An ectopic pregnancy cannot move or be moved to the uterus, so it always requires treatment. Data Sources: An evidence summary from Essential Evidence Plus was reviewed and relevant studies referenced. Levels should then double every 48 hours from weeks four to six, but that isn't the case for everyone. 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. Are you being treated for any other medical conditions? There is no evidence that palpation during the pelvic examination leads to an increased risk of rupture.10, Beta human chorionic gonadotropin (-hCG) can be detected in pregnancy as early as eight days after ovulation.14 The rate of increase in -hCG levels, typically measured every 48 hours, can aid in distinguishing normal from abnormal early pregnancy. In a healthy pregnancy, the hCG level typically doubles every 48 hours. Sound waves from the transducer create images of the uterus, ovaries and fallopian tubes. Yes, ectopic pregnancies are dangerous. doi:10.1089/jwh.2020.8860. If you are pregnant, you can detect it in your urine. During a transvaginal ultrasound, you lie on an exam table while a health care provider or a medical technician puts a wandlike device, known as a transducer, into the vagina. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery or abdominal surgery. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Setting a low -HCG cutoff value increases the sensitivity of ultrasound and -hCG at diagnosing an ectopic . In the case of an ectopic pregnancy, the hCG level may just plateau or increase at a very slow rate, but . The pregnancy then is absorbed by the body over 4-6 weeks. The most common gestational age of diagnosis is between 6 to 10 weeks. It is appropriate for family physicians to treat hemodynamically stable patients in conjunction with their primary obstetrician. Some people with ectopic pregnancies are more stable at the time theyre diagnosed. Association of pelvic inflammatory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: A nationwide population-based retrospective cohort study. At around 8 to 11 days after conception, your blood still has low levels of hCG. Accessed Dec. 4, 2019. As the pregnancy grows, it can cause the tube to burst (rupture). To prevent life-threatening complications, the ectopic tissue needs to be removed. This blood test may be repeated every few days until ultrasound testing can confirm or rule out an ectopic pregnancy usually about five to six weeks after conception. Talk about your feelings and allow yourself to experience them fully. A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management. Uterine aspiration is the preferred procedure for surgical management of early pregnancy loss. In general, 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. See permissionsforcopyrightquestions and/or permission requests. Which procedure you have depends on the amount of bleeding and damage and whether the tube has ruptured. Bed rest does not improve outcomes, and there is insufficient evidence supporting the use of progestins. 2019 Oct-Dec;26(4):235-238. doi:10.4103/npmj.npmj_105_19. . 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]). ERIN HENDRIKS, MD, RACHEL ROSENBERG, MD, AND LINDA PRINE, MD. It uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the pictures to a nearby monitor. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html. Author disclosure: No relevant financial affiliations. This does not require the removal of the fallopian tube. Patients who choose expectant management should have -hCG levels monitored every 48 hours, and medical or surgical management should be recommended if -hCG levels do not decrease sufficiently.5, This article updates a previous article on this topic by Barash, et al.12. Urgent surgical referral is indicated when ultrasonography demonstrates an embryo and fetal cardiac activity outside of the uterus. Your ob-gyn or other health care professional will talk with you about the possible side effects and risks of surgery for ectopic pregnancy. It's important to avoid alcohol, folic acid (in both vitamins and foods) and pain . This period increases to about every 96 hours as you get further along. Patients should be counseled to avoid repeat pregnancy until at least one ovulatory cycle after the serum -hCG level becomes undetectable, although some experts recommend waiting three months so that the methotrexate can be cleared completely.27 There is no evidence that methotrexate therapy affects future fertility.28. Blood tests and ultrasound testing can alert your doctor if another ectopic pregnancy is developing. The diagnosis of threatened abortion should be made in patients with bleeding and an ultrasound-confirmed viable intrauterine pregnancy. Will I need to follow any special precautions if I become pregnant again? If we combine this information with your protected In: Williams Obstetrics. An intra-uterine pregnancy can usually be seen by 5-6 weeks gestation or when the HCG level is more than 1000 IU/l. Levels of this hormone increase during pregnancy. Complications Is an Ectopic Pregnancy Dangerous? Higher-than-typical hCG levels can signal that you're carrying multiples or, in rare cases, have a molar pregnancy. Patient satisfaction, mental health outcomes, infection rates, and future fertility are similar between these treatments.2022 Mental health outcomes are better when patients are included in the decision-making process, and shared decision making should guide management.23. Bilateral ectopic pregnancy is extremely rare, with a tremendous maternal mortality and morbidity risk, requiring rapid diagnosis and management. Another possibility is that you could be experiencing a miscarriage. Ectopic pregnancies are not viable and can cause serious complications for pregnant women, including death. A folate antagonist, it interrupts the rapidly dividing cells of the ectopic pregnancy, which are then resorbed by the body.22 Its success rate decreases with higher initial -hCG levels (Table 3).23 Contraindications to methotrexate include renal insufficiency; moderate to severe anemia, leukopenia, or thrombocytopenia; liver disease or alcoholism; active peptic ulcer disease; and breastfeeding.5 Therefore, a complete blood count and comprehensive metabolic panel should be obtained before it is administered. Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy. Read ACOGs complete disclaimer. An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. If so, was the test positive? 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. Several factors go into the decision to use methotrexate. If the -hCG level does decrease by at least 15% between days 4 and 7, the patient should return for weekly -hCG measurements until levels become undetectable, which can take up to eight weeks.26, Close follow-up is critical for the safe use of methotrexate in women with ectopic pregnancies. If your ectopic pregnancy isnt detected or treated early, you can experience severe health complications, including excessive bleeding, rupture of a fallopian tube, and death. Human chorionic gonadotropin (hCG) is a hormone thats very important throughout pregnancy. An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. They can even be life-threatening. 1.6.11 For women with ectopic pregnancy who have had methotrexate, take 2 serum hCG measurements in the first week (days 4 and 7) after treatment and then 1 serum hCG measurement per week until a negative result is obtained. This procedure uses a slender, lighted camera that is inserted through small cuts in the abdomen. Do you plan to become pregnant in the future? If products of conception are visible on speculum examination, the diagnosis of incomplete abortion can be made and treatment offered. In an ectopic pregnancy, the hCG level may increase less than 66% in 48 hours. When Low hCG Levels Suggest Ectopic Pregnancy . Patient preference should guide treatment decisions. Checking the hCG level and then checking it again in 48 hours tells you how fast the hCG level is rising. 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. Blood tests can determine how high the hCG level is. 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). Patients with suspected or confirmed ectopic pregnancy who exhibit signs and symptoms of ruptured ectopic pregnancy should be emergently transferred for surgical intervention. A single copy of these materials may be reprinted for noncommercial personal use only. Accessed Dec. 4, 2019. The discriminatory level (1,500 to 3,000 mIU per mL) is the -hCG level above which an intrauterine pregnancy should be visible on transvaginal ultrasonography. American Family Physician. Cunningham FG, et al., eds. 25th ed. 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