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Delaying surgery for chronic ectopic pregnancy

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My friend is having ectopic pregnancy on December last year in January she took the injection for that..and followed up beta HUG.test for several weeks..till beta hcg turned less. Than one.last month of november she suffered abdominal pain then she consulted doctor then doctor done scan and found that the ectopic thing is still there but not growing..she suggested for the surgery.but because of some personal problems we can't perform surgery now..but sometimes she suffers from abdominal pain..I want to know is anything life threatening..can we wait. Two more month for surgery..she still gets her period and her beta hcg is still less than one


Category: OBGYN

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello
Thanks for your consult at DoctorSpring.com.

I think what you are referring to is a CHRONIC ectopic pregnancy. Ectopic pregnancy is basically pregnancy occurring outside the uterus - in the fallopian tubes / ovaries.

This can be life threatening if it is acute, as the tube / ovaries are not as spacious as the uterus to accomodate the growing pregnancy.

Invariably, the pregnancy sac ruptures, leading to life threatening haemorrhage.
As your friend responded well to medical treatment ( injection Methotrexate I assume was given ) - this is not a problem any more.

The products remaining from the ectopic pregnancy site will sometimes form an organized mass - known as chronic ectopic pregnancy. Herein, there is minimal risk of rupture and acute life threatening haemorrhage, but it can cause complications like - abdominal pain, blocked tubes leading to difficulties in further conception etc.

There is no emergency, you can wait two more months for surgery, taking symptomatic measures for the pain meanwhile.

As the B HCG is less than 1, do not worry about the mass turning malignant as well. However, the earlier the surgery is done, the better for her pain and overall health.

It would help me if you can upload the ultrasound scan report.
Take care.
Looking forward to hearing from you soon.
All the best.


Patient replied :

is dere any treatment for pain ?
can i take tab meftal spas for pain?
i have attach the mri report..mri was done on 6 nov 2013
i will send ultra sound report as soon as possible


Expert:  Dr. Aarti Vazirani replied 3 Days.

Hello
Yes, you can take Meftal Spas or any other generic painkiller for the pain.
You can wait two months for surgery, you can take a trial of antibiotics and anti inflammatory medications for 5 days, this just MIGHT resolve the mass.
Take care.


Patient replied :

can u plz tell me the name of antibiotics and nsaids??


Expert:  Dr. Aarti Vazirani replied 2 Days.

See, the exact medication depends on the clinical findings of the patient.
Since I have not examined her, its difficult for me to opine.
However, in general, for such a patient, who refuses immediate surgery, I would prescribe the following at least - You should consult your Doctor before taking these medication.
Doxycycline 100 mg. BD for 14 days
Metronidazole 400 mg. TDS for 7 days.
Chymoral forte BD for 10 days.
Injection Placentrex every alternate day - total 10 doses.
This is just a sample prescription, and by no means should you take it without consulting your doctor.
Procuring them OTC and using them is also ill advised, without medical consultation.
Take care.


Patient replied :

okkie...but how many month she can wait for surgery..can she wait till march april..


Expert:  Dr. Aarti Vazirani replied 1 Day.

You mentioned a couple of months, which is the maximum she can wait, unless the mass responds to medical management.
In case it is inevitable to defer surgery till March - April, she should have regular monthly scans, and be prepared for a surgery in case of an eventuality - such as intractable pain, bleeding etc.
Take care


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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