QuestionHi doctor, could you please give me some point of wiew about my case:
I was in a hospital in Europe and had a threat of ectopic pregnancy (levels 6300)a doctor said surgery next morning, next morning another doctor changed this in probably normal missgarriage without getting the result of the blood clout that came down in the night, they gave me MISOPROSTAL in the evening ??? Would you have done that with still possibility of ectopic pregnancy ?? next I was in surgery and ofcourse it was ectopic pregnancy!!! 1 year later I still could not have baby (have 1 before all of this) and I was put in Laparascopic where the liquid could not get through !!! but the ends were looking fine. I was then send to a HSG and there everything was judged as normal open tubes !!!! My question is which surgery or method is more reliable and is MISOPROSTAL under thes circumstances giving at any time without have a result from tests in your hand ???
Many thanks for your time
best regards
Monica
AnswerHello Monica from Spain,
I surely would have treated you differently.
There are criteria that we use to suspect an ectopic pregnancy. The main criteria is if the bHCG level is above 3000 and there is no pregnancy within the uterus, then a diagnosis of ectopic pregnancy is made. In that case, there are two possible treatments: medicinal or surgical. Now a days, if the ectopic is not too far along, we can use a medication called Methotrexate (an injection) that will stop the pregnancy and cause the ectopic to resolve on its own. This will not work if the ectopic is too big. Misoprostol is used to induce a miscarriage. If the ectopic is too big, then surgery will be required and this is usually done by laparoscopy.
In terms of evaluating the tubes afterward, the usual first step is HSG. This is the more reliable test. Injection of the tubes at the time of laparoscopy does not always work, so a followup HSG would be required as in your case. If the HSG showed that both tubes are open, then the tubes are open. However, you must bear in mind that the tubes are a working organ and being open is only one part of the whole equation. The fact that you had an ectopic pregnancy means that there is some type of damage that occurred in the past and caused scar tissue formation within the tube. The scar tissue was not severe enough to block the tube but was adequate to cause the embryo to get stuck in the tube. When one tube is damaged, you have to assume that the other is damaged as well. In an HSG, the tubes would be open but the scar tissue cannot be seen. There is no technology to do that. So, you are at increased risk of another ectopic pregnancy and need to be seen and evaluated as soon as you miss a period. The only treatment option that can bypass the tubes and reduce the risk of an ectopic is IVF.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
