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I have recently been classed as Pregnancy of unknown location (pul) but struggling to understand what happened.
Last Wednesday I had an early scan after having stomach pain and some spotting, I was estimating I was around 5-6 weeks but they did not see a sac or any evidence I was pregnant. I did another pregnancy which confirmed I was pregnant and tested my HCG which was 207.
3 hours after the scan I was in even more intense pain and started bleeding heavily with large clots. I have been back over two 48 hour periods for hcg levels recorded at 160 then 104 yesterday.
As nothing showed on the scan and my hcg levels came down less than 60% they have put me down as pregnancy of unknown location and suggested I would be at higher risk but without any evidence as to why. The scanographer did say she saw a fibroid, which has made me wonder if this could have caused a problem?
I don't know what to take from this, did I miscarry or have an ectopic that dissolved? I am keen to get pregnant again, no previous pregnancies but this has confused, upset and unsettled me. Any help or thoughts would be appreciated xx
I am so sorry to hear of your loss.
Not knowing what is happening to our bodies can be extremely overwhelming and you have friends here who understand.
If scans are inconclusive, doctors would carry out a series of blood tests to check hCG levels to see if the numbers are rising as expected. However, in isolation, hCG tests only provide a part of the picture - declining levels indicate that a pregnancy has ended and will be miscarried. It can also possibly indicate an ectopic pregnancy that is "self-resolving". Also hCG levels rising by less than 66% over 48 hours means it is likely (but not certain) that it is ectopic. If levels rise normally, they suggest the pregnancy is implanted in the uterus. You may see from this that hCG levels only indicate certain possibilities and are not in themselves a definitive guide.
It is important to understand that Pregnancy of unknown location - (PUL) is not a diagnosis; it is a label given until the final location of the pregnancy can be identified with certainty. In the event of a PUL, blood will be taken to measure serum progesterone and hCG and the hCG test repeated 48 hours later. The doctors would also want to repeat the scan.
Until the location of the pregnancy is known definitively or the serum hormone levels have decreased to below pregnancy levels, there is a risk of complications associated with an as yet undiagnosed ectopic pregnancy. Whilst I do not wish to alarm you, for every 100 pregnancies labelled as a PUL about 10 will subsequently be found to be ectopic; but not all of these will need treatment. If treatment is required, (methotraxate injection or surgery) this will depend on the results of blood tests and scans and I would discuss this further with you Dr.
We would gently remind you to not undertake any strenuous exercise or lifting or housework while your hCG levels are dropping. While I do not want to alarm you, there remains the risk of rupture even with low or declining hCG levels. You should not resume exercise until your hCG levels are falling consistently and are in the low 100s.
I am sorry that I cannot provide you with more precise details but I am not medically trained and I hope your levels continue to drop steadily.
Sadly most of us who experience ectopic pregnancy or miscarriage never find out the reason why. It is hard to know how many miscarriages take place because sometimes a miscarriage can happen before the mother knows she is pregnant. The estimated figure is that miscarriage happens in around 1 in 4 recognised pregnancies, with 85% of those happening in the first trimester (weeks 1 to 12). 1 in 80 pregnancies will sadly be 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.
Whilst you may not get definitive answers of what happened, there is hope for future pregnancies. Please do be kind to yourself and allow time to grieve, to heal both physically and emotionally.
We are here for you for as long as you need,
Sending much love,
The Ectopic Pregnancy Trust
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