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Expectant management query

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Expectant management query

Postby JP 495 » Sat Aug 17, 2019 5:30 am

I'm in a bit of an unusual situation and I guess I'm looking for since reassurance. I'm currently overseas on a work contract in a country with an unreliable medical system. I was diagnosed with an ectopic pregnancy 3 weeks ago in the neighbouring country, with severe pain, some spotting but low HCG levels that declined from 750 to 450 in two days. Based on this the hospital opted for expectant management. Since then my levels decreased to 174 and then a week later 162. The doctors here are pushing me to have surgery but given the sheets on the examination table were not even changed between patients I'm very keen to avoid this and I'm assuming that because the levels are declining it's probably okay.

I only have three weeks left in the country before I return home to my wonderfully supportive, but physically absent partner and I'm hoping I can hang on that long. But I'm also concerned about taking a cube hour flight to get home if my levels have not decreased.

This is obviously further complicated by the fact that there really isn't anyone here I can talk to about this and I can't let my work know the exact nature of what is going on as it may impact my future work options.

So basically I'm looking for since kind of reassurance. I've mapped out all the local hospital options and know what I'd do in an emergency, but am I being crazy but opting for a more aggressive intervention? My partner and I are keen to try again quickly (both nearing 40 so a delay is far from ideal) so I was happy to take the option that gave us the best chance at a future pregnancy but now I'm wondering if I made a mistake....
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Re: Expectant management query

Postby JP 495 » Sat Aug 17, 2019 5:31 am

Sorry it's a five hour flight home, not a cube hour flight!
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Re: Expectant management query

Postby NinjaPenguin » Mon Aug 19, 2019 12:15 am

I'm not a dr but your levels are pretty low and declining. Are you usually a UK resident? Are you able to ring your usual GP or even 111? I would strongly recommend speaking to a dr in your home country on the phone. If you had surgery I cant imagine you'd even be allowed to fly that soon after surgery. Good luck, hope everything is ok xx
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Re: Expectant management query

Postby EPT Host 20 » Mon Aug 19, 2019 7:11 pm

Dear JP 495,
I am so sorry to hear of your ectopic pregnancy and loss, sadly I am not medically trained so cannot give you specific advice on your situation.
As your levels are decreasing it maybe a little presumptive to think of surgery however, I would advise that you do not travel until your levels have decreased to pre-pregnancy levels or unless your doctor says you are fit to fly.
We have further information on expectant management here
https://ectopic.org.uk/patients/treatment/
I am sorry to hear that you are not with your family at this time and please do lean on us for as long as you need.
Sending much love,
Karen x
The Ectopic Pregnancy Trust
Registered Charity Number: 1071811

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Re: Expectant management query

Postby EctopicPUL » Tue Aug 20, 2019 7:30 pm

Can you get regular HCG tests?

I was cleared to fly once mine were in the 70s but regularly dropping.

What I would say is they can go up as well as down, it's not unheard of so you do need close monitoring.

I had expectant management. Is methotrexate an option in the country you're in?

If it was me I'd wait it out with close monitoring but that's a personal decision and possibly biased by the fact I eventually didn't need intervention.
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Re: Expectant management query

Postby JP 495 » Sun Aug 25, 2019 4:55 am

Thanks for the replies. My levels dropped quite substantially last week- down to 70- so I'm feeling quite a bit better about it. I think I just had a small meltdown when they only dropped by ten in a week. This has been so much harder than I anticipated and I just really, really want to be home.

Unfortunately as I travel a lot for work I don't a regular doctor so there has been nobody I can call for medical advice and the medical staff here pretty well just wait for me to tell them what I think they should do. For the blood tests I actually just walk into the lab in the hospital and ask for what I want and the lab tech does it. I've been getting full blood pictures as well because it makes me feel better somehow, like if there was a serious problem there would probably be done other indicator as well. At least that's the theory I'm currently going with! I feel like I've read every study published on expectant management over the past four weeks but it's surprisingly hard to find published information for large sample groups.

After the drop to 70 there was a lot more, quite thick, bleeding, so I'm sort of hoping that's signalling the end of all of this, although now it's back to the seemingly endless spotting, so who knows!

I'm​ usually pretty pragmatic and used to take care of myself, but honestly found this without access to proper medical care or any support has been much much tougher than I could have imagined. Being able to read what other people have been through has been actually very helpful.
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Re: Expectant management query

Postby niketsurve_91 » Mon Aug 26, 2019 6:50 am

Thanks for the information
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