The EPT

Becoming pregnant is often a priority after experiencing an ectopic pregnancy but as soon as a woman who has survived ectopic pregnancy thinks she may be pregnant, it is very usual for her to feel anxious and worried.

The following  most frequently asked questions  should help to reduce some of the anxiety you might feel when you think you are pregnant or have had a positive pregnancy test, and will give some insight into what to expect from your health care providers.

When should I test?

The first day of your missed period is still the most reliable day to test, using a good quality home pregnancy test.

Some pregnancy tests claim to be able to detect pregnancy before the first day of your missed period, and indeed many can. However, when you read the small print it becomes evident that the earlier you test, using these very sensitive tests, the less accurate they are.  This is why we suggest you test on the first day of your missed period as any test before this may not register a very early pregnancy. Using a very sensitive pregnancy test on the first day of your missed period greatly increases your chance of an accurate result.

I feel pregnant but my home pregnancy test is negative. Why is this?

There can be a number of reasons for this:

• As the hormones in our bodies change in the later stages of the menstrual cycle, a special cyst called the corpus luteum cyst stimulates an ovary to produce progesterone. Progesterone has many actions on the body but, along with the other changes in your body, it can leave you feeling bloated, with tender breasts and sometimes feeling headachy and nauseated (sick). These can sometimes be interpreted as the feelings you might get in early pregnancy and can leave you feeling disappointed when a period arrives a few days late.
• Sometimes women ovulate later in their cycle than day 14. This might especially be the case if you normally have cycles which are longer than 28 days. If you ovulate later in the cycle, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a home pregnancy test detects.
• Sometimes it can take longer than the average 6 to 7 days for the egg to travel along the fallopian tube and implant. Where this happens, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a home pregnancy test detects.
• The test may be from a faulty batch.

My home pregnancy test is positive but my doctors test is negative. Why is this?

• If the test is done in the surgery using a reagent stick, just like the home pregnancy test you have already done, there is the possibility that the test the doctor is using is not as sensitive as your home pregnancy test.
• Sometimes women ovulate later in their cycle than day 14. This might especially be the case if you normally have cycles which are longer than 28 days. If you ovulate later in the cycle, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a home pregnancy test detects.
• Sometimes it can take longer than the average 6 to 7 days for the egg to travel along the fallopian tube and implant. Where this happens, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a home pregnancy test detects.
• The test may be from a faulty batch.

I have a positive pregnancy test, what should I do?

The first rule is don’t panic. Statistically there is a much greater chance that this is not a subsequent ectopic pregnancy. This rule is, however, very difficult to follow.

If this is the first day of your missed period, you will be considered to be four weeks pregnant. No one can do anything very much at this stage. If you feel well in yourself, have no bleeding or real pain then you should either call your doctor and make an appointment for when you are five weeks’ pregnant. At this appointment you should ask for an early pregnancy assessment referral or early pregnancy scan at between six and seven weeks.

Alternatively, if your early pregnancy clinic accepts self referrals, call them and ask when you can be assessed for early pregnancy. Not all Early Pregnancy Assessment Units see women unless they have worrying symptoms in their next pregnancy and it really does vary from one health care provider to the next.

My home pregnancy test was negative to begin with but now seems to be positive, what should I do?

Home pregnancy test must be read within the time frame specified in the individual instructions on each pack. These times vary a little but any result which appears after 10 minutes cannot be relied upon to be an accurate result. It is not unheard of for people to do a test which is negative, leave it on the bathroom window sill until sometime later, and then when they look at it again a new line has appeared in the test window. This is invariably an evaporation line and not a positive result.

To get an accurate result, it is essential you follow the instructions on the Home Pregnancy Test pack. You should preferably test with the first urine of the day and urine which has been in your bladder for at least four hours. Finally, you should always read the test result within the time frame,clearly stated on the test pack’s instructions.

When should I see my doctor?

If your test is positive, when you choose to see your doctor is if course up to you. Obviously any serious pain or bleeding should be investigated. However, where everything appears to be OK  there are some things you might want to consider.

If you have concerns or worries, then of course you should see your doctor whenever you want to. If you wish to see them for a referral for early pregnancy screening, which is done in Early Pregnancy Assessment Units or Emergency Gynaecology Clinics, then making an appointment for when you are around five weeks pregnant, 35 days after the first day of your last menstrual period, is usually a good time. This will allow your doctor to refer you for an early assessment when you might expect to be scanned at between six and seven weeks, 42 to 49 days after the first day of your last menstrual period.

Why won’t my doctor take my blood for hCG levels?

Doctors in general practice are usually reluctant to do beta hCG levels.

The test done as a one off is not that useful and will not alter the doctor’s treatment plan or action, and so they will often not spend money on a test which is not going to tell them anything they don’t already know. Some doctors will do beta hCG levels but again unless the test is repeated after 48 hours as a screen for ectopic pregnancy, a single test is not very helpful.

When should I be  scanned?

Providing you have no worrying symptoms such as pain or bleeding, the ideal time to be scanned to establish if your pregnancy is in the right place, is between six and seven weeks. However, some hospitals do not accept referrals for scans for early pregnancy assessment, unless there are worrying symptoms and, increasingly, women are referred for a 12 week scan, along with most other pregnant women. Waiting for a scan can cause a great deal of anxiety, especially if your ectopic pregnancy was treated as an emergency before 12 weeks, which of course the majority are. You should take time to make sure your doctor understands your fears as he or she may be able to make a referral on the grounds of it being detrimental to your emotional and mental health not to do so.

If your doctor cannot refer you through the usual channels for an early scan, the Early Pregnancy Assessment unit may take direct referrals and it is always worth ringing them and asking them what they advise.

Unfortunately, there are currently no official guidelines to direct doctors on when to scan a women who is pregnant after an ectopic pregnancy.

Nothing can be seen on the scan, what happens next?

Again, don’t panic. There may be some perfectly good reasons for this, the most usual being that it is simply too early to see anything, even though you may be six weeks from the first day of your last menstrual period. These reasons could include:

* Sometimes women ovulate later in their cycle than day 14. This might especially be the case if you normally have cycles which are longer than 28 days. If you ovulate later in the cycle, the egg may not have implanted until later in the cycle and so the foetus might still be too small to be seen on an ultrasound scan.
* After ovulation and fertilisation, it can take longer than the average 6 to 7 days for the egg to travel along the fallopian tube and implant. Where this happens, again the egg may have implanted later in the cycle and so the foetus might still be too small to be seen on an ultrasound scan.
* Where both these factors have occurred, it is entirely possible for a pregnancy to be anything up to two weeks smaller than you may think by measuring by the first date of your last menstrual period.

So, if you are scanned at around six or seven weeks and nothing can be seen on the scan to indicate a pregnancy in the uterus and just as importantly, nothing can be seen to suggest that there is any other complication such as an ectopic pregnancy,  your doctors should order a serial beta hCG test where blood it taken twice, 48 hours apart, to establish how the hCG levels are performing. The doctor will usually also invite you return for a further ultrasound scan to be repeated in seven days time.

My hCG results are back and they seem low, how do I know if they are OK?

The first result is the baseline. If you are four weeks’ pregnant this level will need to be more than 5>mIU/ml to confirm a pregnancy.

The first result is not really significant as no one can ever be completely sure how pregnant you are, when you ovulated, when the egg implanted and in some cases even, when the first day of your last menstrual period was, so the only important reading is that there is a level of hCG in your blood which confirms that you are pregnant.

48 hours later, your bloods should be taken again and we would hope to see that the level had doublede, or if not, has risen byat least 66%.

For around 15% of women with a healthy pregnancy,  hCG levels do not double but rise by anything upwards of 66%. However, where the level does not double your doctor will probably want to repeat the test again in another 48 hours.

The parameters for normal levels of hCG in each week of pregnancy are vast and so it is very important not to get caught up with the numbers.If the hCG level has doubled this is an encouraging sign, but it cannot rule out an ectopic pregnancy on its own.

My hCG results are back and seem to be high. Should I be worried?

The parameters for normal levels of hCG in each week of pregnancy are vast and so it is very important not to get caught up with the numbers.If the hCG level has doubled this is an encouraging sign. However, increased levels of hCG greater than you might expect to see in a singleton pregnancy can indicate a multiple pregnancy e.g. twins.

I have pain  – what should I do?

Aches and pains in early pregnancy are very common and are often related to the changes which are occurring within your body as it responds to the hormonal changes. One-sided twinges can often be attributed to a corpus luteum cyst which is a normal healthy cyst of pregnancy which stimulates your ovary to produce progesterone to maintain your pregnancy.

If you are only just pregnant, remember that even if you can feel aches and pains, it is unlikely to be related to ectopic pregnancy at this early stage. Ectopic pregnancy usually becomes symptomatic at between 5 and 7 weeks, with rupture occurring usually at between 8 and 12 weeks, although of course there are exceptions.

If your pain is something that is bearable and responds to an over the counter pain relief known to be safe in pregnancy, then your pain is unlikely to be that of a deteriorating ectopic pregnancy.

I am bleeding, what should I do?

Unfortunately, around 3o% of women who have pregnancies in the uterus, bleed in early pregnancy. Of course this causes a great deal of alarm for a women who has a history of ectopic pregnancy but it may not mean there is anything wrong or that the pregnancy is ectopic. However, any bleeding in early pregnancy is worthy of investigation and you should speak with your doctor or Early Pregnancy Assessment Unit who will usually arrange for you to be scanned.