[carmen358]

I'm supposed to be 5.5 wks pregnant but my hcg is low and not doubling. My doctor wants me to go to the hospital as soon as I have bleeding and/or pain. I dismissed that thinking that of course there will be blood and pain with a miscarriage (I had 2 before having DD). However, I realize now that her fears of me having an ectopic pregnancy are because my hcg is still rising but nowhere near doubling.

I'm torn because I don't want to go to the hospital just for a miscarriage. There are long waits and I find hospitals depressing and unclean for the most part.

Any suggestions on how I can actually tell I may be ectoptic and not just miscarrying?

Eta: I'm having no cramping or spotting at all yet.

 

[tenzinsmama]

carmen, could they not do an ultrasound to see if it is ectopic? When I was having some pain early in the trimester with my DS, they did one-- so I'm assuming that in most cases they can see it on the screen? And then you can decide what to do? I know what you mean about hospitals... I worked in one for 11 years...

 

[Jaimee]

I'm sorry for your previous losses! It must be very scary and disheartening to possibly be facing this again. It's very early so it could be difficult to see anything on the u/s. But in a few more days (around 6 weeks) they should be able to see a fetal pole and sac. I would request an u/s if you are concerned about an ectopic pregnancy. An OB should do this for you or refer you to a radiology clinic- not the ER. If your current doctor is not willing then I would find someone else. Otherwise a blighted ovum is a more likely cause of low hCG levels and would result in a m/c at some point- usually within a couple weeks, which is probably what your doctor is thinking. Do you know the causes of your previous miscarriages?

 

[SilaMarila]

Do you have a midwife you could call? Someone that would know someone that could do a private u/s you could pay cash for? That is what I have always done when I needed an u/s. Best of luck momma. Hugs.

 

[gozal]

Carmen, I'm so sorry you're going through this. I've just been through a similar situation - the short answer is, from what I learned anyway, is that unless you have one of the hallmark symptoms of a ruptured ectopic, you can't tell. Had I not had early monitoring, I would have arrived at my 8 week OB appointment having no idea anything was wrong. I didn't have any bleeding or pain. Unfortunately bleeding and low non-doubling numbers are ambiguous - and from my experience I learned that many ectopics are not identified on u/s. (Technically this makes them PULs - pregnancies of unknown location.) Because my numbers were low, my doctors let me wait and see if I would miscarry on my own. Ultimately I didn't and when I got close to eight weeks and my betas got to over 1,000, they treated me for "suspected ectopic" although they actually suspected it was a failing intrauterine pregnancy (with my consent, I agreed that the risks were too great at that point to continue to wait). I also got stern warnings throughout to go to the ER immediately with any pain or heavier bleeding. The not-knowing and waiting and betas every 48 hours was very difficult. Please feel free to ask/PM me if you like. Sending some good thoughts out there to you.

 

[ms_quoted]

So sorry you are going through this right now. I have had four ectopic pregnancies and my fallopian tube ruptured twice (the same tube. The first time it ruptured it was repaired and the last time it was removed). Unfortunately, it is very difficult to see if you have an ectopic off of an ultrasound.

 

[carmen358]

Thanks everyone. I suppose I should probably go to the hospital tonight. My doctor is planning on sending me for an u/s but didn't think we'd see much right now anyway. It's 10pm on Sunday night and I'm just starting to get some intense cramping and a tiny bit of spotting. My lower back is VERY sore. Not fun.

 

[ms_quoted]

(((hugs)))

 

[Jaimee]

Update OP? Sending positive and healing thoughts!

 

[carmen358]

NOTHING happened. I opted to skip the hospital, take an advil and get some sleep and I've had no more cramping or spotting. I am supposed to go for another beta blood test tomorrow and then to see my doc again on Thursday. She said she will likely send me for an u/s at that point (I will be over 6 weeks so hopefully they can see something at least.

Jaimee, no, there was no known cause for my previous losses...one at 5.5 weeks and one closer to 10 weeks. I had no treatment or issues with my pregnancy with DD.

 

[Jaimee]

Glad to hear that things are feeling more positive today! I suppose if an u/s cannot confirm an ectopic, it can confirm a uterine pregnancy and therefore rule out an ectopic. At 6 weeks+ they should also be able to tell if it's a blighted ovum. Though, if you think your dates might be a bit off (that you're not as far along as you think) there is a chance of misdiagnosis of a blighted ovum.

Good luck and please keep us posted!

 

[gozal]

Glad you are feeling well, Carmen, and hoping you get a resolution soon. I really hope they see something indicative on ultrasound.

Quote:

Originally Posted by Jaimee

I suppose if an u/s cannot confirm an ectopic, it can confirm a uterine pregnancy and therefore rule out an ectopic. At 6 weeks+ they should also be able to tell if it's a blighted ovum.

I want to gently point out that a suspected ectopic is not the same situation as a blighted ovum. With a blighted ovum hCG generally rises to levels you don't see in an ectopic until it becomes emergent. Suspected EPs progress in a different way, which is why they raise suspicion. In my case, at 8 weeks u/s could not confirm either IUP or EP. I mention this because I wish someone had told me at 6 weeks that there was a possibility that two weeks later I'd know nothing more and be looking at the same picture on the u/s screen. But it is rare and it very well may not be the case for you. My doctors expected me to miscarry on my own.

 

[Jaimee]

Oh yes, I was not saying that EP and blighted ovum are the same. I was just thinking that low hCG levels could be indicative of a blighted ovum instead and that it could be accurately diagnosable on a 6+week u/s. Conversely I know that often with a blighted ovum hCG can continue to rise normally. With ectopic aren't the levels usually higher than normal?

 

[gozal]

Jaime, absolutely, it could be diagnosable and I really hope that is what happens! Low betas could be a failing IUP as well as an EP, which is what makes the process of getting diagnosed so crazy-making. But in an ectopic numbers are usually lower, often significantly lower, or normal, and persistent. For example, my betas were ten times lower than normal for dates (~1,000 when they were expected to be ~10,000+), but they kept rising slowly.

 

[carmen358]

Thanks for the info and encouragement! I started bleeding heavily early this morning and passed what I believe was probably the start of the embryo. So I'm happy my body is dealing with this on it's own. I took a sick day from work today because the cramps are quite intense. However they're not unbearable so I'm going to skip the hospital and just go see my doc as planned on Thursday and if she wants to send me for an u/s to make sure it's complete then I'll go.

Thanks again, you helped me through a scary time.

 

[tenzinsmama]

carmen, thinking of you... ((hugs))