My partner was recently diagnosed with an ectopic pregnancy and we’re looking for some guidance on how to approach dealing with the NHS and increasing our confidence in the decisions we might need to make.
After some light spotting in W5 we arranged a private ultrasound to ensure everything was proceeding normally. GP told us not to worry about the spotting but thankfully we did as the scan at W6D6 suggested an ectopic. We were rushed to A&E where blood test showed β-hCG levels around 4000. Wife was admitted and eventually given methotrexate about 24 hours after arriving at A&E. However, it doesn’t seem as if any other blood tests were done in those 24 hours or immediately prior to MTX injection.
The hospital has brought us in for follow-up blood tests but doesn’t seem to be following the usual day 0, day 4, day 7 schedule.
I can’t tell whether this is a conscious choice or if they are getting mixed up with the blood draw dates and the MTX treatment date. I understand that the days are somewhat arbitrary, but if we are going to be recommended surgery at the start of day 5 post MTX we are nervous that the medication hasn’t been given sufficient time to work.
Monday evening (day -1) - ultrasound suggests gestational sac 2cm in size in right fallopian, blood β-hCG 4000
Tuesday evening (day 0) - MTX administered, no further bloodwork carried out, no bleeding or blood pressure issues
Friday morning (day 3, but really only about 66 hours post MTX, rather than expected 96) - β-hCG 7800 (a significant step up!). Ultrasound shows no change to sac.
We’ve been asked to come in on Sunday morning (day 5, 110 hours post MTX) for a follow-up blood and ultrasound, but told nil-by-mouth and prepare ourselves that surgery may be required.
A few questions for the forum:
Am I calculating the days post-MTX correctly?
Is it strange that the hospital isn’t following the typical routine?
Would we be out of our minds to push to wait until day 7 before making any decisions about surgery? Can we even do this in the NHS?
We do understand the day 3 β-hCG is high, but its unclear how important this is relative to the other factors and the weird timeline/
The day methotrexate is administered is actually considered Day 1 rather than Day 0 (not intuitive, I agree!). So her first follow-up was done on the correct day (Day 4) but her second appointment does seem to be scheduled 1 day early (Day 6 rather than 7). I would ask your provider the reason for this.
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards
Join us for the first Ectopic Pregnancy Awareness Day on 1 August 2022
If the information provided here or through the EPT website has helped you, you can donate towards our support services, volunteer, or fundraise to raise awareness.
Further information is available on our website.
Email us: ept@ectopic.org.uk
We provide a call-back support line: 020 7733 2653. We are able to provide support in multiple languages including British Sign Language.
Take a look at our newsletters and subscribe to our mailing list.
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
I had a methotrexate injection last month as I had a PUL. My HcG levels had increased on day 4 and had only dropped by 1 on day 7. I asked to wait to have another blood test on day 10 instead of opting for a second injection or surgery which they allowed. By day 10 my HcG had dropped by 42% and have since dropped to 10 in the last week.
My levels were significantly lower than yours though so I’m not sure they will allow this but I’m so glad I stuck to my guns.