PUL and hcg

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1

Hello

I posted earlier in the week after being told I had a pregnancy of unknown location.

Since then I have had two hcg blood tests and today I got the results of the second.

I am hoping someone can offer me some advice to help me understand what things mean.

I had a scan on Monday, which identified the problem. A rescan at the epau on Wednesday confirmed same outcome, so they took blood, the results of which were 1475 (I was 7 weeks). Today my results have come down to 1100. The nurse told me that they would like to have seen the level half, but the fact that it’s come down means it’s failing - wherever it is and that’s a good sign.

She told me that an ectopic would have had levels around the same or just slightly higher.

I have to go back on Sunday for next bloods and from there they hope to make a plan.

I feel very sad that this has proved my pregnancy isn’t viable - I kind of knew that, but there was still a glimmer of hope. But I also feel confused.

It’s the not knowing that’s hard; am I just naturally miscarrying an intrauterine baby that never implanted properly? If so will I just bleed and that’s that? They never saw anything on the scan, in any part, so how do they know it’s ectopic? If my levels continue to come down does this mean my body is dealing with it and I won’t need any treatment?

I am scared that every twinge is a sign of rupture and yet I don’t even know that I have an ectopic. Yesterday I was dizzy and had diahorea. I did tell the unit and they weren’t concerned.

I know no one can answer my questions, when the hospital don’t even know, but hope there will be someone who can relate.

Sarah x

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Dear Sarah,

I am so sorry to hear of the difficult time you are experiencing. Unfortunately I am not medically trained so cannot give you specific advice on your situation but can provide you with a general overview.

A Pregnancy of Unknown Location or PUL is not a diagnosis but a label until the final location can be identified with certainty.

When diagnosing an ectopic pregnancy, doctors use a combination of transvaginal ultrasound scanning and blood tests to check HCG levels. Usually scans take place at around six weeks gestation as there is a reasonable chance of seeing an embryo at around this time. If scans are inconclusive, doctors usually test hCG levels and a hCG level that is rising by less than 66% over 48 hours can mean it is likely, but not a certainty, that the pregnancy is ectopic, declining levels indicate that a pregnancy has ended and will be miscarried. It can also possibly indicate an ectopic pregnancy that is “self-resolving”. You may see from this that hCG levels only indicate certain possibilities and are not in themselves a definitive guide. A positive identification of an implanted embryo on a scan is usually needed before a final diagnosis/certainty that the pregnancy has implanted in the uterus. This is possibly the reason why your doctors are waiting until your appointment to carry out scans and tests.

Having said this, I do think that if you are continue to feel dizzy and have diarrhoea or experience pain which seems unusual and is concerning you and, in particular, if you experience any bleeding or spotting, it is better to get checked out to be on the safe side. Visiting the hospital would give you peace of mind and, if you explain your previous ectopic pregnancy and the pains you are experiencing now, they would be able to check your symptoms and assist you.

Regarding treatment, this would depend upon your hCG levels and scans and we have further information here

http://www.ectopic.org.uk/patients/treatment/

I am sorry i cannot give you definitive answers​, but you certainly have a friend here who understands how you feel. I was admitted with a ? ectopic pregnancy on the Friday evening of a bank holiday weekend and had to wait until Tuesday for scans and information. I was terrified and anxious of every twinge and unusual feeling.

Sending much love and warm hugs,

Karen x

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

Email us at ept@ectopic.org.uk.

Our helpline is 020 7733 2653 (available Monday to Friday 10am - 4pm).

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.