Pregnancy unknown location - expectant management

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Hello,

I’m sorry to read everyone’s sad experiences. I wish anyone reading this well & hope there are happier times ahead for you.

My reason for posting is hoping others might share any experiences of the ‘expectant management’ approach to pregnancy of unknown location or ectopic pregnancy.

I started bleeding at 7 weeks gestation, no pregnancy could be found in my uterus or anywhere else, my hcg then was 1800 it dropped to 1500 48 hours later.

I was told I had a failing pregnancy of unknown location. I bleed lightly for a week then stopped. I’ve never experiencing any significant pain. Subsequent scans still have not been able to locate a pregnancy but my hcg has not dropped as expected.

It has now been 2.5 weeks since my first hcg level and I’ve only dropped from 1800 to 1100.

I’m on a waiting list to be seen by a consultant for a scan but that won’t happen for another 4 days.

I’ve felt I’ve managed fairly well with “expectant management” up until now and felt confident that given time my body will reabsorb or miscarry the pregnancy (wherever it is) but I’m getting more and more anxious. I’m spending every second frightened about the possibility of rupture. Even though I’m not in pain I’m getting lots of weird sensations, some maybe imagined through being so scared a rupture might happen… After nearly 3 weeks I feel I can’t keep waiting and waiting like this any longer!

Ive read the amount of time it takes for hcg to drop varies for everyone but has this slow decline in hcg happened for anyone else and the pregnancy still self resolved without treatment?

Many thanks, K

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Dear K,

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 and as you have mentioned the doctors are also repeating 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; but not all of these will need treatment. If treatment is required, (methotraxate injection or surgery) this will depend on the results of blood tests and scans and I would discuss this further with you Dr.

I do have to mention that you shouldreturn to your hospital if you get any shoulder tip pain, worsening abdominal pain or dizziness and feeling unwell.

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.

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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Further information is available at www.ectopic.org.uk

Email us at ept@ectopic.org.uk.

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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.

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Thank you so much for your caring and informative reply Karen. It seems there is no avoiding this uncertain waiting game. I’ve been searching for stories of self resolving pregnancies with hcg declining as slow as mine to give me some hope I won’t need treatment but everyone’s story seems so different!

Best wishes, K

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Hi Katie,

I also have a PUL which I think now after a second scan they confirm is ectopic. They are managing me expectantly, but did give us all three options to consider. It’s been two weeks now and levels areant dropping so on Monday I’ll probably have to decide whether to take Methotrexate or surgery.

I’m finding the waiting hard and the lack of ability to just get on with my life. I went for a gentle walk yesterday and today my bladder and bowel seem really tender and sore. Weird and worrying. So I feel your pain. I’m someone who likes to be in control, and I’m not!!

Keep me posted with what’s going on? Is this your first pregnancy? It is mine, not great!

Hannah x