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Expectant management - high HCG levels

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Joined: Wed Dec 11, 2019 8:15 pm

Expectant management - high HCG levels

Post by Aimeem »


I was 8 weeks pregnant when I started getting some really light spotting - I mentioned it to my midwife who advised I call the EPU as a precaution. They booked me in for a scan the next day, by this time I was 9 weeks. Sadly the scan showed no baby and they suspected I was having a miscarriage. The nurse took my blood and called me later that day to say they suspected it was an ectopic as my HCG level was 4500. I went back and had a second scan the next day which confirmed it was in my left tube. Since then my blood has dropped to 3800, 3600 and 2400. The first day result was Thursday and the last Monday. The nurses have said that as the drop
has been significant they are happy for me to have weekly tests until my levels drop to 0.
The reason for my post is that I can’t find much information on other people being treated like this, or if so with starting levels that are so high. I would like to know how long I should expect to bleed for? And then how long after that will I have a normal period? And even though my levels have dropped, is there still a chance that my tube could rupture anyway? The pregnancy was 2.4cm when I had my
second scan. I’m also wondering how long it will take for my levels to get to 0? The nurses can’t give me any answers, which I do understand as everyone is different. However has anyone been through anything similar? Or know any average time scales for any of it?
Thank you

EPT Host 22
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Joined: Fri Nov 20, 2015 10:26 am

Re: Expectant management - high HCG levels

Post by EPT Host 22 »

Hi Aimeem,

I'm so sorry to hear you are experiencing an ectopic pregnancy and loss. This can leave us with many questions, and I will do my best to help answer your questions. Please take time reading my response and feel free to ask any further questions.

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, there is no time frame for how long this takes. 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. This process involves vaginal bleeding - it can be clotty or like one of your usual periods and some women have bleeding/spotting for up to six weeks.

Many women experience changes to their menstrual cycles after an ectopic pregnancy and it can take some time to settle back into a rhythm that is more usual for you. Periods can be heavier or lighter or more painful than before - as we are so individual there isn't necessarily a set pattern. Doctors consider menstrual cycles of between 23-42 days to be within normal parameters and, if you find that you are not within these sorts of timeframes, it would be a good idea to speak to your doctors just to be on the safe side.

As a gentle reminder regarding conceiving again, we and many medical professionals advise waiting for two menstrual cycles once your hCG levels are back to pre-pregnancy levels. It is important to allow 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. The first bleed soon after surgery for ectopic pregnancy is not classed as a period as it is the body's response to falling hormone levels.

With regards to trying to conceive, the chances of a further ectopic after a first in the UK is 10%. So that's a 90% chance of the embryo being in the 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. 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).

Importantly early scans are available. 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-referral 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.

I know waiting for hCG levels can be an anxious time, and while I don't want to worry you, there remains a chance of rupture until you are at the non-pregnant levels (below 5mIU/ml). For these reasons, it is important to stay alert to any symptoms of pain, particularly abdominal or shoulder tip pain, or heavy bleeding. In these cases, you will want to be seen at the A&E.

These boards are a safe space for you, and we here for you for as long as you need.

With good wishes,


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Joined: Sat Jan 26, 2019 8:58 pm

Re: Expectant management - high HCG levels

Post by Sunshine84 »

I had an ectopic pregnancy last year and had expectant management. My initial hcg levels were 7000 and it took 8 weeks to get to 0. Hope that helps x

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