Concerned about rupture

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1

Hi everyone,

I am American and I live and work in Thailand. It’s a great place to live, etc. but English isn’t spoken very well by my doctor or the nurses, and I have been very upset by the lack of information and support I currently have.

I found out I was pregnant on Tuesday and two days later that I have an ectopic pregnancy. Since they found it early (I am around 5 weeks) I was given methotrexate. My hcg level was around 2000 (around 900 on my first visit on Tuesday). My doctor suggested that I take three days off work to rest, but I am really worried about having a rupture if I am home by myself where I can’t call 911 like I would be able to at home. She suggested that I go to work so I could be around people in case of a rupture, but I’ve been crying every few hours and feel like a zombie and depressed.

Does anyone have any suggestions? I know that rupture is a possibility but I am being hopeful (after reading many academic articles online) that I will be of the majority that don’t have a rupture. But I also feel like I cannot be around other people who think I went on leave this week because I had a bad backache (this is the reason I went in to the doctor in the first place). But would it be better for me to go and try to explain to my supervisor or HR the circumstances? I work for a well known international humanitarian agency and I believe they would support me.

And back to the backache… did anyone have extreme back pain before they discovered their EP? I haven’t read about this symptom at all and my doctor said it is a separate issue. But also didn’t offer any additional information and kept telling me to focus on the EP because that’s more serious (which is an upsetting thing to tell someone I think, but giving her the benefit of the doubt here as English is not her first language and perhaps it didn’t come out the way she intended).

Thanks for any support, I really appreciate finding this website and group as I have literally nothing here in Thailand to help me, no support groups or counseling or anything.

  • Ranja
2

Dear Ranja,

I am so sorry to hear of your ectopic pregnancy and loss. You have been through a huge amount in such a short space of time and it is very normal to feel overwhelmed. From your words, I can imagine how frightening the experience must be when English is not the first language of medical staff and I am sorry you have had to go though this.

With regards to methotrexate, it is most effective in the earlier stages of pregnancy, usually when the pregnancy hormone ‘beta hCG’ level is below 5000 mIU/mL. The risk of rupture is higher in pregnancies with levels greater than this. Your hCG was less than this and it is good to see that your levels have reduced, your medical team should be completing regular blood tests to ensure it continues to reduce. I completely understand the worry regarding rupture but many women including myself, have methotrexate without a problem.

With regards to work, I understand you wanting to be in work to be close to people, but you also need to rest. Many women, including myself are shocked by how exhausted you feel after methotrexate and it is worth bearing in mind that experiencing ectopic pregnancy is a very frightening experience and many women need to take time to help them deal with the psychological/emotional impact of the loss of their baby, being diagnosed with a life-threatening condition and undergoing major surgery. If you feel comfortable, I would recommend informing your work colleagues. You mention you would like to be at work incase of emergency, but if no-one is aware of what has happened, they may not be as helpful as you need. We also advise that you do not undertake any strenuous exercise or lifting or housework while your hCG levels are dropping to reduce the risk of rupture. You should not resume exercise until your hCG levels are falling consistently and are in the low 100s.

I am afraid it is difficult to predict how long it will take for your hormone levels reach non-pregnant levels. As we are all individual, our bodies respond differently to the drug and it depends on factors like how high levels reached and our unique physiology. What I can say is that it can take a number of weeks and, while it can take some time, it is not as invasive a procedure as surgery. It is also encouraging that your levels have fallen although I appreciate that it can be a drawn out process. Also, in terms of chances of future successful pregnancies, studies do not show a significant difference between treatment routes, whether surgical, medical using methotrexate or expectant management (allowing time for the body to resolve the pregnancy itself).

We have more information on treatment with methotrexate here-

https://ectopic.org.uk/patients/treatment/

With regards to your back pain, it isn’t a common symptom of ectopic pregnancy. If it worsens, I would advise speaking to your medical team and if it continues after you have been discharged from your medical team, please speak to your usual Dr.

Many women experience feelings of isolation after an ectopic pregnancy - I did, too. It is a frightening experience. Like you, I reached out to the Trust for support and 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

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

3

Dear Karen,

Thank you so much for your kind and thoughtful reply. I really appreciate it.

My hcg was originally around 900 and then went up to 2000 when I had the mtx shot. I decided to stay home from work today to rest as i am having some mild side effects from the mtx but also i am an emotional wreck. My mind has been all over the place in worry.

Today i did my day 3 blood draw and it has more than doubled to 5500. I know you said this is common but can you offer any advice here to keep from freaking out? I’m worried now that it’s even higher and I’m at greater risk of rupture.

Thank you so much.

4

Dear Ranja,

The hCG level often rises on the day four blood test because the action of Methotrexate is not instantaneous, so the cells will have continued to divide for two or three days after the injection was given, and some cells release more hCG when they start to disappear. Your doctors are looking to see a drop in your hCG value of at least 15% between days four and seven. If there has not been a 15% drop, this is when the doctors will consider a second dose of Methotrexate or surgery.

Every 3-7 days, beta hCG levels will continue to be monitored to ensure that they are falling appropriately. Most women only need one injection but in up to a quarter of cases a further injection may be required if serum hCG levels are not decreasing.

I wish I had words to make the days go more quickly as I know how worrying it is. Take things easy, and look after yourself,

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

5

As a nurse and a patient dealing with repeat ectopic pregnancy, your concern for rupture is valid. There is always a risk of rupture until your HCG is 0. I just received my second dose of methotrexate yesterday, and all last week (after my first dose) I asked myself, “is this normal cramping or have I experienced rupture?”

Urgent/emergent symptoms include dizziness, severe abdominal/pelvic pain, or pain radiating to your shoulder tip. Don’t hesitate to contact your medical team (which may be more difficult to navigate in another country) if you have any of these symptoms. It never hurts to be re-evaluated which may include an exam, bloodwork, or imaging.

With back pain, it depends on where it is. Lower middle back pain may be related to the ectopic pregnancy. If it is elsewhere, it is likely unrelated.

Personally, I can’t imagine going to work right now with the side effects I am experiencing from methotrexate. Most people can’t go to work because of side effects and/or grief. Everyone is different and you should do what is right for you. Your concern about being home on your own is also valid. Can anyone come check on you or stay with you?

Good luck.

6

Dear Ranja,

I am very sorry this happened to you and in particular while you are in a country where communication with the medical staff appears to be difficult.

I had an ectopic pregnancy treated with surgery less than two weeks ago. My main symptom was one sided back ache on the side the ectopic was and later bleeding. Even though my tube had not ruptured there was some free blood in the abdomen and they gave me all options of waiting, MTX or surgery with surgery being their recommended option and the one we agreed to.

If you are concerned, get a second opinion. Is there an international/american hospital near you? Or a midwife or gynaecologist who might be trained in the US/UK?