HCG levels, methotrexate surgery and cornual

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1

Hi,

Firstly, thanks for creating this forum. I’m finding it comforting and helpful to read everyone’s experiences. I’ve written a timeline of my progress so far incase anyone is interested. Keen to know if anyone has experienced:

  1. Cornual / interstitial ectopic? If so, what were the treatment options and how did it go?

  2. Plateauing HCG levels and how long it took to return to 0? My peak was 7,100 which seems high compared to others I’ve read about.

  3. My HCG decreased but the pregnancy grew 10% plus a “yolk sac” is now visible - anyone had a similar experience and if so what was the outcome?

  4. Anyone had keyhole surgery to inject methotrexate directly into the pregnancy? If so, how did it go?

Here’s my timeline (mainly tracking HCG numbers) to date:

August

3rd: HCG 481.

5th: HCG 781

Thurs 6: HCG 1,174

Fri 7: 1,862 first dose of methotrexate.

Tue 11: 6,544

Friday 14: 7100 second dose of methotrexate

Mon 17: 5701

Wed 19: 5,295

Saturday

9am: 3,400.

11pm: fainted, rushed to A&E HCG 3,221 it grew by 10% and a “yolk sac” is now visible.

Monday

5:30am: 2,823

4pm: keyhole surgery to inject methotrexate directly into the pregnancy.

Wednesday 26th: 1,962

Fri 28th: 1,862

Sat 29: size reduced from 1cm to 0.5cm within 1 week.

HCG still being monitored by regular blood tests and scans.

2

Dear Laura,

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

A cornual/intersitial ectopic pregnancy is very rare so you may not get a great many replies from women who have shared this experience.

Treatment will depend upon the many factors including hCG levels, any fluid in the abdomen and how well you are at the time of diagnosis. It ranges from surgery such as laparoscopic (keyhole) resection or removal of interstitial ectopic, to a total hysterectomy in life threatening, emergency cases, to medical management of methotrexate.

It is normal to view a gestational sac on scanning for cornual pregnancies.

I have never heard of injecting methotrexate directly into the pregnancy and I have asked members of the EPT and in all their vast years of working for the Trust, only one has heard of it before. In the UK, methotrexate is usually administered into the muscle, usually the buttocks. The team member who has heard of it being done before, stated it worked well, but as you have mentioned requires very close monitoring and follow up.

Using techniques to inject methotrexate directly means a smaller dose of methotrexate is required as it is administered directly and you may therefore experience fewer side effects from the medication,

hCG is often higher for cornual pregnancies than those in the tubes, which is why your levels were higher to start with. Due to this follow up may be a more drawn out process however it is encouraging that your levels are reducing steadily and the sac is shrinking in size.

I am sorry that I can not be more specific or if you do not receive many responses from other women sharing their experiences, but as I mention, cornual ectopic pregnancies and rare and directly injecting methotrexate is rarer still (I have learnt something today)

I would say that it is encouraging your bloods are going in the right direction and you are being closely monitored. I’m sure you’ve been informed, but we would recommend you taking things easy and not completing any heavy lifting or strenuous exercise.

I am sending positive thoughts that your levels keep reducing.

Sending much love and warm hugs,

Karen x

The Ectopic Pregnancy Trust

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

During the coronavirus outbreak, The EPT team is still working hard to provide crucial information and support to women and families experiencing ectopic pregnancy as quickly and efficiently as we can.

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3

Thankyou very much for the response.

Indeed, cornual ectopics are very rare. I’ll continue to reply to this post with my progression incase someone in the future finds the information useful.

4

Hi there,

Thought I would reply to your post as I also had a cornual ectopic. I had surgery 11 weeks ago today.

My bf and I had been trying for nearly a year, we were over the moon when we found out I was finally pregnant. I booked an early private scan at 7 weeks pregnant as I wanted reassurance that everything was ok. I am so thankful I booked this scan because it’s the reason I caught my ectopic before it ruptured.

On 21st June we went for the scan and was told it was ectopic, they called an ambulance to take me to hosp. I was devastated and shocked, I had very light spotting that started the day before but no pain so I just thought the spotting was normal.

Once I got to the hosp the doctor scanned me again and confirmed it was a cornual ectopic, my hcg levels were around 5000 I think. The doctor said I needed to have surgery to remove the pregnancy, he said it would be very serious if my ectopic ruptured as it wouldn’t only burst/damage the tube but it would also tear/damage my womb. A few hours later I went in to surgery thinking my right tube was coming out but the surgeon managed to make a tiny incision and remove the pregnancy. After surgery my hcg dropped to 700 and I was discharged from hosp with the advice to do a preg test in 3 weeks which should be negative.

I waited 3 weeks, did the pregnancy test, and it was positive! So I panicked and went back up the hosp, they did a blood test and my hcg had jumped up to 1800. Since then I have been going back to the hosp every week having blood tests and luckily my hcg levels have been slowly going down. The week before last my hcg was at 17 so hosp said I no longer need to go back.

I read that cornual pregnancy’s don’t usually rupture as early as the ones in the tube, because a cornual has more room compared to the ones in the tube, however there’s no way I would have made it to the 12 week scan without a rupture, mine was ready to pop at 7 weeks! (I saw photos the surgeon took during my procedure) So yes I’m thankful for the early scan but it still doesn’t take away from the devastation and traumatic experience.

That’s good that your hcg levels are going down, I hope that continues for you. I would just say to make sure they continue to monitor it very closely (which it sounds like they are) cos you don’t want it to rupture. However it sounds like that second injection of methotrexate is bringing it down.

Wishing you well and sending you a big hug! It’s an awful experience to go through but speaking to others really helps to not feel alone and to know there’s others who understand how we feel xx

5

Hi Laura,

Sending you tons of love and prayers from above.

I found out I had an ectopic Cornual pregnancy on Friday 9/11/20. It’s been 4 days and I still feel like I’m recovering from the shock of everything.

Thursday I had bleeding but did not feel any pain. I called my OBGYN and she asked me to come in for a viability ultrasound the next morning.

Friday 9/11/20, I went in to my OBGYN’s office for the viability ultrasound and that’s when she said she needed more information and she sent me directly to the ER.

After hours and hours of being told conflicting information from your pregnant, oh no wait, your miscarrying, to no wait, your still pregnant, look this is the gestational sac, to finally you have an ectopic cornual pregnancy and you have to go to surgery now.

I was terrified and so confused. Me and my husband had tried all year to get pregnant.

I had a Diagnostic Laparoscopic Ectopic cornual pregnancy removal with my right Fallopian tube removed.

I was discharged around 2 am. And I’ve been crying like a baby for hours and hours some days, and some days I’m okay.

I’m super tired and feel sore in the abdomen and in my throat. They said soreness is to be expected due to the endotracheal tube used for anesthesia during surgery, but it still surprised me that I’m still sore.

I’m trying to be less angry about everything but to be honest I’m still struggling.

I hope your feeling better and doing better. :two_hearts:

6

Sorry you’re going through this. I’m here for you, as is this entire community.

That’s a shame you got such conflicting information but I’ve read that some viable pregnancies were misdiagnosed as ectopic in the past so better they took the time to be sure.

I’ve found the Facebook groups to be really helpful reading other experiences and feeling a sense of community.

The TTC after ectopic also helped me to see women who have successfully had pregnancies after cornual ectopic.

Sending you lots of positivity x

7

Hi Sam1,

Thanks for sharing and sorry you’re going through this. How are you feeling now? It’s so rare to have a cornual so lovely to have each other.

Take care of yourself x