The Scoop on Ectopic Pregnancies

Looking back over the blog I realized that we have not posted anything about Ectopic Pregnancies yet we have quite a few ladies on the board that have experienced them. So let’s go over what a Ectopic Pregnancy is and sign and symptoms to look for. I personally have not experienced one so if any of the ladies that have would like to chime in on anything please get a hold of me.

What is a ectopic pregnancy?

An ectopic pregnancy, or eccysis, is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the mother, since internal haemorrhage is a life threatening complication. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death.

About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes.

In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube and burrows into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding hematosalpinx expels the implantation out of the tubal end and is a common type of miscarriage. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant. Sometimes the bleeding might be heavy enough to threaten the health or life of the woman. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into the nearby Sampson artery, causing heavy bleeding earlier than usual.

If left untreated, about half of ectopic pregnancies will resolve without treatment. These are the tubal miscarriages. The advent of methotrexate* treatment for ectopic pregnancy has reduced the need for surgery; however, surgical intervention is still required in cases where the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or through a larger incision, known as a laparotomy.

*Methotrexate, abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, and ectopic pregnancy.

I’ve suffered an ectopic pregnancy, but my hCG keeps rising.. what could be going on?

There is a chance that you are still retaining tissue from your loss, you may be going through what is called a heterotopic pregnancy, or you may be going through a persstent ectopic pregnancy, either way you should be in contact with you doctor about your concerns for testing and monitoring.

Heterotopic pregnancy

In rare cases of ectopic pregnancy, there may be two fertilized eggs, one outside the uterus and the other inside. This is called a heterotopic pregnancy. Often the intrauterine pregnancy is discovered later than the ectopic, mainly because of the painful emergency nature of ectopic pregnancies. Since ectopic pregnancies are normally discovered and removed very early in the pregnancy, an ultrasound may not find the additional pregnancy inside the uterus. When hCG levels continue to rise after the removal of the ectopic pregnancy, there is the chance that a pregnancy inside the uterus is still viable. This is normally discovered through an ultrasound.

Although rare, heterotopic pregnancies are becoming more common, likely due to increased use of IVF. The survival rate of the uterine fetus of an ectopic pregnancy is around 70%.

Successful pregnancies have been reported from ruptured tubal pregnancy continuing by the placenta implanting on abdominal organs or on the outside of the uterus.

Persistent ectopic pregnancy

A persistent ectopic pregnancy refers to the continuation of trophoplastic growth after a surgical intervention to remove an ectopic pregnancy. After a conservative procedure that attempts to preserve the affected fallopian tube such as a salpingotomy, in about 15-20% the major portion of the ectopic growth may have been removed, but some trophoblastic tissue, perhaps deeply embedded, has escaped removal and continues to grow, generating a new rise in hCG levels. After weeks this may lead to new clinical symptoms including bleeding. For this reason hCG levels may have to be monitored after removal of an ectopic to assure their decline, also methotrexate can be given at the time of surgery prophylactically.

What are some signs and symptoms I should be looking for if I do become pregnant?

Early symptoms are either absent or subtle. Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 5 to 8 weeks. Later presentations are more common in communities deprived of modern diagnostic ability.
Early signs include:

  • Pain in the lower abdomen, and inflammation (pain may be confused with a strong stomach pain, it may also feel like a strong cramp).
  • Pain while urinating.
  • Pain and discomfort, usually mild. A corpus luteum on the ovary in a normal pregnancy may give very similar symptoms.
  • Vaginal bleeding, usually mild. An ectopic pregnancy is usually a failing pregnancy and falling levels of progesterone from the corpus luteum on the ovary cause withdrawal bleeding. This can be indistinguishable from an early miscarriage or the ‘implantation bleed’ of a normal early pregnancy.
  • Pain while having a bowel movement.

Patients with a late ectopic pregnancy typically experience pain and bleeding. This bleeding will be both vaginal and internal and has two discrete pathophysiologic mechanisms:

  • External bleeding is due to the falling progesterone levels.
  • Internal bleeding is due to hemorrhage from the affected tube.

The differential diagnosis at this point is between miscarriage, ectopic pregnancy, and early normal pregnancy. The presence of a positive pregnancy test virtually rules out pelvic infection as it is rare indeed to find pregnancy with an active pelvic inflammatory disease (PID). The most common misdiagnosis assigned to early ectopic pregnancy is PID.

More severe internal bleeding may cause:

  • Lower back, abdominal, or pelvic pain.
  • Shoulder pain. This is caused by free blood tracking up the abdominal cavity and irritating the diaphragm, and is an ominous sign.
  • There may be cramping or even tenderness on one side of the pelvis.
  • The pain is of recent onset, meaning it must be differentiated from cyclical pelvic pain, and is often getting worse.

Ectopic pregnancy can mimic symptoms of other diseases such as appendicitis, other gastrointestinal disorder, problems of the urinary system, as well as pelvic inflammatory disease and other gynaecologic problems.

What causes Ectopic Pregnancies?

There are a number of risk factors for ectopic pregnancies. However, in as many as one third to one half of ectopic pregnancies, no risk factors can be identified. Risk factors include: pelvic inflammatory disease, infertility, use of an intrauterine device (IUD), tubal surgery, intrauterine surgery (e.g. D&C), smoking, previous ectopic pregnancy, and tubal ligation.

Will experiencing an Ectopic Pregnancy lead to fertility problems in the future?

Fertility following ectopic pregnancy depends upon several factors, the most important of which is a prior history of infertility. The treatment choice, whether surgical or nonsurgical, also plays a role. For example, the rate of intrauterine pregnancy may be higher following methotrexate compared to surgical treatment.

*** All this information was obtained by certified sources on Wikipedia.org

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I need to pee, but what on?

Going to the “family planning” section of the store can be a little overwhelming. You don’t want to sacrifice results for a price and you don’t want to get your heart broken by false positives

Between the blue dyes, pink dyes, smilies, words, and midstream or cup variations of a “pee stick”, it’s hard to choose the right one.

What should you look for in a HPT?
It’s commonly known that blue dye tests are notorious for false positives. Pink dyes have been known to give good, early, reliable results. Digitals are more expensive and also have been said to have a harder time detecting a pregnancy early on.

Don’t just look for the price tag, but don’t think you have to buy the most expensive on the market. You can find good reliable tests, yes, even generic, for a price that wont hurt.

You can also choose between midstream tests or the kind where you pee in a cup and dip the test. The more popular is midstream, but you can purchase the dip tests online for quite a good price break. Check Amazon or Early-Pregnancy-Tests.com.

What makes them all different?
As your hCG increases with pregnancy, so do the chances of picking up the hormones on the test strip. Many brands can detect a pregnancy at different points and some are more sensitive than others.

Here’s a wonderful chart from Early-Pregnancy-Tests.com

As you can see, the numbers can vary greatly. The higher the number, the harder it is to detect the hormones early on.

FMU, HPT, POAS, PIAC, what does it mean!?
There are many acronyms when it comes to this subject.

FMU= First Morning Urine. It’s recommended to use your urine first thing in the morning because it’s the most concentrated and will have the highest hormone level.

HPT= Home Pregnancy Test, both midstream and dip tests.

POAS= Pee On A Stick, commonly known as mid-stream tests. These are the ones with the plastic body and tip that is used to catch urine, also comes with a reading window.

PIAC= Pee In A Cup, these tests are for the ovulation tests and home pregnancy tests that you dip into a cup of collected urine. *NOTE you do not dip it in the toilet*

The dip tests are generally cheaper and you can buy in bulk fairly well, both Amazon and Early-Pregnancy-Tests.com will have great options.

Please check the side of this page —>
Note the chart stating the percentage chance of you getting a positive test at a specific number of DPO (Days Past Ovulation). Testing early will increase your chances for a negative, remember to be prepared for it being too early.

What’s your favorite brand to pee on? Join our thread Here or comment below!

BFP by DPO on your HPT (YKWIM)

Thanks, ShellShockedMama, for the chart and commentary! This is an excerpt from TTCAL FAQ’s, also courtesy of ShellShockedMama.

% Positive HPT at x dpo

35% at 10dpo
51% at 11dpo
62% at 12dpo
68% at 13dpo
74% at 14dpo
80% at 15dpo
88% at 16dpo
92% at 17dpo

This is why testing early can be frustrating and disappointing. 65% of pregnant women will get a negative at 10DPO! If you test any earlier than 10DPO, then you’ve pretty much wasted your pee stick. I’ve never met anyone –other than when googling– that ever got a positive test earlier than that. (I think, if they did get a positive at 9DPO or earlier, they probably ovulated earlier than they thought).

Most pee sticks at the store will measure 25 units of the HCG hormone, which is pretty sensitive. Sometimes more sensitive then the ones your doctor has. If you prefer to go to your doctor, say for a blood test, then ask how sensitive the test is. If it measure 100 units of the HCG hormone, you might want to save your co-pay until you’re at least 18DPO ish. the dollar store tests are good and they are sensitive, so use them first. if you get a negative, it’s only $1.

The Package Says it can detect the HCG Hormone “5 days before missed period” is that true? Yes and No. It’s kind of a TTC urban legend that the “average” cycle is 28 days with a 14 day LP. I don’t know who started that myth, but it just won’t DIE! So, when a test tells you you can test 5 days before your missed period, that’s not exactly true. They wrongly assume that you have this average cycle. That you have a 28 day cycle and ovulate on day 14. Let’s do a little math, yes? So, based on the fallacy I just stated about, subtract 5 from 14, which means that the earliest you should even bother testing (and I still think it’s too early, but hey, it’s your pee stick) is 9 DPO. SO, if you have an 11 day day LP, you can only test 2 days before your missed period, if you have an 10 day LP, you can only test ONE day before your missed period. Just keep this in mind when you freak out over a BFN b/c you tested early.