Methotrexate with low falling HCG and reduced liver function

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1

Hi all

I’m hoping someone has a similar story that can give me some confidence this will have a good outcome.

I found out I was pregnant on 31 Aug, approx 5 weeks. A few weeks later I had severe cramping and pain in my abdomen but no bleeding. I went to A&E the following morning and after a day of scans and blood tests was admitted to the EPU with a PUL and suspected ectopic pregnancy. I started bleeding heavily just before I was admitted.

I had a fairly low HCG level so they assumed it was too early to see the pregnancy, and because of the pain on the left of my abdomen they performed a laparotomy. They were unable to locate the embryo or see any issues with my reproductive system, and there was still a chance it had been in the uterus but had miscarried when the bleeding started.

I do have cystic mass on my left ovary which they’re not concerned about as the scans have shown no changes to it despite all the treatment, and two small fibroids.

The pain on the left of the abdomen was still suggesting ectopic and the following day my HCG level was at 1200, they injected me with methotrexate and sent me home.

My Day 4 HCG level came back at 4300, quite a rise. I was asked to go back into the hospital and was readmitted so they could get me a scan, it was a Friday night and I’d have otherwise had to wait until the following week. The scan still showed no embryo, no free fluid etc. The registrar called me a conundrum. I was sent home again. I had stopped bleeding by this point.

Day 7 blood showed HCG at 3800, and one of the liver function enzymes was showing a 5x increase suggesting the methotrexate has had an adverse impact to the liver. With HCG at a less than 15% decrease between Day 4 and Day 7 I was expecting a repeat methotrexate injection, but instead they keep waiting for more blood tests. I assume because of the liver results but no one is really telling me anything and I haven’t seen a doctor since Day 5.

It’s now Day 12. My Day 9 HCG reading was 3000. I’ve started bleeding again. Their advice after the Day 9 bloods was to have them repeated tomorrow, so I’m going back in. They have a Plan B if the levels haven’t dropped sufficiently, but the nurse I spoke to didn’t tell me what that was.

I’m going to demand to see a doctor tomorrow and wait for the blood results so I can get some answers.

In the meantime I’m hoping someone has a similar story that can give me some confidence that this will be ok. I know it’s standard to give a follow up dose of methotrexate if the Day 4 to 7 drop is less than 15% and I’m worried it’s failed and I’m scared that it is going to rupture whilst I’m in this holding pattern where nothing is really being done.

In summary I have a PUL, had one dose of methotrexate, slowly reducing HCG levels, reduction in liver function, and am bleeding for the second time.

HCG

DAY 0 1200

Day 4 4300

Day 7 3800

Day 9 3000

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Dear Loody,

I am so sorry to hear of your loss,

Not knowing what is happening to our bodies can be extremely overwhelming and you have a friend here who understands. Whilst I was not diagnosed with a pregnancy of unknown location, I was admitted to hospital with a ? ectopic pregnancy on a Friday evening of a bank holiday weekend so I had to wait until the Tuesday to be informed that I was indeed having an ectopic pregnancy and it really was the most anxious wait.

It is important to understand that Pregnancy of unknown location - (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. Unfortunately I am not medically trained so cannot give you specific advice on your levels with regards to your liver function. I certainly agree however that you have the right to know what the plans are If the current treatment is failing, and yes, you should speak to a doctor at your next appointment.

We would gently remind you to not undertake any strenuous exercise or lifting or housework while your hCG levels are dropping. While I do not want to alarm you, there remains the risk of rupture even with low or declining hCG levels. You should not resume exercise until your hCG levels are falling consistently and are in the low 100s. Whilst I do not wish to alarm you, I must advise you to seek urgent medical advice with any worsening bleeding or pain, or you start to feel dizzy and unwell.

I am sorry that I cannot provide you with more precise details but I hope all becomes much clearer over the forthcoming blood tests and scans.

We are here for you for as long as you need,

Sending much love,

Karen x

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Thank you Karen.

I returned to the hospital today and my levels have reduced to 1900, which is a bit of a slower rate than the couple of days before it, but the nurse I spoke to explained the doctor was happy with it, and I’m definitely happy they are reducing. Was hoping to maintain the previous rate! I tried to get some answers but was unable to speak with a doctor directly. So I still don’t know why I haven’t been offered a second dose.

They want to monitor the levels weekly now and asked me to come back next Sunday. We’re due to fly to Edinburgh next Sunday to celebrate my 40th so I’m going to have the blood tests on Friday instead. She advised there were no issues with me flying, which I wasn’t expecting! Hopefully Fridays levels will also be positive and I can enjoy the break away. I have no idea what we’ll do there, I can’t seem to do anything at the moment without rapidly getting exhausted.

Thank you again for your help, I’ll update again after the next round of tests in case it’s of help to someone else.