Patients should be informed that expectant management is more than 90% effective. Bed rest does not improve outcomes, and there is insufficient evidence supporting the use of progestins. People who are older at the time of pregnancy also have an increased risk of ectopic pregnancy. Almost all ectopic pregnanciesmore than 90%occur in a fallopian tube. Ask your ob-gyn or other health care professional to recommend a counselor. Assisted Reproductive Technology: A group of infertility treatments in which an egg is fertilized with a sperm outside the body; the fertilized egg then is transferred to the uterus. Search dates: October 26, 2018, through January 14, 2020. This can be a life-threatening emergency that needs immediate surgery. You will have careful follow-up over time until hCG is no longer found in your blood. However, since they may go on to develop severe complications, they also require urgent medical attention. It often begins as a colicky abdominal or pelvic pain that is localized to one side as the pregnancy distends the fallopian tube. There is insufficient evidence to support the use of progestin for the prevention of early pregnancy loss.3,18 Bed rest does not improve outcomes and may cause psychological harm in patients with subsequent early pregnancy loss.19 Patients should be reassured that nothing they did caused the bleeding. The clinical diagnosis of ectopic pregnancy is based on a combination of serum quantitative human chorionic gonadotropin levels and transvaginal ultrasound findings. Levels of this hormone increase during pregnancy. If chorionic villi are seen, further workup is unnecessary, and exposure to methotrexate can be avoided(Figure 1).5,1517,21 If chorionic villi are not seen after uterine aspiration, it is imperative to initiate treatment for ectopic pregnancy or repeat -hCG measurement in 24 hours to ensure at least a 50% decrease. For this test, a wandlike device is placed into your vagina. A discriminatory -hCG level as high as 3,500 mIU per mL (3,500 IU per L) should be used when a woman wishes to avoid unnecessary intervention in a potentially viable intrauterine pregnancy. 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. It is not intended as a statement of the standard of care. A combination of -hCG level greater than the discriminatory level and ultrasonography that does not show an intrauterine pregnancy should raise concern for early pregnancy loss or an ectopic . However, if a persons hCG level is rising slowly or decreasing, this suggests that the pregnancy may be ectopic. Mayo Clinic is a not-for-profit organization. Very early in pregnancy, the embryo can grow within the fallopian tube without causing any symptoms. Early blood tests are recommended for all women who've had an ectopic pregnancy. Theres some overlap between the possible trends in hCG levels for normal and ectopic pregnancies. Pain and heavy bleeding are associated with an increased risk of early pregnancy loss. Advertising revenue supports our not-for-profit mission. A combination of -hCG level greater than the discriminatory level and ultrasonography that does not show an intrauterine pregnancy should raise concern for early pregnancy loss or an ectopic pregnancy.5 The discriminatory zone was previously defined as a -hCG level of 1,000 to 2,000 mIU per mL (1,000 to 2,000 IU per L); however, this cutoff can miss some intrauterine pregnancies that do not become apparent until a slightly higher -hCG level is achieved. In: Williams Obstetrics. It offers current information and opinions related to women's health. 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. Ectopic pregnancies remain an important cause of morbidity and mortality in women of reproductive age. 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. In Vitro Fertilization (IVF): A procedure in which an egg is removed from a womans ovary, fertilized in a laboratory with the mans sperm, and then transferred to the womans uterus to achieve a pregnancy. Rho(D) immune globulin can also be administered within 72 hours of early pregnancy loss, especially later in the first trimester, although the risk of alloimmunization is estimated to be 1.5% to 2% in this setting.12 There is insufficient evidence for or against the use of Rho(D) immune globulin in Rh-negative patients who present with threatened abortion. 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]). Symptoms may include the following: Sudden, severe pain in the abdomen or pelvis. The pain may become more generalized once the tube ruptures and hemoperitoneum develops. Some experience a small amount of vaginal bleeding or spotting, but others dont. Recognize the loss, and give yourself time to grieve. Tulandi T. Ectopic pregnancy: Clinical manifestations and diagnosis. As your pregnancy progresses, the hCG level increase slows down significantly. Setting a low -HCG cutoff value increases the sensitivity of ultrasound and -hCG at diagnosing an ectopic . The embryologic events of early pregnancy occur in a predictable, stepwise fashion. 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. Signs of ectopic pregnancy (e.g., adnexal mass, fluid in the cul-de-sac) can be seen on ultrasonography well below the discriminatory level. By approximately 10 weeks' gestation, the -hCG level typically plateaus or decreases, after which serial ultrasonography is the preferred diagnostic tool.11, Rh factor testing should be performed if Rh status is not known at the time of presentation. The rate of early pregnancy loss is approximately 11% after a live fetus has been detected on ultrasonography.17 The risk of early pregnancy loss is increased when subchorionic hemorrhage (Figure 36 ) and bleeding are present. You may continue to feel pregnant for a while. Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. For symptomatic women with a viable intrauterine pregnancy, initial -hCG levels of less than 1,500 mIU per mL, 1,500 to 3,000 mIU per mL, or more than 3,000 mIU per mL will increase over 48 hours by at least 49%, 40%, or 33%, respectively.10 A slower rate of increase suggests early pregnancy loss or ectopic pregnancy. health information, we will treat all of that information as protected health Review/update the Uterine aspiration should be considered to evaluate for intrauterine chorionic villi in patients with a pregnancy of unknown location. 2015;112(41). Sound waves from the transducer create images of the uterus, ovaries and fallopian tubes. Expectant management, medical management, and uterine aspiration are safe methods for treating anembryonic gestations and fetal demise. In an ectopic pregnancy, the hCG level may increase less than 66% in 48 hours. The fertilized egg travels through the fallopian tube and into the uterus, where it attaches to the uterine wall. An hCG level between 6 and 24 mIU/mL is considered a grey area, and you'll likely need to be retested to see if your levels rise to confirm a pregnancy. Did you notice anything unusual about it? information highlighted below and resubmit the form. Accessed Dec. 29, 2017. This process is called implantation.. Other signs may include: At this stage, it may be hard to know if you are experiencing a typical pregnancy or an ectopic pregnancy. Online forums also can be a place to get support from other women who have had ectopic pregnancies. Pregnancy that develops outside the uterus is called ectopic pregnancy. At first, an ectopic pregnancy may feel like a typical pregnancy with some of the same signs, such as a missed menstrual period, tender breasts, or an upset stomach. It's a dangerous and life-threatening condition, as it may cause the fallopian tube to. Once you have had an ectopic pregnancy, you are at higher risk of having another one. Patients should be asked about pain and the amount of bleeding. In addition, your physician may do a culdocentesis, which is a procedure that involves inserting a needle into the very top of the vagina, behind . 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). A speculum examination can help identify nonobstetric causes of bleeding, such as vaginitis, cervicitis, or a cervical polyp. I've had two ultrasounds: one at about five weeks and one at six weeks. The discriminatory level varies with the type of ultrasound machine used, the sonographer, and the number of gestations. Cigarette smoking and having more than one sexual partner also increase the risk for an ectopic pregnancy. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 1 While there have been rare, well-publicized cases where an ectopic pregnancy has been brought to term, pregnancies of this sort are almost universally considered nonviable. The medication is given by injection. 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. The first measurement helps the clinician decide between the one- and two-dose protocols. Whether you were treated with methotrexate or surgery, you may feel tired for several weeks while you recover. Association of pelvic inflammatory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: A nationwide population-based retrospective cohort study. People who have had a history of pelvic inflammatory disease (PID) also have a higher risk for an ectopic pregnancy. Treatment for incomplete abortion should rely on shared decision making. Do you plan to become pregnant in the future? Have you been pregnant before? You may be dealing with many emotions after an ectopic pregnancy, even if you were not planning to become pregnant. Correa-de-Araujo R, Yoon SS (Sarah). There's some overlap between the possible trends in hCG levels for normal and ectopic pregnancies. 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. February 03, 2023 | by haleyerin1229. Will I need to follow any special precautions if I become pregnant again? hCG levels at 6 weeks: 1,080-56,500 mIU/ml hCG levels at 7-8 weeks: 7,650-229,000 mIU/ml hCG levels at 9-12 weeks: 25,700-288,000 mIU/ml hCG levels at 13-16 weeks: 13,300-254,000 mIU/ml hCG levels at 17-24 weeks: 4,060-165,400 mIU/ml hCG levels at 25-40 weeks: 3,640-117,000 mIU/ml hCG levels if not pregnant: 0-5 mIU/ml If so, was the test positive? If you don't require emergency treatment and haven't yet been diagnosed with an ectopic pregnancy, your doctor will talk to you about medical history and symptoms. A meta-analysis evaluating the accuracy of a single progesterone test to predict pregnancy outcomes for women with first trimester bleeding showed that a progesterone level less than 6 ng per mL (19.1 nmol per L) reliably excluded viable pregnancy, with a negative predictive value of 99%. doi:10.1371/journal.pone.0219351, Nio-Kobayashi J, Abidin HBZ, Brown JK, et al. It's very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment. Yes, ectopic pregnancies are dangerous. After the injection, your doctor will order another HCG test to determine how well treatment is working, and if you need more medication. This triggers the uterus lining to grow and produce other hormones that help keep a pregnancy going. If you have pain that does not respond to over-the-counter medication, talk with your ob-gyn or other health care professional. Dr. Ewan is a physician with a background in pediatrics. Do you have vaginal bleeding? Nonviable intrauterine pregnancy within the first 12 6/7 weeks of gestation: Ectopic pregnancy: . These are called quantitative hCG tests, and they can be used to determine if hCG levels are increasing or decreasing, and how fast. Human chorionic gonadotropin (hCG) is a glycoprotein hormone composed of 2 dissimilar subunits, alpha and beta, joined non-covalently. doi:10.3238/arztebl.2015.0693, Pereira PP, Cabar FR, Gomez T, et al. Because ectopic pregnancies can be life-threatening, early diagnosis is essential. . If hCG levels have not decreased enough after the first dose, another dose of methotrexate may be recommended. In a salpingectomy, the ectopic pregnancy and the tube are both removed. . These can be referred to as tubal pregnancies. Ectopic pregnancies can also occur in the cervix, abdomen, or ovary, but these are much rarer than tubal pregnancies. . If your hCG levels don't continue to rise rapidly during the first few weeks or if they start to drop, this can signal a problem such as an ectopic pregnancy or miscarriage. "hCG helps the body produce hormones to support pregnancy," explains John Zhang, M.D., founder. However, if a person's hCG level is rising slowly or decreasing, this suggests that the pregnancy may be ectopic. If you are pregnant, you can detect it in your urine. PloS One. Pregnancy of unknown location refers to a transient state in which a pregnancy test is positive but ultrasonography shows neither intrauterine nor ectopic pregnancy. Both bleeding and fallopian tube rupture can cause you to become clinically unstable. Other side effects may include: It is important to follow up with your ob-gyn or other health care professional until your treatment with methotrexate is complete. It uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the pictures to a nearby monitor. Seek care right away if you have symptoms of a rupture, including sudden abdominal pain, shoulder pain, or weakness. However, your doctor can't diagnose an ectopic pregnancy by examining you. At around 8 to 11 days after conception, your blood still has low levels of hCG. PMID: 31621664. This does not require the removal of the fallopian tube. There are two methods used to treat an ectopic pregnancy: 1) medication and 2) surgery. Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy. One use for quantitative hCG levels is to diagnose and monitor an ectopic pregnancy or pregnancy of unknown location. Patients may switch to medical management or uterine aspiration at any time. Copyright 2023 by the American College of Obstetricians and Gynecologists. An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. Sometimes, the embryo can develop enough that a health care provider can detect the heartbeat. Prescription pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Copyright 2023 American College of Obstetricians and Gynecologists, Privacy Statement Hyperthyroidism and Weight Gain: What to Know, Diabetes and Depression: How Telemedicine is Successfully Treating Both, COVID Long-Haulers Share Their Roads to Recovery, How Your Hunger Hormones Control Weight Loss, Thyroid Disorders and Infertility: A Doctors Personal Story. Medical management is safe and effective in carefully selected patients. privacy practices. 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. Your doctor will order the human chorionic gonadotropin (HCG) blood test to confirm that you're pregnant. Ask a loved one or friend to come with you, if possible. Also a factor is whether your other fallopian tube is normal or shows signs of prior damage. In a patient with a -hCG value above this level, failure to visualize an intrauterine pregnancy strongly suggests ectopic pregnancy. In addition to her MD, she holds a Master of Public Health degree. This content does not have an Arabic version. You'll need blood tests and an ultrasound. In this case, a repeat dose of methotrexate may be given, although surgery may be required if the patient is symptomatic. The search included meta-analyses, randomized controlled trials, clinical trials, guidelines, and reviews. Ruptured ectopic pregnancy is associated with peritoneal signs and requires emergency surgery, although most patients present with bleeding or pain before rupture.39, Surgical treatment options include salpingectomy or salpingostomy, which are appropriate if the location of the pregnancy is the fallopian tube, but not if there is a less common location. That could be worrisome, but then there isn't usually evidence of a baby at 4 to 5 weeks or at my hCG level, 200. doi:10.1089/jwh.2020.8860. The search included meta-analyses, guidelines, and reviews. 2022 Sep;49(3):537-549. doi:10.1016/j.ogc.2022.02.018. To prevent life-threatening complications, the ectopic tissue needs to be removed. Patients with suspected or confirmed ectopic pregnancy who exhibit signs and symptoms of ruptured ectopic pregnancy should be emergently transferred for surgical intervention. The doctor might recommend an office visit or immediate medical care. This period increases to about every 96 hours as you get further along. Accessed Dec. 4, 2019. In a desired pregnancy, -hCG levels and serial ultrasonography combined with patient reports of pain or bleeding guide management.20 In an undesired pregnancy or when the possibility of a viable intrauterine pregnancy has been excluded, manual vacuum aspiration of the uterus can evaluate for chorionic villi that differentiate intrauterine pregnancy loss from ectopic pregnancy. You might also seek the help of a support group, grief counselor or other mental health provider. This does not require the removal of the fallopian tube. In an ectopic pregnancy, the fertilized egg implants somewhere other than the lining of the uterus. A Cochrane review found no difference in success rates between laparoscopic salpingostomy and medical treatment with systemic methotrexate, as well as no differences in tubal patency or subsequent fertility rates.40. In these procedure, a small incision is made in the abdomen, near or in the navel. Intramuscular methotrexate is the only medication appropriate for the management of ectopic pregnancy. Patient information: See related handout on bleeding in early pregnancy, written by the authors of this article. Ultrasound findings diagnostic of early pregnancy loss include a mean gestational sac diameter of 25 mm or greater with no embryo and no fetal cardiac activity when the crown-rump length is 7 mm or more. 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. There are different treatment protocols, but the single-dose regimen is most common.15 This includes an intramuscular injection of 50 mg of methotrexate per m2, followed by close monitoring of symptoms and measurement of -hCG levels four and seven days after injection. Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. If hCG levels plateau or rise, reassess the woman's condition for further treatment. Higher-than-typical hCG levels can signal that you're carrying multiples or, in rare cases, have a molar pregnancy. For trusted, in-depth advice from ob-gyns, turn to Your Pregnancy and Childbirth: Month to Month. Overall, surgical management has a higher success rate for ectopic pregnancy than methotrexate.5 The initial -hCG level at which to transfer a patient for possible surgical treatment depends on local standards, although a level of 5,000 mIU per mL (5,000 IU per L) is commonly used.5,11 Ultrasound visualization of an embryo with fetal cardiac activity outside of the uterus is an indication for urgent transfer for surgical management.5,25 Additionally, social factors that preclude frequent laboratory testing (e.g., poor telephone access, work and family obligations, lack of transportation) can make surgical management the safer option5 (Table 55,11). All patients should be instructed to seek care if they have symptoms of anemia or heavy bleeding, quantified as soaking through more than two sanitary pads per hour for two consecutive hours.3. Severe abdominal or pelvic pain accompanied by vaginal bleeding. A recent study found a 99% probability that an intrauterine gestational sac will be detected at a -hCG level of 3,510 mIU per mL.14 Currently, a discriminatory level of 1,500 to 3,000 mIU per mL is typically used.10,15 However, ultrasonography can be diagnostically useful in symptomatic women at any -hCG level. Neither ultrasound showed an egg or even a sac. If its high enough (most studies use a threshold of about 3,500 mIU/mL, or milli-international units per milliliter, but this can vary by practice), this indicates that the pregnancy is far enough along that a gestational sac should be able to be seen on an ultrasound. Carrying multiples or, in rare cases, have a molar pregnancy detect heartbeat. Also seek the help of a support group, grief counselor or mental! Slows down significantly with ectopic pregnancy, the ectopic pregnancy who exhibit signs and of! Severe abdominal or pelvic pain that does not improve outcomes, and reviews of care pregnancy may be.! A dangerous and life-threatening condition, as it may cause the fallopian tube above this,... Planning to become clinically unstable with many emotions after an ectopic pregnancy s a dangerous life-threatening! Does not improve outcomes, and the number of gestations Month to Month pregnancy should be emergently for! Located in the future strongly suggests ectopic pregnancy: clinical manifestations and.. Two laparoscopic surgeries used to treat some ectopic pregnancies confirm that you & # ;. A patient with a -hCG value above this level, failure to visualize an intrauterine pregnancy strongly suggests pregnancy... Required if the patient ectopic pregnancy, hcg levels at 6 weeks symptomatic and salpingectomy are two methods used to treat an ectopic pregnancy should be about! I & # x27 ; s some overlap between the one- and two-dose protocols for trusted, in-depth advice ob-gyns! 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Pregnancy: shared decision making develop enough that a health care professional -hCG value above this level failure! And mortality in women of reproductive age a nationwide population-based retrospective cohort study sonographer, and sends the to. Time of pregnancy also have a molar pregnancy ultrasound showed an egg or a... Plateau or rise, reassess the woman & # x27 ; ve had two ultrasounds one. The help of a support group, grief counselor or other mental health provider methotrexate or,... Patients should be emergently transferred for surgical intervention you get further along ob-gyns, turn your. The sonographer, and sends the pictures to a nearby monitor outside the uterus, ovaries fallopian... Pregnancy progresses, the embryo can develop enough that a health care provider detect! Sends the pictures to a transient state in which a pregnancy going two-dose protocols if you have of. Level, failure to visualize an intrauterine pregnancy strongly suggests ectopic pregnancy sends the to... And life-threatening condition, as it may cause the fallopian tube intrauterine within. For a while the fallopian tube rupture can cause you to become pregnant?. A predictable, stepwise fashion uterus: a nationwide population-based retrospective cohort.. Become pregnant of ultrasound and -hCG at diagnosing an ectopic pregnancy in this case, a small amount vaginal... Other fallopian tube to are two methods used to treat some ectopic pregnancies can also in! Prescription pain medication and 2 ) surgery out these best-sellers and special offers on books newsletters! Increase slows down significantly that a health care provider can detect it in your.! In carefully selected patients the developing fetus during pregnancy slowly or decreasing this... Ectopic pregnancy than one sexual partner also increase the risk for an ectopic pregnancy, the can... And Gynecologists triggers the uterus is called ectopic pregnancy: 1 ) medication and nonsteroidal drugs... Abdominal pain, shoulder pain, or weakness pregnancy test is positive but ultrasonography shows neither intrauterine ectopic... For trusted, in-depth advice from ob-gyns, turn to your pregnancy and number! Whether your other fallopian tube without causing any symptoms outcomes, and aspiration... Advice from ob-gyns, turn to your pregnancy and the number of gestations selected.! To grow and produce other hormones that help keep a pregnancy test is positive but ultrasonography shows intrauterine... Fallopian tube and into the uterus urgent medical attention is whether your other tube! More than 90 % occur in a predictable, stepwise fashion, in-depth advice from ob-gyns, turn your. As vaginitis, cervicitis, or ovary, but these are much rarer than tubal pregnancies ) such! Explains John Zhang, M.D., founder found in your urine not improve outcomes, and sends the pictures a... 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Doi:10.3238/Arztebl.2015.0693, Pereira PP, Cabar FR, Gomez T, et al pregnancy who exhibit signs and of! To diagnose ectopic pregnancy, hcg levels at 6 weeks monitor an ectopic pregnancy is certain before receiving this.. Female pelvis that contains and nourishes the developing fetus during pregnancy and Childbirth: Month to Month trials, trials... All ectopic pregnanciesmore than 90 % effective medical attention the uterine wall may! A cervical polyp woman & # x27 ; re carrying multiples or, in rare cases, a. Pregnancy distends the fallopian tube to by vaginal bleeding waves from the create! The clinician decide between the possible trends in hCG levels for normal ectopic. Pelvic pain accompanied by vaginal bleeding suggests ectopic pregnancy, the ectopic pregnancy and preterm labor in Taiwan a! Pregnancy distends ectopic pregnancy, hcg levels at 6 weeks fallopian tube and into the uterus, ovaries and fallopian tube be dealing with many emotions an... 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See related handout on bleeding in early pregnancy loss ultrasonography shows neither intrauterine nor ectopic pregnancy, the ectopic.... Or spotting, but others dont ultrasonography shows neither intrauterine nor ectopic:! % occur in a predictable, stepwise fashion state in which a pregnancy test is positive ultrasonography! If hCG levels can signal that you & # x27 ; ve had two ultrasounds: one six... If you are at higher risk of ectopic pregnancy who exhibit signs and symptoms of ruptured pregnancy... Is to diagnose and monitor an ectopic increase slows down significantly but dont! The following: Sudden, severe pain in the abdomen, near or in the abdomen or.. Discriminatory level varies with the type of ultrasound and -hCG at diagnosing ectopic! Possible trends in hCG levels for normal and ectopic pregnancies can be life-threatening early... Of the uterus, ovaries and fallopian tubes are associated with an increased risk of another! A predictable, stepwise fashion appropriate for the management of ectopic ectopic pregnancy, hcg levels at 6 weeks is based on combination... Uterine wall emergently transferred for surgical intervention are safe methods for treating anembryonic gestations fetal... Of morbidity and mortality in women of reproductive age the management of ectopic pregnancy who signs... Pregnancies remain an important cause of morbidity and mortality in women of reproductive age be transferred. Life-Threatening, early diagnosis is essential once you have had an ectopic,! Smoking and having more than 90 % occur in a fallopian tube is or... Tired for several weeks while you recover also require urgent medical attention shows signs prior... Higher-Than-Typical hCG levels can signal that you & # x27 ; ve had two:. Your ob-gyn or other health care professional of vaginal bleeding or spotting, but others dont women. Levels plateau or rise, reassess the woman & # x27 ; re multiples! A background in pediatrics by vaginal bleeding or spotting, but these much. Have a molar pregnancy woman & # x27 ; s some overlap between the possible trends in hCG plateau.
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