On Tuesday, May 22, much to my surprise, I found out I was pregnant again. This came as a huge shock because we had started trying to become pregnant back in May of 2011 and it wasn't until January that we finally became successful. When that pregnancy ended in loss (suspected ectopic, diagnosed due to abnormally rising and falling hcg levels and I was given methotrexate to dissolve the pregnancy cells) I assumed it would take us a while before becoming successful again. I guess I was wrong.
So, due to the previous ectopic plus another miscarriage prior to that in my history, my OB's office wanted to closely monitor my hormone levels to keep an eye out for any problems. They started out low (41 at 14 days past ovulation) but they did rise normally (went on to get levels of 107, 1600, 3216, 6252 etc) so I wasn't afraid of this being another ectopic.
I did start spotting about a week and a half after I found out I was pregnant and had sharp pain on my left side, but my doctor wasn't too worried about it since my hormone levels were rising so nicely, and the pain she thought was probably a corpus leutum cyst on my ovary, which are non threatening. They told me I could come in for an ultrasound just to check things out, whenever I wanted. I asked if she had any preference or recommendation on when to do it and they left it up to me but said that the longer I waited, the more they would be able to see on the ultrasound but kind of encouraging me to wait "as long as I can stand to". Now, when I was pregnant with my son I remember that we saw the heartbeat at 6w3d and it was 125 bpm, so part of me thought I should schedule this ultrasound for that same gestational age (which would have been that Friday), but something kept urging me to make the appointment Thursday....so I made the appointment for then. Being 6w2d I knew it was still possible for it to be too early to see the heartbeat, which would especially be true if the embryo implanted late, (and I thought that might be the case since my hormone levels started out low) but I just really felt like I needed to go in on Thursday.... I thought that the worst thing that could happen would be that there wouldn't be a heartbeat yet and that we'd have to wait another week before we knew if it was a viable pregnancy or not. But I was wrong again, that wasn't the worst thing that could happen that day.
During the external ultrasound, the tech asked me if I'd had any pain on my left side and I had told her yes, a week prior I had, but not since then. I saw she was looking at things on that side but I assumed it was the cyst that the doctor had mentioned since I couldn't really tell what was what on the screen. When she was done with the external ultrasound, she told me to undress from the waist down, left for a few minutes and returned to do the internal exam. When she came back, she mentioned that the Nurse Practitioner wanted to see me when we were done, to discuss the results. I thought that was kind of odd, since we hadn't really seen anything yet, but didn't think too much in to it and was just anxious to get on with the scan. When she was doing the internal ultrasound, she measured the gestational sac and the fetus. It measured at 6w0d (2 days less than I was) but I wasn't worried about it, again just thinking it had implanted later than normal. Then she zoomed in and I saw the flicker on the screen. My face lit up and asked, "Is that the heartbeat?!?!" She said "yes", but with sorrow in her voice. She then went on to tell me that it was not a viable pregnancy and that it was outside of my uterus, on my left side. My heart sank. Immediately I began to sob and couldn't stop. The exam continued for another 5 minutes or more while she finished taking measurements with the probe inside of me and apologized repeatedly, while all I could do is cry. I saw on the screen that my baby had a heartbeat of 120 bpm. It is so hard knowing that the baby was living, there was nothing wrong with it, it was just in the wrong spot. I was devastated.
After the exam we went in a room to meet with my Nurse Practitioner. My clinic's OB was out that day. The NP told me that I had a living ectopic and my hcg was in the 9,000's at my blood draw the day before. She said I needed to come back the next day at 9:20AM to see the OB and that I would probably be sent for methotrexate again. She stressed that if I had any pain at all, to go to the hospital immediately because the risk of rupture was high at that point.
So home I went and after a good long cry, I began to do a little bit of research online. I found that methotrexate is not used when hcg is over 5,000 or if a fetal heartbeat is present. And in talking with two other ladies who had ectopic pregnancies that had reached the point of a fetal heartbeat, they were sent straight to the hospital for surgery that day and were not allowed to even walk and both had the affected fallopian tube removed. I was really surprised I'd been sent home and only told to come back in the case of pain (which would mean rupture and could possibly be life threatening ...but at the very least, incredibly painful) So I called the ER, and after getting bounced around and explaining my situation to three different people, the last person finally found an OB - who advised me to go to the ER right away and not to wait until the next day to be treated.
At the ER, they took more blood from both arms, hooked me up for an IV and waited until the OB they had to finish delivering a baby. While waiting, I learned that my hcg was now > 12,000 and this pregnancy was far past the point of methotrexate. Then I learned doctor was waiting for me in the O.R. They brought me up there and she explained that in cases like mine, that she prefers to remove the whole tube, to ensure that no pregnancy tissue is left behind, (which, if that happened would require Methotrexate, plus scar tissue in the tube that would have an increased risk of future ectopics) but she assured me that many women are perfectly capable of getting pregnant with only one tube. She also said that an egg ovulated from the left ovary can be received by my right fallopian tube. I don't understand how this is true but I guess it happens. Reluctantly/feeling like I didn't have many other options, I agreed. They put me out for surgery, they made 3 incisions in my abdomen and they took my fallopian tube and my baby with a beating heart that was inside of it. The doctor sent home photos of the surgery with my husband and I can plainly see that the tube that had the ectopic was swollen to about 75X the size of the other one, and bleeding had already started around it. She said if I'd have waited, it would have ruptured.
Looking back, I am surprised that they didn't have me go in for the ultrasound as soon as they knew my hcg levels were high enough for there to be something visible on the scan. Then it would have been caught sooner and never would have developed a heartbeat and surgery could have been avoided. I am also very surprised I'd been sent home instead of straight to the hospital. Had I not done my own research and been my own advocate, my tube would have ruptured. Lastly, I really wish I'd of asked to have an HSG done after my first ectopic, because then this may have been prevented completely. :(
It's been 4 days and I go through phases of different emotions. Hurt, angry, scared, numb... It changes from one minute to the next. I really wish I were one of the women who becomes pregnant easily and stays that way. To me, when I get a positive pregnancy test, excitement is not the dominant emotion. Instead it brings fear & anxiety more than anything. Three out of four of my pregnancies have ended in loss and enjoying a pregnancy, I think will be impossible for me. I really worry about the chances of me having a successful pregnancy in the future and fear that it may not be in the cards for us.
To top things off, I usually work out in order to work off frustrations or emotions. Now in this time of major emotional pain, I can't do much of anything without hurting myself due recovering from the surgery. So I sit and think.. about how much I hate this and wish it were different. I also made the mistake of telling our son I was pregnant again. He has been asking for a sibling forever. When I told him that the baby went to heaven, he asked me if Jesus and God would put the baby back in my belly. If only he knew how much I wished that were possible.
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