Dear Alpacadrama,
I am so sorry to hear of the difficult time you are going through.
Pain is very subjective and some ladies do experience ectopic pregnancy with very little pain indeed.
When diagnosing an ectopic pregnancy, doctors use a combination of transvaginal ultrasound scanning and blood tests to check HCG levels. Usually scans take place at around six weeks gestation as there is a reasonable chance of seeing an embryo at around this time. If scans are inconclusive, doctors would carry out a series of blood tests to check hCG levels to see if the numbers are rising as expected. However, in isolation, hCG tests only provide a part of the picture - declining levels indicate that a pregnancy has ended and will be miscarried. It can also possibly indicate an ectopic pregnancy that is “self-resolving”. Also hCG levels rising by less than 66% over 48 hours means it is likely (but not certain) that it is ectopic. If levels rise normally, they suggest the pregnancy is implanted in the uterus. You may see from this that hCG levels only indicate certain possibilities and are not in themselves a definitive guide. A positive identification of an implanted embryo on a scan is usually needed before a final diagnosis/certainty that the pregnancy has implanted in the uterus.
When Dr’s cannot yet see and evidence of an implanted embryo or pregnancy outside of the uterus, they may use the term Pregnancy of unknown location - (PUL). It is important to know that PUL is not a diagnosis; it is a label given until the final location of the pregnancy can be identified with certainty. In the event of a PUL, blood will be taken to measure serum progesterone and hCG and the hCG test repeated 48 hours later. The doctors would also want to repeat the scan.
Until the location of the pregnancy is known definitively or the serum hormone levels have decreased to below pregnancy levels, there is a risk of complications associated with an as yet undiagnosed ectopic pregnancy. Whilst I do not wish to alarm you, for every 100 pregnancies labelled as a PUL about 10 will subsequently be found to be ectopic; but not all of these will need treatment. If treatment is required, (methotraxate injection or surgery) this will depend on the results of blood tests and scans and I would discuss this further with you Dr.
Whilst I do not wish to alarm you, I would always advise to seek urgent medical advice if you experience any worsening bleeding, abdominal pain, shoulder tip pain or feel dizzy and unwell.
I presume you have further blood tests and a scan booked, which will hopefully give you some answers. In the meantime, we are here for you for as long as you need,
Sending much love,
Karen x
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