The risk was too great, they said.  The 30-40 minutes drive between home and hospital could make the difference between life and death.  I had to stay in hospital until my levels dropped – normally this takes about a week.  I was not happy about this.  But they didn’t drop.  They doubled.  The doctors were worried.  They were concerned I might have a molar pregnancy or more aggressive trophoblastic disease, when the pregnancy cells go rogue, and can metastasize throughout the body.  I was assigned a gynaecological oncologist.  I had a chest x-ray and a CT scan.  It seemed to take forever to get the results.  Finally they came in.  I was clear. 

And after a week, my hCG levels plateaued, and I was sent home.  It took another week for my levels to begin to fall.  I felt as if I was getting out of the woods.  But the nightmare wasn’t quite over yet.  It took another five-six months, two more hospital procedures/surgeries, numerous visits to the wards and WHAU, blood tests, stress and tears, before I was given the all clear to try to conceive again.