Miscarriage/Pregnancy Loss

Miscarriage that was actually ectopic...

Hi ladies, Looking for folks who have been there... I thought I was having my 3rd consecutive miscarriage 2 weeks ago. They saw an irregular looking sac on the US (no fetal pole or yolk sac) and had low, slow-rising HCG levels. I should have been 7 weeks at that point so they said I would more than likely miscarry and offered cytotec. Having been through 2 mcs so recently, I jumped at the cytotec as I didn't want it to drag on. 10 days later, I had weird pelvic pain that I attributed to indigestion or possibly a UTI and had a follow-up appointment scheduled to discuss recurrent loss so asked for a urine test then. Urine negative. They ran a lot of bloodwork for the recurrent loss workout and also ran my hcg again - well my hcg had gone slightly up (1500 2 weeks ago, 1600 yesterday). They immediately brought me in for an US to see if I needed cytotec again or possible D and C. My uterus was empty, no free fluid, so they started looking around and found a "mass" on my right ovary - ectopic pregnancy.

Shouldn't they have seen this 2 weeks ago? I am so glad they caught it now before it became an issue but I can't help but wonder why this wasn't detected earlier? From what I have read, slow rising hcg can be an indicator of ectopic - and maybe they looked for something 2 weeks ago but just didn't see anything. I ended up getting the methotrexate injection and am now in bed waiting it out. I am so tired, physically and emotionally, and now frustrated that I will have to wait another 3 months to even try again. AND, now I technically don't even have recurrent loss since this was ectopic and not a miscarriage. I love my doctor but wondering if he just missed this. I have an appointment with a fertility specialist in April and maybe he will have more ideas. I have no idea if this is truly just bad luck or if something is wrong with me. Thanks for reading this far. 

Re: Miscarriage that was actually ectopic...

  • I’m I’m sorry for your losses and having to go so long without being diagnosed. Hopefully you have a speedy recovery.  I’ve had 3 losses but not an ectopic so I have no information on that. 
  • I just had a similar thing happen. I had hcg of 1500 on Wednesday and went in again Friday and only rose to 1800. I was bleeding constantly for about 10 days but I thought it was normal. I had some cramping too. My doctor did a us and saw nothing in my uterus but said it might just be too early. I went in Saturday and ended up having emergency surgery to remove my left tube. I had no indicators or anything that would suggest that an ectopic pregnancy would happen to me, but sometimes it is just really bad luck. I’m so sorry this happened, it’s not fair. Sending love your way! The only thing I wish I had done differently is speak up for myself more. I know my body and I knew something was wrong but I trusted the doctors more than myself. 
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  • @jmg142 I am so sorry. It's my understanding that ectopic pregnancies can "hide" but it seems like docs would be more alert to the subtle symptoms when hcg is slow rising, especially since they can be so dangerous. So frustrating. I am so glad that you are ok.  <3
  • I've had a few ectopics.

    The type you're describing (mass on the ovary) are pretty rare, and most ectopics present as masses in the tube.

    The thing that makes it difficult to diagnose an ectopic on the ovary is that on ulrasound, ovarian ectopics share the same color patterns (blood flow that looks like a ring) of a corpus luteum, and corpus luteums are present in all normal pregnancies because it produces the chemicals to sustain pregnancy until the placenta is developed enough to take over.

    If your doc didn't catch it, that is probably because it looked like a corpus luteum.
  • @kathrenne thank you, that is really helpful. I'm sorry you've experienced this more than once. I can't wait for this to be over, but honestly, I am feeling very nervous to get pregnant again. 
  • Update: the methotrexate didn't work. The mass doubled in size and they did an emergency surgery, had to remove both the right tube and the right ovary. :(
  • I'm sorry; that's really rough.

    Obviously you don't need me to tell you that removal is better than waiting and risking a rupture, and you also don't need me to tell you that pregnancy is very achievable with only one tube and ovary. I will also say, though, that it might be just as well that you didn't go with a second methotrexate injection (sometimes that's done when the mass is static; yours getting bigger was really not good) because it does stay in your system for a while and can mess with your liver. Combined woth the cytotec, that's a lot to go through.

    Also, recurrent loss and ectopics can definitely be related, as miscarriages can cause scar tissue in the tubes and uterus, and/or scar tissue from something like endometriosis can cause the infertility.

    In theory, they hopefully would have noticed symptoms of endometriosis while they were in there dealing with the ectopic; so hopefully the surgical report can be forwarded to your fertility specialist to either confirm or rule that out as a potential cause.

    Logic really doesn't play a huge role in recovering from this for most women. For me, I had to remind myself to be patient and be kind with myself, and reach out when I needed to, even if it made other people uncomfortable.

    I wish you luck and a good recovery.
  • kathrenne thank you so much for sharing, I didn't know about how similar it looks and I'm sorry this has happened to you more than once (even at all)
    eggo2301 I'm pretty sure we are sharing the same timeline right now.

    On Feb 6 I was told I had a CP, Dr did a u/s and said my uterus, tubes and ovaries were "clear". That didn't feel right and I asked for a referral for a imaging center and the next day they found the ectopic. I was furious at my OB. That day I got the shot in the ER as well. The ectopic was right up against my ovary and the head of my OB practice told me that his u/s wouldn't have been able to see it (why are they even using them then?! I still have some issues with this, obv) and to not blame her for not seeing it.

    I got my hcg levels checked every 4 days, and ate nothing but meat and cheese for a week so I wouldn't have any folate. The methotrexate didn't lower my hcg levels at all, and it kept rising. 

    Last Tuesday (2/19) I had my left tube removed. I'm feeling nervous too and my Dr suggested getting a test on the other tube with contrast xray if I really wanted; perhaps you can talk to your dr about that? Reminding myself that this was all completely out of my control, and I know 3 women (1 very close to me) that have gone on to have healthy happy babies after having their tube removed. You can PM me if you need anything. 
  • Yeah, that must be frustrating with your OB; I've always been able to trust mine because she practices out of the local hospital and always went toe to toe with ER docs for me if they resisted imaging or treatment (some were truly, truly shitty and accused me of seeking pain meds despite the fact that I cannot fake hcg beta quants or CBCs).

    I will say that I had the imaging you are talking about (HSG- timed xray with contrast to track if tubes are clear based in injecting contrast through catheter and tracking flow theough tubes), and it wasn't effective for diagnosis. The images indicated that my left tube was functioning normally, and it wasn't until my OB did an exploratory laparatomy that it was discovered that my left tube was completely severed and the thing causing the ovarian ectopics was that the portion of the tube connected to my uterus had the opening pressed into my ovary, so sperm was getting into my pelvis and fertilizing completely outside of reproductive organs.

    Fallopian tubes are so delicate, it can be really hard to find or diagnose blockages. :-/
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