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HomeAnswersInfertilitymolar pregnancyShould I undergo a D&E for an ectopic pregnancy?

I am afraid a possibly viable pregnancy has been prematurely ended. Please advise.

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At November 8, 2017
Reviewed AtFebruary 7, 2024

Patient's Query

Hello doctor,

I was given the hCG trigger shot on the 5th of last month after showing a good follicle in response to Letrozole. I first showed positive for pregnancy on the 19th of last month with an hCG result of 17. On the 2nd of this month, I had a transvaginal ultrasound with no visible gestational sac and no indication of ectopic pregnancy, as well as an hCG of 806. I was told that the pregnancy was abnormal and that a molar pregnancy was suspected. A D and E were suggested, and I was told that if my hCG levels still increased, then I would be treated for possible ectopic pregnancy. My pathology reports came back to a normal gestational sac, and no signs of a molar pregnancy. Genetic results are still pending. Looking at the reports now, they had indicated pregnancy of unknown location as the cause for the procedure. Is that the usual course of treatment based on my clinical presentation? I am afraid that they had prematurely ended what could have been a viable pregnancy.

Answered by Dr. Balakrishnan R

Hello,

Welcome to icliniq.com.

I am extremely sorry for your loss.

I would like to put forth a few facts.

1. Beta hCG is the pregnancy hormone that is produced by the baby, and it doubles in 48 hours. So, if the level was 17 on the 19th, then it would be 34 on 21st, and so on. The normal doubling at this rate indicates healthy fetal tissue. It also indicates when we can see the baby on the scan. So, a level of 800s on the 2nd was normal. But, the scan has minimal sensitivity. What I mean is that only after a level of 1500 units of beta hCG can the baby be seen on the scan, not before that.

2. It is definitely not molar, as in that case, your beta hCG would have been much higher, and the rate of increase in hCG would be faster. You cannot call this ectopic pregnancy unless you have seen it on the scan.

3. For the diagnosis of pregnancy at an unknown location, beta hCG should have crossed the threshold value of 1500 IU. Unless you were in great distress or bleeding or pain, or any other significant complaint, no intervention was needed.

I am sure the genetic results will be normal. For a single-time loss, genetic analysis is also not indicated.

Hope I have clarified your query. Do write back if any more queries. All the best.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Balakrishnan R
Dr. Balakrishnan R

Obstetrics and Gynecology

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