advice on treatment choice

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1

I’m in my 5th pregnancy but suspect it is ectopic. I have yet to go get a scan as everything was closed Friday and I am trying to avoid the ER, prefer to be diagnosed by the specialist I saw for all my other ultrasounds. Hoping to get in tomorrow. But I am almost 6 weeks. Pain on left side that comes and goes, cramping that comes and goes, and intermittent bleeding/spotting that never makes it to a pad but can be bright red to bright pink and a lot when wiping. Very strong lines on tests but I don’t have my usual nausea yet. Between the pain and the bleeding I am guessing it is an ectopic. Feels off from all my other pregnancies, I’ve never bled before.

Trying to go into appointment understanding all my options well. I’m really not happy, I am Catholic so this is hard for me. I am currently still breastfeeding a toddler. I also due to some trauma issues, I’m sad to say have had some past stints with heavier drinking. Not proud but it is what it is in covid times. I’m trying to figure out what would be the safer treatment option for me and to not prematurely wean my son. Would the risk of liver damage be higher if I opt for methotrexate? Might an outpatient surgery be a safer choice? I am a stay at home mom, I don’t really want to be sick from the med for weeks if the surgery is safe and could be a faster option. I feel very lost. Do they just offer methotrexate first because it is easier? I have been very blessed to not have had any complications before other than one csection, but now I am very scared. I always felt very in control of the risks with my other births, and now I feel like a ticking time bomb. I’m scared enough and don’t want to be dismissed or badgered in an appointment. I’m going to have to go in all by myself because we have no one to watch our kids right now but my husband. Afraid I’m even going to have to fight to get an appointment and I really, really don’t want to do this through the er with a dr I don’t know. Neither my ob nor my midwife have imaging in their offices. :frowning:

2

Dear rcmama,

I am so sorry to hear of the worrying time you are going through.

As you have a positive pregnancy test and pain and bleeding, I must urge you to seek urgent medical advice by attending your emergency department straight away.

Without blood tests and scans, there is no way to know if you are experiencing and ectopic pregnancy and although I do not wish to alarm you, if this is an ectopic pregnancy, they can be live threatening if they rupture so I have no choice but to strongly advise you to seek urgent medical advice.

Regarding treatment, this would be decided upon how high your hCG levels are, if there is any fluid collecting in your tummy and blood test. If your liver function tests aren’t within normal limits, they may not wish to use methotrexate. In the UK We also wouldn’t give methotrexate to someone who is breastfeeding. It is a discussion for yourself and your doctor and I would urge you to discuss your concerns and preferences.

It can be extremely worrying not knowing what is going on with our bodies, you have friends here who understand. I cannot emphasise enough, that none of this is your fault. Please be kind to yourself.

I understand you wanting review with your own doctor, but I really wouldn’t be doing my job properly if I didn’t strongly advise you to seek urgent medical advice.

We will be here for you to lean on for as long as you need.

Sending much love and warm hugs,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

If we have been able to help you, are you able to help us with a small donation or by volunteering or fundraising?

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team

3

Thank you for giving insight into what they would do in the Uk. That is very helpful. I’m hoping to get in first thing in the morning unless I start to experience more pain since it at times goes away completely and I would not call it severe at any point yet. Unfortunately ER care here is not affordable in the least even with insurance. I know I’m taking a bit of a gamble waiting one more day but hoping since it is very early time will be on my side. My dr didn’t even care for me to come in for a blood draw. :frowning: Dh is ready to drive me in at a seconds notice.

4

Dear rcmama,

A little message to say you are being thought of and I hope you have managed to get some advice today,

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

If we have been able to help you, are you able to help us with a small donation or by volunteering or fundraising?

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team

5

Just putting in an update. I ended up going to the er on Sunday night. The pain picked up and while I wouldn’t call it severe (I’ve given birth 3 times unmedicated, and 1 time a csection so I know pain), it picked up a lot and I started shaking like I have when I was in transition during previous labors. That didn’t seem right. Took forever in er, kids were batty in the car with their father waiting, but it was diagnosed as an ectopic. I ended up having surgery around 4 am that day. Dr was confident that there was nothing in my uterus and that it was possibly in my left tube or ovary and that because my numbers were high enough he did not feel that methotrexate would be the safe choice, feared I would rupture before it would work. So surgery it was. I was thankfully able to nurse my toddler before my husband took the kids home so he only ended up missing his morning nursing, some tears shed, but they came back to pick me up at 11 the next morning. So it was fast. I feel very run down, pain isn’t that bad but the effects of the general are wiping me out. I’m trying hard to not dwell too hard on what actually happened and keep trying to tell myself it was so early that I wouldn’t feel as sad if it had just miscarried this early. But it’s hard knowing I lost my tube. They thankfully are going to return the tissue to me so I can bury it in the yard, have some closure. And the nurse gave me a crocheted blanket and cried for me - it was nice to have someone acknowledge that I did lose a baby I wanted. I know I am blessed to have 4 already, but I wanted this one too. I also had a nice woman pray over me whom I bumped into in the hall a little before the surgery. I wish I knew her name (she was staff) because it was what I needed. I had to be in there all alone because we had no one to watch the kids. Sorry to ramble, don’t have anywhere else to share it.

For anyone who is reading and searching for symptoms, mine came and went. The pain kept coming back each night. It was one sided, but did not get severe (in my terms anyway) though it was not great. But it would go away. The bleeding was bright red and just spotting. That also came and went. I would have normally been nauseated at 6 weeks already and I was not. When they did the surgery, it had not ruptured but I was slowly leaking blood at the end of the tube so that explained the pain. I am thankful the surgery was uncomplicated, I think this was the better choice given how busy our home is, I’m not sure feeling ill and risking still a rupture would have been a good path.

6

Dear rcmama,

I am so sorry to hear of your ectopic pregnancy loss, I am however very grateful that your sought medical advice with worsening symptoms and are now home safe and sound.

Generally speaking, you should take it very easy for about six weeks after surgery. Your body will be using its energies to heal internally. It is normal to feel physically and emotionally exhausted during this time so please do be kind to yourself. Recovery can take time and some days will be better than others. One day you may be okay and the next you may be in discomfort or more emotional. This is perfectly usual and the healing process will go back and forth in this way for however long you need. It is important to listen to your body signals. Pain and feeling tired are your body signals to tell you to rest. We suggest keeping a healthy diet drinking lots of water and resting.

Emotionally however it can take a lot longer. Experiencing an ectopic pregnancy can be very traumatic for some and it can take up to 3 months to even start to process a traumatic event. Take the time you need to heal both physically and emotionally.

We will be here for you for as long as you need,

Sending much love,

Karen x

The Ectopic Pregnancy Trust Registered Charity Number: 1071811 **************************************************************************

If we have been able to help you, are you able to help us with a small donation or by volunteering or fundraising? Further information is available at ectopic.org.uk Email us: ept@ectopic.org.uk We provide a call-back helpline service: 020 7733 2653 The latest EPT newsletter is out now! You can take a look at the Winter edition and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team

7

Thank you Karen. Everything else I was reading was making it sound like I’m just going to bounce back, but I’m now on day 3 and I’m still worn out walking across the room.

How long does the abdominal swelling take to go down? I’m mentally having a hard time having gone in not looking pregnant and come out looking pregnant but not. :frowning:

8

Dear rcmama,

I t is completely normal to feel this way after surgery, please do not rush things. It can take up to 6 weeks to recover and you are at the very early stages of your journey. Your stomach May take 3 weeks or so to settle. Please do take things easy, I can appreciate how a swollen stomach at this stage would make you feel and I am so sorry you are having to go through this.

We have more information on our website about surgery and recovery which you may also find helpful

https://ectopic.org.uk/physical-recovery

https://ectopic.org.uk/emotional-recovery

Sending much love and warm hugs,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

If we have been able to help you, are you able to help us with a small donation or by volunteering or fundraising?

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team