Hi,
I’ve never used forums before but am recovering at home after laparoscopy a week ago to remove my right fallopian tube due to ectopic pregnancy. I was lucky to be diagnosed early at my EPU and had the surgery the same evening at only 6 weeks pregnant. We found it difficult to decide between the drug treatment or surgery especially since I saw the baby on the scan even though it was very tiny but I couldn’t face the stress of going back and forth for blood tests and didn’t like the thought of our little baby suffering so opted for the surgery. The surgeon said it was the right decision because my tube had started to rupture and bleed by the time I got to the theatre. I’ve been using the information on this site to help me and I’m hoping that someone can answer a question I have about PUL and ectopic.
I had a complete natural miscarriage with my first pregnancy in Nov 2010 at 5w5d so when I found out I was pregnant for the second time in July 2011, we were over the moon but very scared. I had light bleeding on and off from the day my period was due and initially was told it might be implantation bleeding so tried to stay positive. After about two weeks or so, the bleeding got heavier and more frequent so HCG tests were done which showed my level to be low and falling consistently. It got to 54 and combined with very heavy bleeding like a period, the hospital diagnosed a miscarriage. We were devastated but went away on holiday anyway (it was our first wedding anniversary 
). About 10 days later and only about 4 days after the bleeding stopped, I started bleeding heavily again. I had some cramps with the bleeding but other than that, no pain at all. So straight back from holiday to get more blood tests and my HCG was at 156 and the EPU was concerned because it had risen so sent me for a scan. The scan showed suspicion of an ectopic or a cyst but they were unsure so they wanted to do laparoscopy to check. It was the biggest shock as I never even considered anything like this might happen but I had the surgery that same evening 30/08. They didn’t find an ectopic but a cyst on my right ovary, said both my tubes looked fine and took scrapings of the womb lining to check for pregnancy tissue. These came back inconclusive and I was told it was a pregnancy of unknown location. My HCG levels were tested for several weeks to get back to <5 and we were told to wait one cycle then we could try again that we were just unlucky and it was very likely that everything would be ok next time.
Since it took several months after the first miscarriage to fall pregnant, we decided to try straight away thinking it would take months again. We were shocked when we got the positive test in Nov straight away in the first cycle but again I started bleeding lightly on and off around the time my period was due. I tried to remain positive and resisted phoning the EPU as I was scared they would give me bad news but when the bleeding got heavier I knew I had to go. HCG was 376, 377 then 354 with the pain on my lower right side and back (and also weirdly at the top of my right leg) becoming more constant I knew something was wrong so off I went for the scan where this time they were 99% sure it was ectopic so I had the surgery last week.
So the question I have is could the PUL actually have been an ectopic that resolved itself? The pattern of bleeding was so similar both times and I’ve read that getting pregnant very soon after one ectopic can result in another ectopic. I know there will be no proper answers and I shouldn’t blame myself but could we have caused this ectopic by trying again too soon? I never knew before that ectopics could resolve themselves or made any connection between them and PUL’s.
Sorry this is so long and thanks for any info anyone can give.
Hugs to everyone for their losses.
Ali
Hi there
I am so very sorry to learn of your losses but glad you found us and that you are recovering
It might help you once I explain that a PUL isn’t a diagnosis - a pregnancy of unknown location is exactly that it’s a pregnancy but we don’t know where it is. It might be a pregnancy which is too early to see, a pregnancy which is ending in miscarriage or an ectopic pregnancy. The term PUL is used to describe a pregnancy which is confirmed with hCG tests and other signs such as a thickened endometrium but where no pregnancy is visible on an ultrasound scan.
So yes the PUL might have been a self resolving ectopic pregnancy or a miscarriage. unfortunately there is no way of knowing for sure.
I hope that you continue to heal well and will keep in touch and if you have any other questions please do not hesitate to ask them
Thanks so much Izzie, what you’ve said all makes sense.
In my heart I’m convinced that my PUL was a self resolving ectopic even though it was never diagnosed, because the bleeding both times was so similar. I just feel very guilty that by trying again so soon we might have caused this to happen. I also feel more traumatised this time having seen something on the scan and having to make a decision about which way to kill our baby in order to save my own life was just the most awful thing. After all, there was probably nothing wrong with the baby, it was just stuck in the wrong place. I almost wish I had ruptured sooner so the decision would have been made for me but I know that would have been worse. What frustrates me most is that no one seems to be asking any questions of us, we’ve had one miscarriage and two surgeries and no one seems to care about the losses or be interested in what we’ve been doing or eating or anything. It’s sad that so many pregnancies are lost and the medical profession just tell you it’s unlucky, surely if they asked some questions of the many many women this affects we might know more, maybe if my PUL was considered to be resolved ectopic and I’d been told to wait before trying again this wouldn’t have happened. It’s so hard to have no answers .
Does anybody know if there are many times when ectopics occur right after a PUL?
Sorry for the rant and thanks again,
Ali
Hi there
Trying again so soon is unlikely to have caused a subsequent ectopic. There was some research some years ago that suggested there might be an increased risk of ectopic pregnancy if you become pregnant within the three months following treatment for ectopic pregnancy but the study has been refuted now on several occasions and so the jury is out on that and it’s actually unlikely that the link the initial researchers thought they’d found existed. What we do know however is that pregnancy alters our immune system and so does surgery and coping with infection or treatments of any kind and we also know that the immune system plays a very important part in miscarriage, a compromised immune system appears to make us very much more at risk of a subsequent miscarriage.
The next bit I have to share isn’t easy to write or to read but I hope it’ll make you feel a little better. Though you saw an image on the ultrasound screen, it’s unlikely that the baby you lost had grown normally - the reason being the placenta or the tissues which would have become the placenta were unable to implant in the right place and so there tends to be an overgrowth of the trophoblast cells as they try to find a good place to implant and whilst this is happening you baby is unable to grow properly. In fact more than 90% of ectopic pregnancies never develop a heartbeat.
Tubal ectopic pregnancy occurs as a result of some underlying damage to the tube - nothing you eat or your lifestyle won’t affect this and can’t alter any damage that has been done already. Usual causes of damage are things like a pelvic infection which you may or may not have known about but there are still a proportion of ectopic pregnancies which occur and we simply never know the reason why. After a first ectopic pregnancy, you are at greater risk of a subsequent risk of a second one, and the risk rises from 1 to 2% to somewhere between 10 and 20% depending upon your own personal risk factors - this however means that there is still a much, much greater chance of a subsequent pregnancy being something other than ectopic. Miscarriage however occurs around one in every 4 pregnancies but anecdotal, doctors think it may be as many as one in three. So statistically, somewhere between a quarter and a third of all women who become pregnancy have experience of a miscarriage and the risk increases with age steadily over the age of 35 until in your mid 40s when there is a 70% chance of miscarriage …
What I am trying to say is, even with your terrible experiences so far and your very sad losses, for which I am so very sorry there are still strong chances of a healthy pregnancy for you in the future - if you decide it’s right for you to try.
I hope the information helps you a little - but what is really important is you allow yourself time to grieve and recover from all you have been through - you are coping with multiple losses and that will take a little time so be gentle with yourself. For now eat healthily when you can eat, rest, sleep when you can sleep and heal. Avoid alcohol in large quantities and if you do decide to try again, avoid alcohol altogether, task folic acid for several weeks before you try and during the pregnancy itself for the first 12 weeks, take a little exercise, gentle walking, swimming, and low impact stuff is fine and avoid caffeine and NSAID pain relievers (Ibuprofen for example) as they have been associated with miscarriage.
But most of all go easy on yourself, this is not your fault
Hi Izzie,
Thanks for taking the time to reply and explain everything, I feel a lot better now knowing the baby probably wouldn’t have been growing normally, I just assumed it would have been and that was upsetting. We are hoping to be referred for tests to see if anything is wrong since all my losses have been at 5-6 weeks so we’ll see what that brings in the new year. Until then I’ll definitely take your advice to rest and recover.
Thank you so much for providing this website and forums, it really is great and an amazing source of comfort to be able to get a proper explanation about things without feeling that if you don’t ask all your questions now then too bad!.
best wishes,
Ali
Hi Ali
Glad the info’ might have helped a little, that’s what were here for and we will be here whenever you need to shout out or ask a question
Gentle hugs