Expectant management query

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1

Hi all,

I am currently being monitored for a PUL (likely ectopic) where nothing can be seen on a scan.

I have had HCG levels that started at 266 14days ago, went up to 466 after 1 week and then started coming down (397 48hrs later, and today 309 which is 4.5days later).

I have had spotting throughout and just today started to have slightly heavier bleeding (like a light period) with a mild intermittent cramp on one side that just started.

I’ve got an appointment with EPAU tomorrow where I know they will suggest MTX but I’m wondering if it is reasonable that I ask to continue on expectant management?

Is this rate of decline acceptable?

I know there is always a risk of it going back and/or rupture even at low levels… but my gut thinks it will be ok I guess.

I haven’t been able to find much out there about this and know they want to see levels to drop quicker than this, but seeing as it is still somewhat “dropping” wondering if I am reasonable in not wanting methotrexate yet (hopefully not at all)?

Thank you in advance,

xx

2

Dear Elle11,

I am so sorry to hear of your ectopic pregnancy and loss,

In deciding whether expectant management was appropriate, doctors would first of all look at the results of blood tests, ultrasound scan(s) and undertake an assessment of your general health. Expectant management would then be considered for treatment when:

– The hormone being made by the pregnancy (beta hCG) is low

– General health appears to be stable

– Pain levels are considered to be acceptable

– An ultrasound scan shows a small ectopic pregnancy with no worrying bleeding into the abdomen.

We have more information here-

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

I would advise speaking your options through with your medical team, but certainly discuss the option of expectant management.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

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