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Twin Ectopic - so many questions

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AngelKT
Posts: 2
Joined: Mon Oct 28, 2019 11:36 pm

Twin Ectopic - so many questions

Post by AngelKT »

Hi Everyone
I have read lots and lots of information since my recent twin ectopic pregnancy and I’m still searching for answers.
Before I knew I was pregnant (although had been actively trying for 17 months) I experienced a feeling of strong pressure on my right hand side, like trying to force something through a small space. Could this have been implantation or the pregnancies trying to move down the Fallopian tube?

From when I found out the exciting news that I was at long last pregnant, I read so much on the does and don’ts to keep the babies safe. One of the recommendations was to sleep on your left side. In doing this every night I felt an unusual sensation in my right pelvic area, I can only describe it like the softest pins and needles with a gentle tugging feeling. Despite never having been pregnant before, something told me this wasn’t right. I mentioned it at my first midwife appointment and asked nervously about whether there was a chance of ectopic. I was relieved to be told no “I’d Know as I would be in agony”. A week later it was still at the back of my mind and the sensation while sleeping was now there intermittently when awake and sitting up. I spoke with the Early Pregnancy Team and was offered a scan the following day. The scan showed that I had two pregnancies, both in the right Fallopian tube and some bleeding into my abdomen. Utter devastation is all I could feel with a strong view that if at all there was anyway it could be avoided, I did not want to have surgery to remove the tube and pregnancies. The consultant and early pregnancy were amazing they really listened and gave me 48 hours at which point they fully expected they would then be doing the operation, I thought otherwise as I just knew (a bit like the previous gut instinct) that my body would resolve this on its own. 48 hours later my hcg had halved and I didn’t need to have the operation. The back pain was quite intense and some other symptoms but on that side of things I felt extremely lucky. I felt bad for saying/thinking it was a good outcome, for saying I was delighted to the consultant when he told me the “good” news. On the whole there was nothing about this situation that was good or delightful but maybe someone who has went through expectant management will understand?

Has anyone else had a Twin ectopic pregnancy? The team at the hospital had never seen it before, even those with almost 40 years experience. Seemingly in the case of ectopic with twins, one would typically make it to the uterus and one gets stuck in the Fallopian tube. If one can make it why not both? What causes neither to go? What makes twin ectopic so rare? Other than the fact that twin pregnant is rarer than single pregnancy in the first place.
I’ve read that regardless of treatment for ectopic, it is harder to conceive again. Why is this? It was already so hard, so I’m very anxious that it just won’t happen now that it’s seemingly even harder. I just don’t understand why?
Why is the chance of a further ectopic increased? From what I’ve read this seems to be applied to all and not only where there may be some pre-existing factors such as scar tissue etc. I can’t understand why though, does anyone know?
With expectant management does your body still need to go through healing? I’m thinking it will, although not sure how you know when everything is healed?
How can you tell if scar tissue has occurred from self resolving? Is this likely?

I could go on all day with my list of unanswered questions, there’s just so much I don’t understand and feel like I need to. If you’ve got this far, thank you so much for taking the time to read and hopefully answer any questions.

EPT Host 20
Posts: 1587
Joined: Thu May 31, 2012 9:58 pm

Re: Twin Ectopic - so many questions

Post by EPT Host 20 »

Dear AngelKT,
I am so sorry to hear of your ectopic pregnancy and losses. I know when I had my ectopic pregnancy, I searched for answers too, especially why and how. Sometimes however, we do not have the full answers but it is important to understand that there is nothing you could have done differently to prevent ectopic pregnancy and it is not your fault.
I wish I could give you all the answers, but I am afraid it is impossible for me to comment on individual circumstances. I have such limited information and do not have access to your medical records, but I will try my best to help with general answers and would advise speaking to your medical team for any further advice or clarification.

You are right in saying that twin ectopic pregnancies are rare and yes it is rare for both to be in the same tube. Natural twin pregnancies are rare In comparison to singleton pregnancies and there are two types of twin pregnancies. Identical twins happen when 1 fertilised embryo splits into 2. This may not be seen in the early stages with ectopic pregnancy whereas Non-identical twins happen when 2 eggs are fertilised by 2 sperm at the same time. Eggs maybe released by the same or different ovaries. If released by different ovaries, one egg may successfully travel to the womb (uterus) whilst the other implants outside the uterus, most commonly in the fallopian tube in ectopic pregnancy. With yourself, it would appear that both eggs were released by the same ovary. One has implanted in your fallopian tube and the other has possibly become stuck behind.

There are many factors that increase the risk of ectopic pregnancy such as pelvic inflammatory disease, tubal surgery, endometriosis and previous abdominal surgery, to name a few. However many women, including myself have never had any of the common known risk factors and still sadly experience ectopic pregnancy.
Sadly there is an increased risk of a second ectopic pregnancy following the first, this maybe due to a previous known risk factor or damage from the first ectopic. The chances of a further ectopic after a first in UK is 10%. So that's 90% chance of the embryo being in right place next time.
While generally it is possible to conceive after an ectopic pregnancy, the amount of time it takes varies from couple to couple. Factors include age, general health, reproductive health and how often you have sex, among other things. It may be comforting to know that 65% of women are successfully pregnant within 18 months of experiencing an ectopic pregnancy and some studies suggest this rises to around 85% after two years. Importantly, help is available if conceiving naturally has not yet been successful after some time trying - and the EPT advises that women under 35 should seek medical advice following 12 months trying to conceive and those over 35 should seek advice after 6 months.

I must warm you that you may find this next bit a little difficult to read. Please take your time and be kind to yourself and stop if you do not wish to read further.
With treatment for ectopic pregnancy through expectant management, when the pregnancy is ended, the whole pregnancy sac including any cells that might have grown into a baby is usually reabsorbed by the body. This is normal and happens in many cases of miscarriage. This process can take weeks and sometimes months. In some cases, the Fallopian tube may remain blocked and take time to shrink. Sometimes the tissue can separate and be passed through the vaginal bleeding that occurs. The bleeding that follows an ectopic pregnancy can be very heavy and clotty and result in the passing of what we call a decidual cast. This decidual cast is the lining of the uterus when we are pregnant. The sudden drop in hormones can cause the material inside the uterus to be shed in layers and the material that is passed can be grey, pink or white as well as appear like a clot or dark or frank red blood. Women can often mistake it for the tissue of their baby which can cause worry but it is important to remember that it is a normal process for the uterus lining to be shed.
In the UK, women aren't routinely scanned or offered additional investigations to see if a mass is still present before ttc again. We therefore advise advise waiting for two menstrual cycles before ttc. This time is important as it allows time for your body to recover and emotions to surface and be worked through. This is so that you have some comfort that your body is returning to its natural rhythm and you have a last menstrual period date from which to date a new pregnancy - key information in checking you are not suffering from an ectopic pregnancy in the future. As a gentle reminder, the first bleed soon after ectopic pregnancy is not classed as a period as it is the body's response to falling hormone levels.

Importantly early scans avail for future pregnancies. As soon as you know you are pregnant, contact your local EPU to inform them and book in for an early scan at around six weeks. Remind them of your previous ectopic pregnancy. This self refer route is the best route in our view. Hopefully you will have some comfort to know you are under the radar of medical professionals right away. Also, in terms of chances of future successful pregnancies, studies do not show a significant difference between treatment routes, whether surgical, medical using methotrexate or expectant management (allowing time for the body to resolve the pregnancy itself).

Above all, please be kind to yourself and allow time to grieve, to heal both physically and emotionally. There is a specific Preparing for Your Next Pregnancy board for you to look at whenever you feel ready and we will of course be here to answer any questions as best we can and offer our support whenever you need it.

Sending much love and warm hugs,
Karen x

The Ectopic Pregnancy Trust
Registered Charity Number: 1071811

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