Ectopic Pregnancy Signs and Symptoms

If you find yourself reading this blog post, it’s probably for one of the following two reasons:

  1. You’re my friend or follower and you usually read my blog (Hello again, thanks for reading!)
  2. You found me on Google or some other forum because you fear that you (or your partner) may be experiencing an ectopic pregnancy. If this is you, I first want to say that I am deeply sorry. I hope that the information I share in this blog post can provide some clarity on what is happening to you right now.

Ectopic pregnancy (called EP for short) is a potentially dangerous condition that occurs when the baby is growing outside of the womb. If the ectopic pregnancy ruptures, it is a serious, life-threatening medical emergency that must be surgically treated right away.

I think every woman who is considering becoming pregnant needs to know about the [albeit rare] possibility of having an ectopic. Only 1-2% of pregnancies are ectopic, so statistically speaking, it’s probably not something you’ll ever have to worry about! To put it in perspective, you actually have a better chance of conceiving twins than you do having an EP. The overwhelming majority (98-99%) of pregnancies are NOT ectopic. However, there is still that small subset of women who will experience an EP. And although it feels like it could never happen to you, always remember that it could happen to you. So, you should be equipped, informed, and empowered. That’s why I’m writing this blog.

Having just gone through my own ectopic pregnancy experience, I hope that the things I learned can help you.

 

 

What is an Ectopic Pregnancy?

The word ectopic is Latin for “out of place”. So in the most basic terms, an ectopic pregnancy is simply a pregnancy that does not occur in the right place. The only place that a baby can grow and survive before birth is in the mother’s womb. Normally, the egg and sperm meet in the Fallopian Tube and then the fertilized egg travels down the tube to implant in the uterus. In an EP, the fertilized egg gets “stuck” in the tube (or otherwise finds itself in a place it does not belong) and begins to grow. It’s an unbelievably unfortunate accident that almost always results the death of the baby because it can’t get all the nutritional support it needs to survive.

The vast majority of EPs happen in the Fallopian Tube, you may have heard it referred to as a ‘tubal pregnancy’. EPs can also happen in the ovary, cervix, and even in the abdomen, but this is far less common.

About 80% of EPs are discovered before the tube ruptures. Some doctors choose to do what is called ‘watchful waiting’ or ‘expectant management’, in which they just let the body do it’s thing and wait for the EP to resolve itself. Sadly, most babies will die on their own and the mother will miscarry because the embryo can’t get the nourishment it needs. Ectopics can also be treated with an injectable drug called methotrexate which terminates the pregnancy and causes her to miscarry.

Unfortunately, medical science has not yet found a way to transfer an EP safely into the mother’s womb where it belongs.

In about 20% of cases, an EP is not detected before the tube ruptures. The mother may be unaware that the pregnancy is non-viable, and the baby keeps growing until it stretches the tube to a maximal point, at which the tube begins to tear and eventually burst. This can cause massive internal bleeding, which is why ectopic pregnancies are no joke. A ruptured ectopic pregnancy can. kill. you. if you don’t get help. With the advent of medical technology and blood transfusions though, expectant mothers with a ruptured EP generally have a good prognosis after treatment.

 

 

What puts you at risk for developing an Ectopic Pregnancy?

Anyone can have an EP, but there are certain things that put you at greater risk:

  • Endometriosis
  • Fertility Treatments – taking fertility medications and/or using assisted reproductive technology like IVF or IUI
  • Advanced Maternal Age
  • Smoking
  • History of Pelvic Inflammatory Disease
  • History of Abdominal/Pelvic Surgery
  • Previous Ectopic Pregnancy

I had several of these risk factors under my belt already, and now that I’ve experienced an EP my risk for another one has gone up even higher. You should know what the risk factors are and talk to your doctor about what this means for you. If you fall pregnant and have several risk factors for ectopic pregnancy, make an appointment with your doctor for an early scan and ask them for serial Hcg levels (repeated every 48 hours). You should be closely monitored until it is confirmed that the pregnancy is not an ectopic.

 

 

What are the signs of Ectopic Pregnancy?

Let me start by stating the obvious, everyone is different. Just because you have these symptoms does NOT mean that you for sure have an ectopic pregnancy. Also, you may have an EP and not experience any of the symptoms I’ve listed below. The key is knowing your body and discerning what’s normal or abnormal for you. For the most part, my EP was pretty textbook. I broke each of my symptoms down a little just to give more insight into my experience. The signs and symptoms I had before my tube ruptured were:

  1. Vaginal Bleeding – I had bleeding the whole time that I was pregnant. People kept telling me “bleeding in early pregnancy can be normal”, and I know that this is true for some. But in my case, with this pregnancy, the bleeding was not normal. It was a warning. Most days it was just spotting..mostly brown, sometimes pink, definitely controlled with a liner. For about a day or two the flow was moderate and bright red – more than spotting, but not as heavy as a normal period. Then it turned back to light spotting and eventually tapered off. Anytime you have bleeding during pregnancy it’s safe to just go get it checked out!
  2. Lower Back Cramps – This started happening about 3 or 4 days before my tube ruptured. I was using a heating pad and trying to avoid medications to protect the pregnancy, but eventually used Tylenol to help with the pain. At the time it was hard for me to tell whether this was an early pregnancy symptom or  not.
  3. Low Progesterone – Progesterone is a hormone that helps regulate your cycle and maintain pregnancy. Medical science seems to be ambiguous as far as the causal relationship between progesterone and ectopic pregnancy. Some sources say that low progesterone may be a cause of an ectopic (or otherwise non-viable) pregnancy, while other sources say that low progesterone is a sign of an ectopic pregnancy. Basically, it’s unclear as to what comes first: is your progesterone low because you have an EP? Or do you have an EP because your progesterone is low? Either way, there is a definite correlation between serum progesterone levels and ectopic pregnancy. Progesterone is not a routine prenatal lab so you’ll probably have to ask for it to be done if you suspect reason for it. I had my progesterone drawn in the ER about a week or so before finding out I had an EP and it was extremely low.
  4. Low Hcg – Okay so my Hcg levels were doubling every 48 hours initially, right on target. As time went on though, they kept going up but weren’t rising as fast as they were supposed to. This is called ‘slow-rising Hcg’. It was concerning and I really should’ve been more closely monitored by my gynecologist because of it, especially considering that my ultrasounds showed no evidence of an intrauterine pregnancy at a point where something should’ve been visible. Unfortunately, early pregnancy is tricky that way because not everyone follows the “textbook” pattern, making it difficult to diagnose when something is wrong as opposed to just a deviation from “the norm”.

 

The morning that my Fallopian Tube ruptured I experienced:

  1. Severe, Localized Abdominal Pain – It started off as a sharp pain in my right lower tummy, and over time the pain gradually spread throughout my abdomen and pelvis. It happened very suddenly; I was sitting in bed doing nothing and then BOOM, I was doubled over in pain. I would describe the pain as severe, I felt like I couldn’t move. It was quite literally the worst pain I’ve ever felt. I have ruptured several ovarian cysts, endometriosis causes me pretty bad menstrual pain, I have like 6 tattoos..but this pain was borderline unbearable. Also, it was waxing and waning, meaning that it randomly got worse and then a little better..and then worse again and then a little better. But the underlying pain was always there.
  2. Shoulder Pain – I told the paramedics that I had burning shoulder pain, and one of them told me that it was probably because of anxiety and that I should just calm down. In reality, shoulder pain can be a sign of internal bleeding caused by blood in your abdomen irritating the nerves that control your diaphragm.
  3. Syncopal or Near Syncopal Episode – Syncope means “passing out” or fainting. I’ve never passed out before so these symptoms really freaked me out. My hands were shaking and I was super dizzy. I started grabbing at everything around me because I could barely hold myself up. Then suddenly my vision was blurred, I became extremely nauseous, hot, and sweaty, and then cold and clammy. My poor husband was so scared and helpless, all he could do was hold me up and try to keep me awake while we waited for the ambulance.
  4. Symptoms of Shock – Once I arrived to the ER, things went from bad to worse. My heart rate went up to 130, my blood pressure dropped as low as 90/50, I felt really weak, sweaty, and mentally I was completely out of it. My body was going into shock from the blood loss and I knew I was extremely ill. At this point they were still running tests and stuff trying to figure out what was going on but I seriously thought I was dying. I had my husband make calls to our family to inform them of what was happening.

 

 

Why am I going through all of these lengthy details? 

Ectopic Pregnancies can be tricky to diagnose. In the weeks leading up to my hospitalization, I went to my gynecologist twice and had even made a trip to the ER because of the symptoms I was having. I had several ultrasounds and my blood work was done each time.

All three times I was sent home.

The paramedics didn’t take me seriously either, and it’s literally their job to recognize life-threatening emergencies. After I explained my symptoms to them and told them that I was 7 weeks pregnant, one of them (a woman) said to me “I had cramping and bleeding with my son. He’s 6 years old now and perfectly healthy; so there’s probably nothing wrong with you”.

I could smell the stench of arrogance from across the room. She was so condescending and I wanted so badly for her to stop talking, but she wouldn’t shut up.

“It’s just a little cramping honey, you should really just calm down. Your shoulder pain is most likely due to anxiety”.

I’m pretty sure she could see the steam coming from my head at that point.

She went on to say that the ambulance could “give me a ride” to the ER if I felt like I really needed to go, but that I shouldn’t expect immediate answers because I was so early in my pregnancy. I even told her that I was concerned about the pregnancy being ectopic and she was still completely dismissive. She literally tried to convince me that it was all in my head.

And to be honest, she almost did.

First of all I never in a million years thought that this would happen to me. Even with me having several risk factors, I just didn’t think it would happen. Not to mention, I really didn’t think I’d loose two babies in a row. That was out of the question.

Also, I think as women we tend to try and be tough when it comes to pain. Speaking for myself, I think it may stem from a fear of coming across as melodramatic. I don’t want to appear weak, I want to look strong. I want to be strong. Plus I didn’t want to feel stupid if it turned out that nothing was even wrong with me. But in that moment I had to realize this truth: it takes both strength and wisdom to admit when you might be in trouble.

So, I politely told the paramedic that I would like to be taken to the ER by ambulance because I think that something is wrong. I then went on to explain that I am in medical school and have several years of clinical experience, mostly in emergency medicine. I’m not stupid. It’s not all in my head. And I know what I’m talking about. She was a little less condescending at that point but I could tell she was still skeptical.

Right before I went into surgery my gynecologist looked me square in the eyes and told me that it was a good thing that I came to the Emergency Room when I did. Had I listened to the paramedic and ignored my body, it’s possible I wouldn’t be here to tell you about it today. My husband really looked out for me and pushed me to get help when I didn’t want it. It was his decision to take me to the ER, and his decision to call the ambulance when I wasn’t thinking straight for myself. I lost a baby and I lost a Fallopian tube, but I didn’t loose my life because we acted quickly and got the help I needed!

So, that’s my story. If it’s one thing I want you to take away from all of this, it’s that you have to speak up for yourself.

You must be your own advocate.

Ask for those extra tests. Bring your questions and concerns to someone’s attention. Don’t take ‘no’ for an answer and don’t be scared to be wrong. Most doctors are very great at what they do but they are humans too, and they can make mistakes. I can’t help but think how different this all could have been had my early concerns been investigated more thoroughly.

My incisions are healing up, the bruising on my tummy is starting to go away…but the hole in my heart is still very fresh. Part of me feels like I haven’t fully processed what has happened, it all still feels so surreal. I know that this pregnancy was never truly viable, but to us, it is a devastating loss. We will always remember our unborn child and the joy we shared for the 7 weeks that he or she was with us. And now, 12 days after surgery, the real healing process begins.

 

Everything You Need To Know About A D&C

As if losing a child to miscarriage isn’t hard enough, adding surgery on top of that can be overwhelming for some women. I know it felt that way for me! For those who don’t know my story, I found out at 10 weeks that I miscarried my first child with my husband. My body did not expel the pregnancy on its own; I had what is called a missed miscarriage.

This type of miscarriage means that there are little to no symptoms, the baby just dies and usually the mother doesn’t find out until the next routine ultrasound. The only symptom I had was very light, bright pink discharge, but this was enough to send me to the ER in a panic. That night we found out we had lost the baby; I was supposed to be 10 weeks but he was only measuring at 9 weeks. This meant he had likely already been dead for a week or so, unbeknownst to me. My body held on to the pregnancy – both the tiny placenta and tiny baby remained inside of me – seemingly unphased by the fact that this little life was over now and the pregnancy was no longer viable. So, one week later at 11 weeks “pregnant” I found myself at the hospital having a D&C.

 

What is a D&C?

D&C stands for dilation and curettage; a surgical procedure that is performed to remove the contents of the uterus. The surgery is typically performed when a woman is having intrauterine problems, like an incomplete or missed miscarriage, uterine fibroids, endometriosis, or heavy vaginal bleeding. Dilation is the act of opening your cervix; the “mouth” of the uterus. Curettage is the part where the tissue is removed- usually by suction or by a tool called a curette, which is a small metal tool used to scrape the uterine lining.

 

What happens during a D&C?

During the surgery, you lay on your back and they put your feet up in stirrups  – exactly how it’s done during your yearly lady exam. A speculum is inserted into your vagina to open it, and then your cervix is dilated to access your uterus. The procedure is minimally-invasive, meaning that no cuts have to be made and that everything is done through the natural openings in your body. The surgery is commonly done under general anesthesia (they put you completely under), though sometimes it can also be done with a local anesthetic (they numb the area). It’s usually completed in less than 20 minutes, you have to wait around for a few hours, and then usually you get to go home. Just make sure you have someone to drive you! Depending on the circumstance, some of the extracted fetal tissue may be sent to labs for examination but in my case, the tissue was not tested. They may do this for recurrent miscarriages or at the family’s request.

 

How do you feel initially after the D&C?

Waking up from the surgery, the first person I saw was my husband, which was the most comforting thing. But I also remember feeling

  • Sad
  • Tired and Groggy (from the anesthesia and from the pain medicine)
  • Tender and Sore
  • Thirsty
  • Nauseous and
  • Angry

I barely remember anything any of the doctors or nurses said to me that day. But I will always remember how I felt.

How was the recovery after the procedure?

Physically, recovery was a little painful but definitely manageable. I stayed in bed for a couple days and after that I was up and about, but my activity was restricted. I could not exercise, be submerged in water (no pools, hot tubs, bubble baths, etc.), lift anything heavy, wear tampons, have sex with my husband, or do any other vigorous activity for 4 weeks.  Other than that, it was back to class and studying as “usual”.

My Gyn did prescribe Misoprostol, which is a medicine I took after the D&C that is used to stimulate contraction of the uterus. This is not required of everyone that has a miscarriage and I hated that I had to take it myself, but if it is indicated by your doctor then I advocate following their advice. They usually have you take it if you have retained some fetal tissue, it helps to expel everything and prevent infection. But please be aware: This same medicine can also be used to induce labor. It was painful. It was extremely bloody. It was draining. My doctor also prescribed Ibuprofen and Tylenol with Codeine though, so I was able to stay ahead of the pain and keep it managed… it was like bad menstrual cramps with a very painful contraction thrown in here and there.

For a week or so after the surgery, I had to sleep on a bath towel and set alarms throughout the night to wake up and change my pad. There was A LOT of blood. One day while at school the bleeding was so bad that I contemplated going to the ER; I was soaking a pad every half hour for about 3 hours straight, and passing huge clots. In between classes I went to the bathroom and had a big contraction while squatting over the toilet. I passed a clot, and then some tissue literally the size of the palm of my hand fell onto the bathroom stall floor – the pain from the contraction was so bad that I winced and subsequently missed the bowl. I had to clean blood off the floor and the side of the toilet bowl before heading back to class. Still haven’t gone back in that bathroom.

I was SO frustrated that I had to go through this after the D&C. It seemed unfair that the miscarriage was dragging on for this long. But, I have to imagine that had I not had the D&C, there wold have been much more blood and pain than I could handle going through the miscarriage naturally. Possibly even an infection. So ultimately the procedure was worth it for me as the physical pain was manageable; it was the emotional pain that was far worse.

 

How long after the procedure does it take to get your period? What was that like?

It took exactly 5 weeks and 4 days from the day of the D&C for me to get my first period. Textbook is anywhere from 4-6 weeks, but of course that varies from woman to woman. If you go longer than 7 weeks I’d call your doctor; not because it means there is something wrong…but just for your sanity. That first period was bittersweet. Bitter because it really put the nail in the coffin for me (no pun intended). I hadn’t had a period since November and my first period post-miscarriage was in March, so reality really set in that this baby was gone and I was no longer pregnant. It sucked. But the “sweet” aspect was that I felt like my body was finally getting back to normal. Having a period was a good thing! Even though it kicked my butt and hit me like a ton of bricks, it meant things were functioning the way they were supposed to in there and I could finally move forward physically with recovery. 🙂

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Just make sure Dr. Love isn’t your gynecologist and you should definitely survive your D&C 🙂

All in all, the D&C was an effective way to complete my miscarriage when my body wouldn’t do it on it’s own. If you have any questions about my experience with the procedure feel free to comment below or shoot me an email!

How was your experience with D&C? Did you have to help nurse your partner back to health after the surgery? Are you a little less nervous about your upcoming procedure after reading this? Let me know! 🙂

 

 

xoxo

 

-N