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Expectant management vs medication management

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Expectant management vs medication management

Postby K80 » Wed Sep 11, 2019 9:00 am

Hi there,

I was told I have a left sided ectopic yesterday with a BHCG of 440 and have opted for expectant management. I am wondering what other people’s experiences are this? And also those of medication management. I obviously don’t want to lose my tube but am concerned about the damage and risk of another ectopic. This is my first pregnancy and am absolutely devastated.
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Re: Expectant management vs medication management

Postby EPT Host 20 » Wed Sep 11, 2019 7:03 pm

Dear K80
I am so sorry to hear of your ectopic pregnancy and loss,
When we experience ectopic pregnancy we are suddenly faced with a life threatening emergency and it's treatment, reduction in fertility, concerns about the future and the loss of our babies. Experiencing any one of these is an ordeal, putting them together is immense and your feelings are completely normal.

Research has shown that, in patients with an ectopic pregnancy who are properly assessed and their pregnancy hormone level (beta hCG) is dropping, up to 50% of these pregnancies will end naturally and there will be no need for an operation or a drug to treat the condition.

In deciding whether expectant management was appropriate, doctors would first of all look at the results of blood tests, ultrasound scan(s) and undertake an assessment of your general health. Doctors would then want to test your blood repeatedly to ensure that your hCG levels are dropping, usually twice in the first week and then weekly thereafter, until the levels have dropped to below 5<mIU/mL. It is not usually necessary to do another ultrasound scan unless you present with other symptoms, in which case your doctors will undertake a reassessment.

How long you need to keep going for repeat tests will depend upon how long it takes for your hCG levels to drop to below 5<mIU/mL and this can vary quite considerably from woman to woman. As a general rule, as long as your hCG levels are dropping between blood tests, your doctors will continue to monitor you and manage you expectantly. It can take anything between two weeks and three months, for your hCG levels to fall back to a non-pregnant level but, for most women, hCG levels have reached a non-pregnant state within around four weeks.

In these circumstances, your hospital would give you a number to contact for health advice if you feel that anything is changing, or you will have been told to report to the Accident and Emergency Department (A&E). If you have not been told what to do and need to speak to someone ring the hospital department which is treating you or the NHS 111 Service by dialling 111.

Methotrexate, being a drug can have some unwanted side effects and surgery can be quite invasive, however you can discuss treatment options with your Dr.

It may be comforting to know that 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).

We advise that you do not do any heavy lifting or strenuous exercise whilst your levels are dropping. Above all, be kind to yourself, allow time to grieve, to heal both physically and emotionally. We will be here for you for as long as you need.
Sending much love,
Karen x

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Re: Expectant management vs medication management

Postby pammy3 » Wed Sep 11, 2019 8:56 pm

So sorry to hear about your ectopic. I was in exactly the same position 8 weeks ago with mine. Also my first pregnancy.

I opted for expectant management as I didn't like the sound of methotrexate and thought I might as well see if my body could sort it itself, naturally.

My initial hormone level was almost 5000! I was supposed to go into surgery-but it halved in a day, then kept dropping, hence expectant.

I experienced bleeding and on/off abdominal pain for the next 6 weeks. It was all manageable, but the important thing is to rest! I luckily already had a holiday booked by the seaside and I very much believe in the power of healing yourself. I was completely switched off and rested. After that trip the hormone level dropped considerably. I then returned to work but took it easy.

My level is now down to 40 and no longer have to go into hospital for bloods. From day of diagnosis to this has been 6 weeks.

No-one can make the decision for you, but I figured I might as well see if my body could heal itself first, as judging by other messages I'd seen on here, methotrexate can take weeks also.

Just be prepared to take things slow and look after yourself. I still have the odd pains now (most the time i feel normal), but as the nurse reminded me-although you feel normal-your body is still dealing with a trauma essentially.

Look after yourself. I've felt sad at times and that my body let me down but I figured the good news is I can conceive, this one just wasn't meant to be.
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Re: Expectant management vs medication management

Postby pammy3 » Wed Sep 11, 2019 8:59 pm

Apologies I just realised you were weighing up against surgery not methotrexate.

I was also concerned about leaving in a damaged tube if not removed. The consultant said there's no way of telling if it's damaged until it's physically removed! I also agonised over this. Again, unfortunately comes down to your decision. I'm worried I'll still have a damaged tube but going to look into exploratory options to see what's happening in there!
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Re: Expectant management vs medication management

Postby K80 » Thu Sep 12, 2019 2:22 pm

Thank you both for your replies, it’s really comforting to know someone else made the same decision I did. I had a BHCG and progesterone check today, progesterone is low and BHCG static so therefore will have another BHCG check in 1 week. With no symptoms and static BHCG I am hopeful that my body will heal itself.

Thank you again, it’s so nice to know that there is someone out there I can talk to. I am also pleased to hear things settled for you.
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