Dear all,
We would like to share our recent experience with “ectopic pregnancy”, as an educational aid to couples planning for children.
Key messages:
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Ectopic pregnancy is a life-threatening emergency.
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It is very hard to suspect ectopic pregnancy clinically. Shoulder pain is an important clinical symptom. Otherwise, it can be known only just before rupture, or after rupture, when it is life-threatening!
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In normal pregnancy, the beta-HCG levels will keep doubling every day, but in ectopic, it will not!
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If you are in Chennai, India, you must be particularly prepared to manage an emergency on Sunday mornings, as no doctor will be easily available!
Our story as-is:
First, we would like to congratulate you on your marriage and wish you a happy pregnancy and contended life ahead! Like every other couple, we were also desirous of children, and were fortunate to have one normal and healthy (to add very intelligent) girl child in 2013. Now it was time to try for the next one. As they say, the number of children to have is a matter of personal preference; me and my wife only had internal differences in this topic. My wife wanted one more child, and i was skeptical of my ability to justify the requirements of two children in today’s job-volatile and inflated scenario. Nevertheless, we did not properly plan for the next pregnancy, or practice contraception either. To compound the matter, my wife has PCOS (Poly-cystic Ovarian Syndrome), and a little bit of hypothyroidism. Hence, it is usual for her to experience irregularities with her menstruation. We also believed that it was the same PCOS that had been having an “insulating effect” against pregnancy since my wife’s first delivery in 2013 (her first pregnancy materialized under hormonal fine-tuning with metformin, which we stopped after first delivery).
On a particular week in Nov 2017, when she had to get her next periods, it got postponed. We did not look at it with any degree of suspicion, given her history of irregular menstruation. A week and half passed by, and both my mother and my wife’s mother began considering the pregnancy angle. But my wife had quickly denied it due to the absence of any typical symptoms of pregnancy (nausea, vomiting, morning sickness, etc). Another week had passed, and that’s when I and my wife started discussing if we had to do urine pregnancy tests by buying strips from a pharmacy. But since i was going through back to back hectic weeks at work, i really could not stop by a pharmacy to buy the test stripes. Neither my wife could buy it directly from the pharmacy as it was “sensitive” to be asked directly to male pharmacists at the store. Another week passed by, and there were no signs of menstruation or pregnancy. Then on an evening, i remember my wife saying that her legs are having an intermittent pain similar to what she gets during her periods. This indicated to me that she was on her way to getting menstruation, but then there had been too much delay this time. I had always been advocating gym to my wife as a non-pharmacologic (without medicines) intervention to her PCOS. But then, procrastination turned out to be the biggest blockade. With that info about leg pain, both of us ignored the problem for another week. On a Saturday night, during pillow-talk, both of us decided that it was high time to get a urine pregnancy done, whether or not there were symptoms of pregnancy. The plan was to buy the test stripes next morning, and put a full stop to this doubt. But then…
My wife was woken up with an “extremely severe” pain in her lower stomach by around 5:30 am in the morning. The pain was so intense that my wife could barely move out of bed. At first, it was thought to be flatulence (gas in stomach), and my wife managed to step out of bed and go to the bathroom with the hope of passing gas. But no gas could be passed, and the intense pain persisted. Instead, she managed to pass little urine, and crawled back to bed. There was also constant nausea. Since then, she had been holding on to her stomach for about an hour until 6 30 am, when rest of the family woke up. We also thought that it is some stomach pain, and considered rubbing oil on stomach for relief (old south Indian remedy). But i knew she had not taken any gaseous food last night, and hence this was not due to gas. So we immediately started calling doctors in the neighborhood. To our dammed surprise, no one could be reached! Most of them had switched off their phones on a Sunday morning! Also, we wanted to check only for lady doctors as the pain is in the lower stomach/genital region. Only the husbands of two lady doctors picked the call, and said that we have to call back at 9 am as the doctors were still sleeping. We then took our local telephone directory, and started dialing all lady doctors in the surrounding region. No one could be reached. The next thing we did was calling out to local hospitals, and asking for gynecologists. We had four hospitals within a 5 km radius, and none of them had lady doctors at that time of the day (one NABH certified hospital asked us to call again at 9 am to know whether the duty doctor posted for Sunday OP was a guy or lady doctor!). Another hour passed in intense pain without any progress. There was only one last option. I was a dentist once upon a time, and have a good rapport with an older dentist in my neighborhood. His wife happened to be a MBBS doctor specializing in skin (dermatology). I decided that i will ride my bike to their home around 0.5 km away, knock their door, wake them up, and request for urgent help. I did the same at around 7 30 am in the morning, and begged for help. They said fine, and asked me to bring my wife. With no autos at that time of the morning, I had to ride my wife on my scooter very carefully and slowly. But imagine, with excruciating pain crippling the slightest of movements, she had to get down from first floor of my home, and board my scooter for travel to doctor’s office. Hats off to her tolerance! We then reached doctor’s office and started the examination. At the back of my mind, i had some fear about the diagnostic ability of the doctor, as she was a skin specialist who might have lost touch with the depths of general medicine/gynec topics. But then i could see that the doctor was doing a thorough examination, considering the possibility of spontaneous abortion, spotting, etc. She finally narrowed down on renal colic (urinary tract infection) in the absence of bleeding from vagina, and the history of passing urine on that morning. She then gave a strong pain killer tablet. She also wanted to prescribe antibiotics, but she first wanted us to complete urine pregnancy test. She also advised to go for an abdominal scan to have better clarity on the situation. We were relieved to know that it was just UTI curable with antibiotics and not anything more serious. I then took my wife straight to a lab 500 meters away (with scanning facilities in it), to start off with urine sample collection for the pregnancy test. But then, my wife was not getting urine only! She was asked to drink water from the lab. Somehow it made her more nauseous. When checked for radiologist, we were told that he comes only by 11 AM. Given my wife’s condition, i did not want to take her to any other lab too. So we decided to take a specimen bottle for urine, and leave to our home. I then dropped my wife back home, and rushed for tablets. Once again, the dammed surprise! There were no pharmacy outlets open at that time of the morning. I had to travel 2 kms away to find 2 shops of which one did not have the medicine prescribed. Fortunately, the other pharmacy had only 2 tablets remaining of that medicine prescribed by the doctor, and i bought them. Now, the problem was my wife had to eat something to take these medicines. With so much of pain at the bottom of her stomach, and having nausea additionally, taking tablets only seemed like an insurmountable challenge! She managed with half a cup of milk, and then the tablets. Now, i was relieved as the pain killer taken by my wife was a smooth muscle relaxant specifically indicated for lower stomach pain, and not a normal paracetamol (paracetamol we all know has become totally ineffective these days). Another 30 mins passed, but there was no reduction in the pain, and my wife stayed put on a chair next to washbasin so that she can vomit if required. She mentioned that her pain had now become “exploding” in nature. I didn’t know what to do. My only hope was that medication will take effect in sometime. After an hour, she passed some urine. We reverted back to the lab and got to know that she tested positive! I double-checked it against a strip bought along with tablets, and it tested positive too. Alas, we didn’t know how to celebrate! We were worried the UTI is complicating the start of pregnancy, and had to patiently wait until 11 AM for the radiologist. Only god knows how my wife was bearing pain in the interim. At 11 AM, we were told at scan centre that for the test, my wife’s bladder has to be full of urine! She is barely able to take in anything, and now she has to drink a liter of water to fill her bladder. With nausea challenging every gulp of water, she had to forcibly drink water for the test. Another hour passed in pain and suffering. Then, she was called in by the radiologist. Me being an ex-dentist, i briefed the radiologist to look for signs of UTI/spontaneous abortion/ectopic pregnancy just before the scan. After 20 mins, he confirmed that it looks like ectopic pregnancy, and i had to immediately contact a doctor. There vanished the happiness of second pregnancy! My wife was doomed to know about it. I immediately called my wife’s previous gynecologist at a different part of the city, and explained the situation. She said it is a “life-threatening” emergency, and that i should immediately seek admission at a local hospital for laparoscopy. I told her that we don’t know any local hospital that well, and want to get admitted at her hospital only, which is 30 kms away. She denied it saying that travel is not recommended in such emergencies. But i insisted that i will somehow reach there in 1 hour. She agreed, and had promised to keep emergency arrangements ready for my wife. In the meanwhile, my wife also mentioned that her pain had subsided by a negligible bit. This provided hope to me that i can take my wife, and entrust her into the safe hands of our gynecologist. At this juncture, we were fortunate to have one of our relatives turn up to the same lab unexpectedly. After hearing our story, our relative suggested to avail of an ambulance immediately. If not for that suggestion, i was only thinking about taking a taxi and reaching the hospital (how a fool i must have been not to be able to think of an ambulance even in that kind of emergency). We immediately availed an ambulance, and reached the hospital in the next hour. Once again, i do not know how my wife tolerated the excruciating and explosive pain. Thank god, there was no rupture. As promised by the doctor, she had kept emergency arrangements ready, and my wife was straight away taken into labor ward. In 15 mins, i was told surgery is the only option, and they proceeded towards it. The surgery was over in 30 mins, and they said my wife was safe! She was then discharged in 2 days. The entire treatment was uneventful except for some urinary incontinence post the surgery. It required catheterization for 3 more days, and then things were nearly back to normal.
The next week, i went to the clinic of the dermatologist to thank her in person for being the only doctor to help last Sunday morning. After she heard the story from me, she said god was the only one who saved my wife! She said ectopic pregnancy is very hard to discern clinically. It seems she had actually asked my wife about any shoulder pain in the days before last Sunday, and my wife had denied it. But then my wife told me after laparoscopy that she was having some shoulder pain for few days while pouring dosa (a south Indian food) at the kitchen. She had ignored it altogether thiking it must be due to her general tiredness! What a flimsy indication of a serious emergency about to unfold! The dermatologist also told that if the lab did not have a radiologist, and had only a sonologist on that day, ectopic pregnancy couldn’t have been found! How lucky we were! She advised that the only way to find out ectopic pregnancy is to monitor beta-HCG levels. In normal pregnancy, the beta-HCG levels will keep doubling every day, but in ectopic, it will not! Who knew about this! We consider ourselves very lucky at end of the day to have survived the incident! Please be aware of this if you are planning for pregnancy. May luck be with you too…
this is a common misconception that they don’t double or get very high.