Is This Really an Ectopic Pregnancy? -or- Can an Ectopic Pregnancy Be Misdiagnosed?
What You May Not Know about Ectopic Pregnancies
It is believed that an estimated 2% of all pregnancies are found to be ectopic.
If not treated immediately, ectopic pregnancies can affect future fertility and are still a leading cause of maternal death during the first trimester.
At the Misdiagnosed Miscarriage site, we often encourage women to be absolutely certain they are indeed going to miscarry before ending the pregnancy. Unfortunately, with an ectopic pregnancy, that just isn't an option. If women are showing signs of an ectopic pregnancy, they need to be treated. Some women prefer to get a second opinion if symptoms are not worsening.
This page is to help clarify whether you may indeed have an ectopic pregnancy, may want a second opinion and the options in treating that pregnancy.
I am not a medical professional. The information I share is meant to supplement the information given you by your doctor. If you feel your doctor is not doing enough for you or not willing to listen to your concerns, I strongly encourage you to take what you've learned here and get a second opinion.
According to this article on ABC News , roughly 40% of pregnancies diagnosed as ectopic are indeed viable!"
Frequently Asked Questions - about Ectopic Pregnancies
What is an ectopic pregnancy?
An ectopic pregnancy is one in which the baby implants outside the uterus.
How common is an ectopic pregnancy?
According to the American Pregnancy Association, one out of every fifty pregnancies may be ectopic so they are quite common.
When do symptoms typically appear?
Many women report feeling symptoms between eight to ten weeks when the baby is located in the tube. However, if implantation took place somewhere else (i.e. abdominal cavity, ovary or cervix), symptoms may appear a bit later.
What are the symptoms
Symptoms vary from pregnancy to pregnancy but may include:
-sharp stabbing pain on one side of abdomen or the other
-spotting brown blood
-low hCG levels which tend to either rise slowly or bounce around a bit.
-weakness or dizziness.
-absence of gestational sac on ultrasound when hCG numbers reach 1,000. Keep in mind, many women report much lower numbers with an ectopic pregnancy so if your hCG numbers are under 1,000 and rising slowly or jumping around, you may need to treat this as an ectopic pregnancy.
When do symptoms typically appear?
Many women report feeling symptoms between eight to ten weeks when the baby is located in the tube. However, if implantation took place somewhere else (i.e. abdominal cavity, ovary or cervix), symptoms may appear a bit later in the pregnancy.
What should I do?
Whenever an ectopic pregnancy is suspected, women must stay closely monitored by their physicians.
Depending upon the individual case, some doctors may:
- decide to simply monitor the pregnancy if the ectopic pregnancy is resolving itself (miscarriage) and the risk of rupture is low.
- offer a shot to help dissolve the pregnancy
- decide to perform surgery if the risk to the mother is great.
Are Pregnancies ever Misdiagnosed as Ectopic?
I must admit, I am hesitant to include this information here. Whenever an ectopic pregnancy is suspected, you have to take it seriously! While women can wait out many miscarriage diagnoses, an ectopic pregnancy can have very serious consequences if left untreated.
That said, however, yes, even ectopic pregnancies are misdiagnosed. I am including links to stories of women who have been misdiagnosed. My hope in sharing these stories is that you may read them and decide whether you need a second opinion or whether you need to be treated immediately.
Rethinking How Ectopic Pregnancies are Diagnosed - as well as the myths of hCG doubling rates
Exploding the myths of hCG doubling rates as well as diagnosing ectopic pregnancies. Great take away message, Doctors need to take their time in diagnosing. If you are going through this scare, take a half hour to watch this video!
Misdiagnosed Ectopics in the News!
FRIDAY, Jan. 13 (HealthDay News) - Women with normal pregnancies that were misdiagnosed as ectopic who were treated with methotrexate in the first trimester either miscarried or gave birth to a severely deformed baby, the results of a small study suggest.
An ectopic pregnancy is one where the egg begins to develop outside the womb, which means that the fetus cannot grow normally and will not survive. The drug methotrexate (Rheumatrex, Trexall), which is used to treat rheumatoid arthritis and certain types of cancer, is also known to be dangerous to developing fetuses and can end an ectopic pregnancy.
Researchers affiliated with the Organization of Teratology Information Specialists (OTIS) cautioned that their findings, published in the December issue of the American Journal of Obstetrics & Gynecology, may be a red flag for a larger problem. They said more effective tools are needed to properly diagnose ectopic pregnancies.
"This report describes a subset of cases that occur in the general population and it suggests that this misdiagnosis is not limited to one center or one part of the United States or Canada,"
Sharon Lavigne, study co-author and coordinator of OTIS' Connecticut affiliate, said in a news release from the organization. "There are likely many more of these scenarios out there that our services never hear about," she added.
For the study, the researchers examined eight North American women with normal pregnancies that were misdiagnosed as ectopic. The women were given high doses of methotrexate, which resulted in miscarriage, termination of the pregnancy or the birth of severely malformed babies. The investigators concluded that more accurate and effective tools are needed to diagnose and treat ectopic pregnancy.
"This is a challenging diagnosis, and efforts to accurately locate the pregnancy in suspected early ectopic pregnancies would benefit from improved diagnostic tools,"
another study co-author, Myla Moretti, assistant director of Motherisk, OTIS' Canadian affiliate, explained in the news release.
"Establishing a non-punitive reporting mechanism to explore the magnitude of this problem will be helpful in increasing awareness and possibly preventing these events in the future."
Your Treatment Options
Expectant management is when your doctor does not try to end the pregnancy with the use of medication or surgery.
Can women just wait out an ectopic pregnancy diagnosis?
Ectopic pregnancies are risky. Sometimes doctors will just wait out a diagnosis. Medical literature indicates that if a woman's hCG levels are low and falling, shows no symptoms and the gestational is still small, waiting for the ectopic pregnancy to resolve itself may be an option. The risk of rupture is still a possibility even in women who meet this criteria. Discuss with your physician the risks when treatment is being discussed.
Medical Studies about Expectant Management
The authors The authors conclude that as long as a woman is showing no signs of complication and her hCG levels are relatively low, expectant management may be a viable option.
Is expectant management an option?
Methotrexate is a cancer-battling drug that has been shown to make sure the developing baby is reabsorbed back into the body. In women with ectopic pregnancies, the best success rate is with injection.
When do doctors tend to recommend Methotrexate?
If the ectopic mass is less than 3cm and hCG levels less than 5,000 (although levels seem to vary between studies...one study says 15,000!), Methotrexate may be used with a high success rate (averaging about 90% success). If a heartbeat is seen, the pregnancy may be too far along for the drug to be successful.
Are there side effects?
Commonly women tell me they are experiencing nausea and dizziness as a side effect. As with any medication, if side effects seem more severe, call your doctor or be seen immediately. With the drug, you should stay out of direct sunlight and avoid all alcohol. For more information on the drug itself, read the consumer information for Methotrexate online.
According to Kaiser, with the use of Methotrexate, women have a lower risk of future ectopic pregnancy than if they have surgery.
Women have had tubes rupture after the Methotrexate. Your physician should want to monitor you until your levels are normal again. Often, they'll look at your levels about two days after the injection and then monitor you weekly until those levels drop. If your levels are not dropping or are bouncing around, you may need surgery. If you don't feel your doctor is doing enough for you, you may need to find a new doctor.
More information about Methotrexate
A study showing the effectiveness of single and multiple-dose Methotrexate.
Your doctor may choose between two different laparoscopic surgeries.
What is a Salpingostomy?
This method is considered the more conservative approach. If the ectopic mass is located near the end of the tubes and is not too large (over 2cm) a cut may be made to remove the mass. The tube is preserved although there is a higher risk for future ectopic pregnancies.
What is a Salpingectomy?
This method is a removal of a portion of the tube or the entire tube. This is done if the tube looks as if it is about to rupture or has in fact already ruptured. The risk of future ectopic pregnancy is a bit less with this procedure but still a possibility.
If you've had an ectopic pregnancy, how was it treated?
Reported hCG levels with an Ectopic Pregnancy
Keep in mind, hCG levels vary from pregnancy to pregnancy even with an ectopic pregnancy but here are numbers women have reported with confirmed ectopic pregnancies:
(numbers in parenthesis are days between tests)
A - 1st level: 175 -- (2 days) 187 -- (7 days) 167 -- (2 days) 148 -- (1 day) 172
B - 1st level: 52 --(2 days) 55 --(4 days) 73 --(2 days) 93 --(7 days) 458--(7 days)935
C - 1st level: 19 -- (3 days) 95 -- (7 days) 121 -- (3 days) 278
D - 1st level: 1600 (mass seen in tube)
E - 1st level: 49 --(4 days) 774 -- (2 days) 452 -- (6 days) 651
F - 1st level: 432 --(2 days) 218 -- (7 days) 418 (mass seen in tube)
G - 1st level -31(2 days) 2nd Level-81(2 days) 3rd Level-248(2 days) 4th Level-545 (5 days) 5th Level -3393 (found in right tube)
If you have had a confirmed ectopic pregnancy and would like to include your hCG numbers, please leave a comment below
If you are certain your pregnancy is ectopic or have had one in the past, sharing your levels may help women who are going through the same situation. Please include the number days between each level check as well as when the ectopic mass was seen (if it was seen)
Actual Ectopic Pregnancy Stories
One of my hopes by sharing these stories and links is that women who know of other stories or have their own success story will share them here as well. You can find each of these stories on the Misdiagnosed Miscarriage page:
At six weeks, after having cramps and pain, the baby was found in her tube.
One woman was told she did not have an ectopic pregnancy. Her hCG numbers continued to jump around and she had spotting, pain and dizziness.
Despite extreme pain and spotting, one woman had to wait more than a week to be diagnosed with an ectopic pregnancy.
If you have had an ectopic pregnancy and would like to share your story, please visit our miscarriage stories forum.
Misdiagnosed Ectopic Stories
Some women are misdiagnosed and here are a few of those stories. Again, these stories can be found on the Misdiagnosed site.
Because her hCG levels were over 10,000, Swolladad believed her doctor was wrong about having an ectopic pregnancy. She sought a second opinion and found out her pregnancy was not etopic...it was twins!Swolladad's Story
With hCG levels at 900 and no gestational sac, Jennifer's doctor wanted to give her the shot to dissolve the pregnancy. Jennifer insisted upon a follow-up ultrasound and found her baby.
Read Jennifer's story,
Summer was diagnosed with an ectopic pregnancy at the ER. A visit to her RE showed a viable baby instead
Read Summer's story,
Ashley's doctor wanted to give her something to expel the tissue due to ectopic pregnancy. Fortunately, Ashley got a second opinion.
Read Ashley's story,
If you have had a misdiagnosed ectopic pregnancy and would like to share your story, please visit our forums.
An E-Mail I Received
worth reading if you are diagnosed as well
"Dear Kay, First of all I would like to thank you for all you do and for all the information you provide. Recently I was diagnosed with an ectopic pregnancy. The doctors were sure, even though I didn't have any of the classic symptoms. They removed my right tube. They thought that the embryo was in my ovary, but since they during surgery found a small swelling on my tube, they decided to remove it... to be safe.(!!) After the surgery my hcg went from 15000 to 8000. They still had suspicions that it was in the ovary, but decided to empty my uterus to be sure. They had seen a small sac about 11 mm (I was then 5+3) but they told me it was a pseudo sac and they saw no sign of a pregnancy inside. I questioned this, as I know that it's not that common to see anything but a sac at this week. But the doctor did not listen to me. The sac grew from 8 mm to 11 in two days, which is normal. What they saw on the ultrasound (that they interpreted as an ectopic) also grew. It was about 28 mm at this time. They found a pregnancy in my uterus. I asked what type of pregnancy and I got the answer that It probably was a normal pregnancy. What they found in my tube was just some small collection of fluid/water. The thing they thought was an ectopic (in my tube) was not what they saw on the ultrasound. What they had seen was corpus luteum. They couldn't tell the difference between corpus luteum and an ectopic pregnancy.
The pregnancy in my uterus did not survive the surgery and I am now left with only one tube. Both my tubes were in a bad condition, but the one they removed were the better one. I have had no problems getting pregnant, so they must have been just fine. The doctor thought that I was further along in my pregnancy than I said, because of my high level of hcg. So he absolutely thought that something was wrong when he couldn't see anything in the gestational sac. I know exactly when I got pregnant. I can feel when I'm ovulating, and even tell from witch side the egg releases. Plus I used opk to know. If he had known this before the surgery... maybe this would never have happened. I live in Sweden. We are supposed to be really good at this stuff, but I'm starting to doubt that. I found almost no information on Swedish websites, and that's how I found your page on squidoo. I hope that doctors become more careful when they diagnose women with ectopic ore miscarriages. Keep up the good work! Best wishes
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