At first, an ectopic pregnancy may feel like a typical pregnancy with some of the same signs, such as a missed menstrual period, tender breasts, or an upset stomach. Many people who have an ectopic pregnancy had no risk factors at all. health information, we will treat all of that information as protected health
Established criteria should be used to determine treatment options for ectopic pregnancy, including expectant management, medical management with methotrexate, or surgical intervention. Almost all ectopic pregnanciesmore than 90%occur in a fallopian tube. You may be dealing with many emotions after an ectopic pregnancy, even if you were not planning to become pregnant. In this instance, a health care provider can order a test for the hCG level. Treatment of threatened abortion is expectant management. Talk about your feelings and allow yourself to experience them fully. Sometimes surgery is needed even if the fallopian tube has not ruptured. Cigarette smoking and having more than one sexual partner also increase the risk for an ectopic pregnancy. An ectopic pregnancy is when the fertilized egg remains in the fallopian tube and continues to develop. In an ectopic pregnancy, the hCG level may increase less than 66% in 48 hours. Your hCG level can inform your doctor whether there is a risk of an ectopic pregnancy or whether a miscarriage has occurred. About one half of all women who have an ectopic pregnancy do not have known risk factors. Rho(D) immune globulin (Rhogam) is indicated within 72 hours for all Rh-negative patients with abdominal trauma or ectopic pregnancy, and in those who undergo uterine aspiration. Association of pelvic inflammatory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: A nationwide population-based retrospective cohort study. If hCG levels have not decreased enough after the . Your doctor may also test your progesterone levels because low levels could be a sign of an ectopic pregnancy. At-home urine tests require higher levels of hCG to detect a pregnancy, typically at least 20 mIU/mL. Yes, during treatment with methotrexate you should avoid the following: Vitamins and foods that contain folic acid, including fortified cereal, enriched bread and pasta, peanuts, dark green leafy vegetables, orange juice, and beans. Levels of hCG should be increasing by at least 60% every 2-3 days, but ideally doubling every 48-72 hours. HCG levels alone do not diagnose an ectopic pregnancy. Confirming pregnancy You will have careful follow-up over time until hCG is no longer found in your blood. the single-dose protocol should be used in patients with -hCG levels less than 3,600 mIU per mL (3,600 IU per L), and the two-dose protocol should be considered for patients with higher initial -hCG levels, especially those with levels greater than 5,000 mIU per mL. . Prescription pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Many regimens for using misoprostol alone have been studied, and none has been proven optimal.22 One common regimen is 800 mcg vaginally, with a repeat dose in 24 to 48 hours if the first dose is unsuccessful.27 Besides the expected cramping and vaginal bleeding, common adverse effects include nausea and diarrhea.22. A transvaginal ultrasound allows your doctor to see the exact location of your pregnancy. Pelvic Inflammatory Disease: An infection of the uterus, fallopian tubes, and nearby pelvic structures. Which procedure you have depends on the amount of bleeding and damage and whether the tube has ruptured. Read common questions on the coronavirus and ACOGs evidence-based answers. This content does not have an Arabic version. Kelly Gleason describes the roller coaster of a miscarriage and ectopic pregnancy diagnosis, and the importance of shared decision making. Methotrexate may be used if the pregnancy has not ruptured a fallopian tube. . Trends in quantitative subunit of human chorionic gonadotropin (-hCG) levels provide useful information when distinguishing normal from abnormal early pregnancy. Intramuscular methotrexate is the only medication appropriate for the management of ectopic pregnancy. Tulandi T. Ectopic pregnancy: Epidemiology, risk factors, and anatomic sites. A Cochrane review found that medical management with misoprostol (Cytotec) in women with incomplete abortion does not improve rates of completed abortion or decrease the need for unplanned surgical procedures compared with expectant management.22 In contrast, medical management is more effective than expectant management for the treatment of anembryonic gestation or embryonic demise.25 The most effective regimen for medical management is 200 mg of oral mifepristone (Mifeprex) followed 24 hours later by 800 mcg of vaginally administered misoprostol.26 Success rates at two days with this regimen are 84% vs. 67% in those treated with misoprostol alone. 2015;112(41). If we combine this information with your protected
In the case of an ectopic pregnancy, the hCG level may just plateau or increase at a very slow rate, but . Are you in pain? Pregnancies can also be classified as pregnancy of unknown location if the hCG is positive but the pregnancy cannot be visualized on ultrasound (either inside or outside of the uterus). In the vast majority of ectopic pregnancies, the fertilized egg implants somewhere in the fallopian tube. Salpingostomy is preferred for patients who wish to preserve fertility; however, it may result in inadequate evacuation of products of conception and a recurrence of symptoms. As an ectopic pregnancy grows, more serious symptoms may develop, especially if a fallopian tube ruptures. After the injection, your doctor will order another HCG test to determine how well treatment is working, and if you need more medication. Pregnancy of unknown location refers to a transient state in which a pregnancy test is positive but ultrasonography shows neither intrauterine nor ectopic pregnancy. Will I need to follow any special precautions if I become pregnant again? Typically, however, a ruptured tube must be removed. If the ectopic pregnancy has ruptured a tube, emergency surgery is needed. manual vacuum aspiration of the uterus can evaluate for chorionic villi that differentiate intrauterine pregnancy loss from ectopic pregnancy. Ectopic precautions and serial -hCG levels should be continued until the level is undetectable. Approximately 25% of pregnant women experience bleeding before 12 weeks' gestation.1,2 The differential diagnosis includes nonobstetric causes, bleeding in a viable intrauterine pregnancy, early pregnancy loss, and ectopic pregnancy. The most common drug used to treat ectopic pregnancy is methotrexate. In cases where methotrexate is contraindicated or not preferred by the patient, surgical management can usually be performed laparoscopically if the patient is hemodynamically stable. This pain can be managed expectantly as long as there are no signs of rupture.5 Gastrointestinal adverse effects (e.g., abdominal pain, vomiting, nausea) and vaginal spotting are common. In: Williams Obstetrics. In some cases, an ectopic pregnancy may resolve on its own. Progesterone levels rise much differently than hCG levels, with an average of 1-3mg/ml every couple days until they reach their peak for that trimester. However, most ectopic pregnancies do not reach this stage. information and will only use or disclose that information as set forth in our notice of
Surgical options include salpingostomy or salpingectomy. Treatment options for early pregnancy loss include expectant management, medical management with mifepristone and misoprostol, or uterine aspiration. In viable intrauterine pregnancies with initial -hCG levels of less than 1,500 mIU per mL, 1,500 to 3,000 mIU per mL, or greater than 3,000 mIU per mL, there is a 99% chance that the -hCG level will increase by at least 49%, 40%, and 33%, respectively, over 48 hours. Approximately one-fourth of pregnant women will experience bleeding in the first trimester. The hCG levels in an ectopic pregnancy often rise slower than usual, meaning they will not double every two to three days in early pregnancy. Because ectopic pregnancies can be life-threatening, early diagnosis is essential. There's some overlap between the possible trends in hCG levels for normal and ectopic pregnancies. Pregnancy tests look for hCG (human chorionic gonadotropin) which is excreted in pregnancy. An hCG level that is lower than expected is one reason to suspect an ectopic pregnancy. Ectopic pregnancy should be considered in any pregnant patient with vaginal bleeding or lower abdominal pain when intrauterine pregnancy has not yet been established (Table 2).10 Vaginal bleeding in women with ectopic pregnancy is due to the sloughing of decidual endometrium and can range from spotting to menstruation-equivalent levels.10 This endometrial decidual reaction occurs even with ectopic implantation, and the passage of a decidual cast may mimic the passage of pregnancy tissue. Very early in pregnancy, the embryo can grow within the fallopian tube without causing any symptoms. See permissionsforcopyrightquestions and/or permission requests. Expectant management can be considered for patients whose peak -hCG level is below the discriminatory zone and is decreasing, but has plateaued or is decreasing more slowly than expected for a failed intrauterine pregnancy.30 In cases where the initial -hCG level is 200 mIU per mL (200 IU per L) or less, 88% of patients will have successful spontaneous resolution of the pregnancy; however, rates of spontaneous resolution decrease with higher -hCG levels.31 Patient counseling must include the risks of spontaneous rupture, hemorrhage, and need for emergency surgery. 2020;101(10):599-606. https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html, Long Y, Zhu H, Hu Y, et al. 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