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Diamond
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![[*]](./images/reflections/default_icon.gif) posted on 6.18.2009 at 09:28 PM |
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I'm surprised it's taking 2 weeks for a definitive diagnosis...esp via an ultrasound..nowadays...either they see it in the uterus...or they
don't...
maybe i read this wrong...let me re-read it...
My heart goes out to you with the "not knowing" for sure that doc's can put a woman thru...they do have to make sure though...But I do understand
the wait on some important news like this is painful...
My prayers going out to you...
Winners Never Quit...Quitters Never Win...
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VAGurl
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| posted on 6.19.2009 at 09:40 AM |
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Well with my last pregnancy I had to wait at least a week because the first ultrasound they did was just of my uretus and they didn't see the baby
but there and I had like three positive pregnancy tests both blood and urine. But when they did the next one that's when they discover it was in my
tube.
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Diamond
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| posted on 6.19.2009 at 10:05 AM |
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^^^ I can't imagine your nerves during the wait time..wow..,my heart goes out to you to...for real...
I was reading where she's saying 2 wks...including a battery of tests and ultrasound(s) plural???? OB-GYN is not my specialty...but the 2 wks threw
me off....as serious as a ectopicpregnancy can be and the after effects on a Mom if left untreated..or slow to be diagnosed can be serious on the
woman's body afterwards...in the long run...I wish her DOC would make a final diagnosis...NOW...ya know..
| Quote: | | I have been going back and forth taking blood test and ultrasounds for the past two weeks. ...
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Winners Never Quit...Quitters Never Win...
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VAGurl
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| posted on 6.19.2009 at 02:11 PM |
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My nerves for terrible I spent every night praying, crying and talking to my lil angel trying to covince it to move to were it was supposed to be.
Ms. Shy you have to let us know when you find out something my heart is hurting for you right now.
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Ms_Shy
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| posted on 6.19.2009 at 03:13 PM |
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| Quote: | Originally posted by soulitude78
I have not had to deal with a situation like this, but If you choose to terminate the pregnancy, and you feel that's best, then do what is best for
you. The biggest concern I would think, would be for your health. If you boyfriend is supportive, then definitely continue to lean on him. I would
just be prepared and open to all possibilities. Have you sought or received a second opinion? |
No I have not yet recieved a second opinion. I am pretty much trusting what he is saying at this point, I have dealt with him in the past before and
had no problems. So hopefully all goes well. The situation is just making me nuts and driving me mad. I go back to the dr. in two weeks so hopefully
then we will have a more definite answer or outlook on the situation.
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 03:49 PM |
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| Quote: | Originally posted by Tea_Honey
Like most, I've heard of ectopic pregancies, know they are LIFE-THREATENING to the woman who has one. Reading the OP, I decided to google up some
additional information (and you should too!  ):
Ectopic Pregnancy
JOSIE L. TENORE, M.D., S.M.
Northwestern University Medical School, Chicago, Illinois
Ectopic pregnancy occurs at a rate of 19.7 cases per 1,000 pregnancies in North America and is a leading cause of maternal mortality in the first
trimester. Greater awareness of risk factors and improved technology (biochemical markers and ultrasonography) allow ectopic pregnancy to be
identified before the development of life-threatening events.
Ectopic pregnancy is any pregnancy in which the fertilized ovum implants outside the intrauterine cavity. More than 95 percent of ectopic pregnancies
occur in the fallopian tubes.1 Another 2.5 percent occur in the cornua of the uterus, and the remainder are found in the ovary, cervix or abdominal
cavity.1 Because none of these anatomic sites can accommodate placental attachment or a growing embryo, the potential for rupture and hemorrhage
always exists. A ruptured ectopic pregnancy is a true medical emergency. It is the leading cause of maternal mortality in the first trimester and
accounts for 10 to 15 percent of all maternal deaths.2-4
Modern advances in ultrasound technology and the determination of serum beta-subunit human chorionic gonadotropin (ß-hCG) levels have made it easier
to diagnose ectopic pregnancy. Nonetheless, the diagnosis remains a challenge.
Epidemiology
The number of ectopic pregnancies has increased dramatically in the past few decades. Based on hospital discharge data, the incidence of ectopic
pregnancy has risen from 4.5 cases per 1,000 pregnancies in 19705,6 to 19.7 cases per 1,000 pregnancies in 1992.2 The rise can be attributed partly to
increases in certain risk factors but mostly to improved diagnostics. Some ectopic pregnancies detected today, for instance, would have spontaneously
resolved without detection or intervention in the past. Ectopic pregnancy is more often detected in women over 35 years of age and in non-white
ethnic groups.1
Ruptured ectopic pregnancy is the leading cause of maternal mortality in the first trimester and accounts for 10 to 15 percent of all maternal
deaths.
The case-fatality rate has declined from 35.5 maternal deaths per 10,000 ectopic pregnancies in 1970 to only 3.8 maternal deaths per 10,000 ectopic
pregnancies in 1989.6 Even though overall survival has increased, the risk of death associated with ectopic pregnancy remains higher among black
and other non-white minority women.
Risk Factors
Several factors increase the risk of ectopic pregnancy (Table 1). These risk factors share a common mechanism of action--namely, interference with
fallopian tube function. Normally, an egg is fertilized in the fallopian tube and then travels down the tube to the implantation site. Any mechanism
that interferes with the normal function of the fallopian tube during this process increases the risk of ectopic pregnancy. The mechanism can be
anatomic (e.g., scarring that blocks transport of the egg) or functional (e.g., impaired tubal mobility).
In the general population, pelvic inflammatory disease is the most common risk factor for ectopic pregnancy. Organisms that preferentially attack the
fallopian tubes include Neisseria gonorrhoeae, Chlamydia trachomatis and mixed aerobes and anaerobes. Unlike mixed aerobes and anaerobes, N.
gonorrhoeae and C. trachomatis can produce silent infections. In women with these infections, even early treatment does not necessarily prevent tubal
damage.7
Previous ectopic pregnancy becomes a more significant risk factor with each successive occurrence. With one previous ectopic pregnancy treated by
linear salpingostomy, the recurrence rate ranges from 15 to 20 percent, depending on the integrity of the contralateral tube.1,9 Two previous ectopic
pregnancies increase the risk of recurrence to 32 percent, although an intervening intrauterine pregnancy lowers this rate.1,10
Cigarette smoking has an independent and dose-related effect on the risk of ectopic pregnancy. Cigarette smoking is known to affect ciliary action in
the nasopharynx and respiratory tract. A similar effect may occur within the fallopian tubes.3,12
Multiple sexual partners, early age at first intercourse and vaginal douching are often considered risk factors for ectopic pregnancy. The mechanism
of action for these risk factors is indirect, in that they are markers for the development of sexually transmitted disease, ascending infection, or
both.3,10
Clinical Findings
Recent technologic improvements have made it possible to diagnose ectopic pregnancy earlier. This has altered the clinical presentation from that of a
life-threatening surgical emergency to a less severe constellation of signs and symptoms.
Historically, the hallmark of ectopic pregnancy has been abdominal pain with spotting, usually occurring six to eight weeks after the last normal
menstrual period. This remains the most common presentation of tubal pregnancy in symptomatic patients. Other presentations depend on the location of
the ectopic pregnancy. Less commonly, ectopic pregnancy presents with pain radiating to the shoulder, vaginal bleeding, syncope and/or hypovolemic
shock.
Physical findings include a normal or slightly enlarged uterus, pelvic pain with movement of the cervix and a palpable adnexal mass. Findings such as
hypotension and marked abdominal tenderness with guarding and rebound tenderness suggest a leaking or ruptured ectopic pregnancy. Case reports
indicate that viable abdominal ectopic pregnancies may be discovered at cesarean section, albeit rarely.13
Diagnostic Evaluation
Between 40 and 50 percent of ectopic pregnancies are misdiagnosed at the initial visit to an emergency department.4,14 Failure to identify risk
factors is cited as a common and significant reason for misdiagnosis.4 A proper history and physical examination remain the foundation for initiating
an appropriate work-up that will result in the accurate and timely diagnosis of an ectopic pregnancy.
Identification of risk factors can raise the index of suspicion and lend significance to otherwise minor physical findings. For example, subtle
changes in vital signs, such as mild tachycardia or lower than usual blood pressure, should prompt further investigation. Scoring systems have been
proposed to facilitate earlier diagnosis of ectopic pregnancy by indicating the level of risk as a function of weighted risk factors.15
Biochemical Markers
After a careful history and physical examination, ancillary studies may include a urine pregnancy test and determination of the serum progesterone
level and serum quantitative ß-hCG levels. Other chemical markers, such as creatine kinase16,17 and fetal fibronectin levels,18 have been investigated
and rejected because of inadequate diagnostic sensitivity.
Compared with abdominal ultrasonography, transvaginal ultrasonography diagnoses intrauterine pregnancies an average of one week earlier because it is
more sensitive and has a lower discriminatory zone (i.e., a ß-hCG level between 1,00022 and 1,500 mIU per mL [1,000 and 1,500 IU per L]). An ectopic
pregnancy can be suspected if the transvaginal ultrasound examination does not detect an intrauterine gestational sac when the ß-hCG level is higher
than 1,500 mIU per mL.
Once an ectopic pregnancy has been diagnosed, the patient should be reevaluated clinically. Expectant or medical management may be attempted if the
patient remains stable and is reliable. If the patient's condition deteriorates, surgical management is indicated (Figure 3).
Medical Therapy
Earlier diagnosis has made medical management of ectopic pregnancy an option. The potential advantages are the avoidance of surgery and its
concomitant hazards, the preservation of tubal patency and function, and a lower cost. Chemical agents that have been investigated include
hyperosmolar glucose,27,28 urea,28 cytotoxic agents (e.g., methotrexate [Rheumatrex]28 and actinomycin), prostaglandins28 and mifeproston
(RU486).28
The most studied of these agents is methotrexate, a folic acid antagonist that is metabolized in the liver and excreted in the kidney. Methotrexate
inhibits the synthesis of purines and pyrimidines. Thus, it interferes with DNA synthesis and cell multiplication. Rapidly dividing cells are most
vulnerable to methotrexate. This accounts for the drug's effect on trophoblastic tissue, as well as its side effects on the buccal and intestinal
mucosa, urinary bladder, bone marrow and skin.
Although the potential for serious toxic effects exists, the low dosages of methotrexate that are used in patients with ectopic pregnancies generally
cause only mild, self-limited reactions. Common side effects include nausea and vomiting, urinary frequency and mild diarrhea. Thus, when the
diagnosis is certain and an ectopic mass is less than 3.5 cm in greatest dimension, methotrexate therapy is an option.
Surgery
Previously, salpingectomy by laparotomy was the gold standard for the treatment of ectopic pregnancy. The laparoscope has virtually eliminated the
need for laparotomy. Currently, laparotomy is the preferred technique when the patient is hemodynamically unstable, the surgeon has not been trained
in laparoscopy, physical facilities and supplies to perform laparoscopic surgery are lacking or technical barriers to laparoscopy are present.
Salpingectomy is used much less often than salpingostomy. It is preferred only in patients with uncontrolled bleeding, extensive tubal damage or
recurrent ectopic pregnancy in the same tube. It is also used when the patient wants a sterilization procedure to be performed.
Heterotopic Pregnancy
Any discussion of ectopic pregnancy would be incomplete without mention of heterotopic pregnancy (coexistence of intrauterine and ectopic
pregnancies). In Europe and the United States, this condition occurs in one of 2,600 pregnancies.34 With fertility treatments, the incidence of
heterotopic pregnancy increases to as high as 3 percent.34 Heterotopic pregnancy is extremely difficult to diagnose, and 50 percent of cases are
identified only after tubal rupture. If retention of the intrauterine gestation is desired, the ectopic pregnancy must be treated surgically.1,12
http://www.skweezer.com/s-0ectopic+pregnancy.aspx/-/www~aafp~org/afp/20000215...
btw, do not let other people's prejudices and buttinski morality concerning YOUR body sway you in deciding whether you wish to continue with the
pregnancy which can result in YOUR death. If the doctors are correct - and that is IF they are correct.... I'm with Soul, get a second opinion - the
fertilized egg (it is NOT a baby) is in your fallopian tubes. A fallopian tube is about 3.9 inches long, and at its widest, approximately 1/3 of an
INCH wide (.39"). No "baby" can fit into a 3-4 inch long tube that is less than one inch wide.
So my suggestion to you is to 1) do your OWN research, and 2) get a second opinion. Good luck and God bless. |
Awesome information! Thanks so much, I have been reading things here and there, but I never came across this information, it was very informative. I
really appreciate it!
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 03:58 PM |
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| Quote: | Originally posted by deep_thinker
My opinion is that: if this is a life-threatening pregnancy then you might want to terminate the pregnancy and try again soon. If you
are excited about having a child I suspect part of that excitement has to do with being there to experience that child's life - which may not happen
considering the circumstances. And if this was an unplanned pregnancy I understand the emotional connection that you might have with your unborn but
are you really ready to have a child and/or risk your life having a child you didn't even plan/prepare for?
Again, this is just my opinion - I believe that all women should have the right to terminate a pregnancy if bringing a child into the
world is not the right option for them due to the specific circumstances. And no one can make that determination but you. |
I don't believe in abortion per say, but I have never been put in this type of situation. I guess I am like in a position to where if this is an
ectopic pregnancy let's just do the procedure and get it over with, but if not, let me do the right things to get prepared. No this was not planned,
but I will welcome this new life into my life with open arms.
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 04:03 PM |
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| Quote: | Originally posted by Confucius08
| Quote: | Originally posted by soulitude78
I have not had to deal with a situation like this, but If you choose to terminate the pregnancy, and you feel that's best, then do what is best for
you. The biggest concern I would think, would be for your health. If you boyfriend is supportive, then definitely continue to lean on him. I would
just be prepared and open to all possibilities. Have you sought or received a second opinion? |
I am in agreement. Please get a second opinion. I have you on my prayer list, I couldn't imagine what your feeling.
In my personal opinion (and my opinion is all it is)...please look at all options, from my understanding, no live baby will come from your condition
so abortion may be the only option for this to preserve your health. But this is my opinion. |
Like I mentioned earlier, I have an appointment in two weeks, and hopefully we will have more definite answers when those results come in. Thanks for
keeping me in your prayers!
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 04:08 PM |
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| Quote: | Originally posted by deep_thinker
She did say they thought she'd be able to have it. How would that be possible? Would they have to surgically remove and re-place the fetus?
Either way, getting a second opinion is sound advice. |
Okay hopefully I can clear this up better than I did before in the first post. I was told that I might have a possible ectopic pregnancy, but I will
need to continue to have beta hcg test and ultrasounds to see where the development is happening. The first ultrasound did not show any growth, and my
beta hcg levels were at 100. So it was showing that I was pregnant through the hcg levels, but the ultrasound was showing no gestational sac. On the
second ultrasound only eight days later, it showed that a gestational sac might be present, still early to see. But my hcg levels had risen. Right
now, well as of Wednesday, my hcg levels were at 1400. So those are picking up, but he ultrasound is not really showing much growth in the uterus.
I am being told that we have to wait and see it is still early.
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 04:12 PM |
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| Quote: | Originally posted by Tea_Honey
| Quote: | Originally posted by deep_thinker
She did say they thought she'd be able to have it. How would that be possible? Would they have to surgically remove and re-place the fetus?
Either way, getting a second opinion is sound advice. |
This is why I agreed with Soulitude that she should get a second opinion. You can't have an ectopic baby. Every one I've ever heard of had to be
terminated or it burst inside the woman's body.
According to the article I copied and pasted, 40% to 50% of doctors in the ER MIS-diagnose ectopic pregnancies. It also says something about most
doctors aren't sure about the best way to handle such a pregnancy - surgically (abort) or through administering drugs that will abort (for the
details, click on the link. I was trying for laymen's info, not to confuse with the "details" of the types of surgeries, the percentages of the
best drugs, etc.).
At any rate, just from what I heard growing up, I felt there was something "odd" about the doctors saying she "might" be able to deliver the baby.
No one delivers an ectopic baby! So I was seriously wondering if maybe she misunderstood (not to talk around you Ms Shy; just answering Deep
Thinker's post), or if it is truly an ectopic situation in the first place. 
P.S.
BTW, that's not a fetus in her tube. It's a collection of dividing (growing) cells. Fetuses are too big to fit in a 1/3 of an inch space.
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No no, you are fine. I mean he said that I might be able to have the baby, meaning it might not be an ectopic pregnancy, but the early ultrasound said
it is a possible ectopic pregnancy. Do you kind of see where I am coming from?
My hcg levels started real low, but they are slowly rising. He has me so confused, but I am not a doctor, and I have been looking at different over
the net, but you know he has the medical degree not me.
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 04:20 PM |
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| Quote: | Originally posted by VAGurl
I had an ectopic pregnancy, well actually two, the first one if hadn't gotten to the hospital when I did it could have been serious they rolled me
right to surgery that night. The second one I found out about early because I had been trying to get pregnant for 5 years. Unfortunately there is
not way to "move" the embryo so there are only three choices D&C, then there is a medication (I forget the name) that you have to take to terminate
pregnancy and the worse case scenrio laproscopic surgery. I know because I had to do all three because the lil angel I was carrying was stubborn
after the first two procedures they still kept getting a heartbeat. My mom even kept questioning the doctors hoping and praying that there was more
that could be done to save the baby because she knew how bad I wanted it.
I'm going to be honest with you, you're going to be on an emotional roller coaster it's been two years for me and I still have my moments of
"ifs". I cried myself to sleep many a nights with hubby just hugging not saying a word. You're definitely going to need a really strong support
system right now and for the days to come. Sorry if this seemed to be too much but there's no need to sugar coated it you need to know what lays
ahead.
You will definitely be in my prayers and I hope that things will work out for the good for you. If you want to talk more you can u2u me.
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Wow, thanks! And I will be sure to keep that mind. I appreciate you reaching out to me, it means a whole lot. 
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 04:26 PM |
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| Quote: | Originally posted by Diamond
I'm surprised it's taking 2 weeks for a definitive diagnosis...esp via an ultrasound..nowadays...either they see it in the uterus...or they
don't...
maybe i read this wrong...let me re-read it...
My heart goes out to you with the "not knowing" for sure that doc's can put a woman thru...they do have to make sure though...But I do understand
the wait on some important news like this is painful...
My prayers going out to you... |
I know I hate the wait. And everytime I am about to leave the dr.'s office, he tells me "if you feel any pain or have spotting go to the er
immediately". That alone shakes me up and makes me want to stay home. Thank god I stay maybe two minutes from the hospital and work about five
minutes away from one. But yeah I have a few ultrasounds and you would think I would find out something sooner, but now, things are not moving as
quickly as I would have hoped.
I have been having the transvaginal ultrasounds and I have never had to have that before, that alone is freaking me out. Still there is nothing more
coming from this, but patience on my part and the hope that things will get better.
It is what it is.
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Ms_Shy
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| posted on 6.19.2009 at 04:29 PM |
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| Quote: | Originally posted by VAGurl
My nerves for terrible I spent every night praying, crying and talking to my lil angel trying to covince it to move to were it was supposed to be.
Ms. Shy you have to let us know when you find out something my heart is hurting for you right now. |
My next appointment is July 1, I will let you guys know something as soon as possible. And you know it is funny how you are never aware of certain
things until you are in that situation. Thanks to all you guys, I really appreciate the love CL!!!!
It is what it is.
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Ms_Shy
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| posted on 7.6.2009 at 05:59 PM |
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Okay, I am late, but here is the update:
I AM HAVING A BABY! It is not an ectopic pregnancy, the baby is in the right place as far as we can see. I am currently six weeks pregnant. I must
have found out I was pregnant like as soon as I concieved. I guess we had been trying for so long that it took me by surprise when it happened.
When I say my cycle was on time it was on time, so the day it was supposed to surface and it didn't I went out and got a test. I waited a couple of
days and then it came, a positive test. I went to the doctor the next week and started the process from there.
Thank you guys for all of your prayers and hopefully all goes well, and it will be nothing but good news from here. If you guys have any questions, I
check in as often as I can.
Thank everyone again for being so supportive! I hope you all will continue to be blessed, I appreciate you guys. You are truly a group of awesome
women.
It is what it is.
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NyssaHoney
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| posted on 7.8.2009 at 02:37 PM |
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Glad everything is working out for you!
"Marriage is a lasting climax on top of a great relationship"
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