The EPT

Bleeding

Is the bleeding after treatment or monitoring of my ectopic pregnancy my period?

The bleeding you have after surgery, or after treatment with Methotrexate, or if you are managed “expectantly”, is not actually classed as a period. This is your body expelling the thickened lining of the uterus.

Once the beta hCG levels have dropped, the chemical signals to retain the thickened uterine lining that has built up in preparation for pregnancy, are no longer being produced and so the lining of the uterus is shed. The process involves vaginal bleeding and the material may be clotty, heavy, dark in appearance or appear just like one of your normal period bleeds. The bleeding can continue for up to six weeks and it is not unusual to bleed, stop, and have spotting during this time.

How long will the bleeding last?

This varies from woman to woman but after any pregnancy loss, you can spot and bleed for up to six weeks. Providing you aren’t soaking a pad in less than an hour or the pain is so severe you can’t manage it with over the counter pain relief, you should seek reassessment.

Pain

Should I expect any pain or discomfort after my treatment and how long will it last?

Depending on which treatment you have had, a varying amount of pain or discomfort may continue for several weeks afterwards as the healing process continues and scarring continues to heal. This should lessen as time progresses. However, it is not unusual to still report some discomfort several months after an abdominal operation.

How can I tell if the pain I have means there’s something wrong?

Pain is most usually the bodies way of telling you to rest. Whether you were treated with a major abdominal operation or a keyhole procedure, some pain is normal and you should expect to take things very easily for the first week or two after keyhole surgery and for around six weeks after the major abdominal operation. Many hospitals discharge their patients with some kind of pain relief. If yours did not, then take over the counter pain remedies, a pharmacist can advise you and these are usually sufficient to help you through the first few days. Pain is however, unique to everyone and if your pain is sever and not responding to over the counter pain relief then call your doctor for advice. If your pain is associated with other symptoms, you may also need to consult with a doctor. Any of the following signs, might suggest the pain you have needs further medical assessment : -

• A rise in your normal body temperature, so a temperature of greater than 37° C (98.6° F).
• An increased vaginal discharge which smells fishy or offensively.
• Raised lumps and bumps over the puncture sites, or scar, which are redder and hotter to touch than the rest of the surrounding skin.
• Wound site which are not only weeping but appear to be oozing thick creamy or white discharge.

The wound site

What should I know about my stitches?

There are a variety of ways to close a wound after surgery. By far the most common is to use sutures or stitches, and after any kind of abdominal surgery you might expect to find stitches even in a puncture wound from keyhole surgery. These stitches can be made of different materials which means that some need to removed while others may be dissolvable.

How do I know what my stitches are made of?

If you are not sure what your stitches are made of and weren’t told whether you had to get them removed or if they will dissolve on their own, call the hospital ward that treated you and they should tell you. Dissolvable stitches are supposed to dissolve on their own between about 10 and 21 days after surgery but unfortunately dissolvable stitches sometimes don’t dissolve.

What if my dissolvable stitches don’t dissolve?

If after 21 days they are still there and you have been soaking in the bath (preferably) or showering, then you should contact the practice nurse at your surgery to perform a wound check and remove them for you. Removing a stitch takes a second and is relatively painless. You should never pull at them yourself. This can result in complications such as a would infection. If you think your stitches are stuck then when soaking in the bath you can wipe firmly over them, with a clean damp flannel, once each in a north, south, east and west direction but be careful to do no more than that.

What should I clean the wound with?

Whilst you have an open wound or stitches, you should avoid using bath oils or other strongly scented bath treats. Until the wound is healed and the stitches are gone, warm water and very gentle soap are all you should be using for your bathing needs. Other than a daily shower or bath, there should be no need to clean your wound with anything else. There is no reason not to bathe normally when you have stitches.

Should I put a plaster on my wounds?

It is better to leave the wound site uncovered. However, if the stitches pull or rub on your clothing then covering with with some low adherent dressing which is available from most pharmacies and supermarkets is recommended. You should not use any antiseptic or cream type preparations on a new scar unless it has been prescribed by a doctor.

Do I have stitches inside me?

If you had a major abdominal operation, yes you do. These stitches will dissolve on their own and you are unlikely to be aware of them. The muscle that they are uniting will take between four to six weeks to knit together like the skin wound does after a few days and this is another reason you should be taking it easy and not lifting anything for six weeks after surgery.

When will my wounds have healed?

As a general rule you should expect the wound to be clean and dry with no evidence of weeping after 10 days. If you are in any doubt about your wound site ask your doctor or practice nurse to take a look. Once the skin has healed, the scar can look quite raised and red for some weeks and months. This is not unusual but it will fade with time from red to pink and then eventually to a silvery white and become almost unnoticeable. This process can take many months, however, and as long as the wound site is comfortable, does not become sore to touch, does not begin to feel warmer than the surrounding skin and remains closed then you can be confident the wound is healed.

I don’t have stitches. What do I need to know?

There are other ways of closing a wound. Clips and staples need to be removed by a nurse or doctor, and you are normally given an appointment before you leave, or they might be removed before you leave hospital. Sometimes the wound will be sprayed with a special adhesive that seals the skin. This kind of dressing has different names but you might hear it called “opsite” dressing or plastic skin – it is a liquid plastic which sets when sprayed on to the skin and comes into contact with the air and it wears off after a few days.

Your body

Still feeling pregnant

Women often report still feeling pregnant, sometimes two or three weeks after surgery and for longer after treatment with methotrexate or expectant management. Even after surgery, where the fallopian tube is partially or completely removed, it can  take some time for the hCG Levels to drop, which along with the raised level of progesterone in your bloodstream can make some women feel pregnant, even after they have lost their baby. These feelings of still being pregnant usually subside as the hCG levels drop.

Bruising

After surgery, it is not uncommon for the area below your tummy button right down in to your pubic hair line, to be very bruised. The bruising can be very noticeable indeed. Howver, it is usually not anything to worry about and gradually fades over about six weeks.

Aching

After an operation, people often get aches and pains in places they did not expect to. The back, neck, hips and legs can all be very sore. The staff in the operating theatre take great care of you when you are asleep and try to move you in to the positions they need you to be in very gently. However, because your muscles are very relaxed as a result of the anaesthetic, sometimes muscles can ache for several days after your surgery. Take it easy, take the pain relief you were given in hospital and your aches should resolve over a few days.

Tiredness and fatigue

Anything which compromises our immune system will leave us feeling tired. Surgery is a huge event for your body to cope with and  in the first weeks after your surgery, your immune system will be pouring all of its resources into healing your wounds and keeping infection out. During this time, women often report feeling very tired. Those treated with methotrexate can feel especially tired as the medicine used depletes the body of one of the essential vitamins which helps maintain our energy levels. Taking it easy, eating small healthy meals often, and rest will all help to combat the tiredness and fatigue.

About the baby

What happened to my baby after treatment?

In an ectopic, there is often a pregnancy sac, but most often a foetus or baby as we would know it, is not developing.

If you were treated with methotrexate, this explains what has happened to your baby.

Methotrexate does prevents the trophoblast cells from dividing. Trophoblast cells are the invading cells of the pregnancy and those that form the afterbirth or placenta. It is these that rupture the tube, cause the pain and have the potential to cause internal bleeding to the mother. Once these cells no longer divide, the pregnancy is ended and the whole pregnancy sac, including any cells that might eventually have grown into a baby, is usually reabsorbed by the mother. This is normal and happens in many cases of miscarriage. You may feel pain after being given methotrexate but this is due to the pregnancy sac swelling and not due to effects on the baby. The tube, however, may remain blocked by the pregnancy tissue which can take some time to shrink. Occasionally it may not shrink and will leave a blockage in the tube, by way of a small cyst. However, the use of Methotrexate does not reduce the chances of successful future pregnancy, whatever the outcome in the affected tube.

If you were treated surgically this information may be useful.

Please be aware that this information may be difficult for some bereaved women to read.

Both the Royal College of Nurses and the Royal College of Obstetricians and Gynaecologists have produced guidelines for professionals about the importance of disposing of foetal remains in a sensitive way. As a result, many hospitals have adopted arrangements with local crematoria for the sensitive disposal but they are guidelines, and procedures vary from hospital to hospital. The Human Tissue Authority have also produced guidelines to help hospitals decide how to dispose of the remains of a baby.

We recommend that for local information, you contact the Pals Department and ask what the hospital policy is on the sensitive disposal of foetal remains.

The hospital chaplain will do whatever they can to accommodate your needs in relation to your honouring your loss. They will almost certainly have a baby loss service of some kind and you might also like to see what the Baby Loss Awareness Campaign has organised in your area for the next celebrations and acts of remembrance.

The Future

What are my chances of a future successful pregnancy?

This depends very much on the health of your tubes. It is usually possible to conceive and over all 65% of women are healthily pregnant within 18 months of an ectopic pregnancy. Some studies suggest this figure rises to around 85% over 2 years.

 

To see our Frequently Asked Questions about recovery from ectopic pregnancy, please follow this link.