One of the dreaded complications of infertility treatment is an ectopic pregnancy . Infertile patients and IVF patients have a higher risk of having an ectopic pregnancy because of tubal damage.
An ectopic pregnancy can be a major disaster if the diagnosis is delayed, as it can rupture. Sadly, it’s very easy to miss an ectopic. Patients with an ectopic may not have any symptoms or signs until they rupture. Even worse, the commonest symptoms of an ectopic – pain and bleeding during pregnancy - are very nonspecific. These occur in healthy pregnancies and during miscarriages as well – both of which are much commoner than an ectopic. This is why, even if you suspect something is wrong, your doctor may dismiss your complaints as being of no importance. However, if the doctor misses the right diagnosis and the ectopic ruptures, then you will need emergency surgery to remove the tube. Not only is this expensive, it can also be life-threatening; and can also reduce your fertility even further.
While there are standard medical protocols for making the diagnosis of an ectopic early, these work well in text books. In real life, the eye only sees what the mind knows, and if your doctor doesn't think of the possibility, it’s easy for him to miss the diagnosis.
This is partly because the diagnostic protocol needs the doctor to interpret a combination of both HCG blood test results as well as vaginal ultrasound scanning reports. Sadly, the sonographer doing the scan may not think of the possibility of an ectopic; or may not have good quality equipment; or may do an abdominal scan, instead of a vaginal scan. Because the gynecologist is dependent upon the skill of the sonographer, if you are unlucky and the ultrasound specialist is not good, you are in deep trouble.
Sometimes gynecologists themselves are not really sure how to interpret the hCG levels in combination with the scan results . This is why they sometimes order a vaginal ultrasound scan too early ( for example, when the HCG level is less than 1000 mIU/ml, and misdiagnose an early intrauterine pregnancy as an ectopic because the sonographer cannot see the sac inside the uterus).
Conversely, an ectopic pregnancy is misdiagnosed as being an intrauterine pregnancy ( for example, the doctor may be fooled by a ultrasound report which mis-interprets a pseudogestational sac as being an intrauterine sac), something which can potentially have catastrophic consequences.
Also, many doctors are still unaware of the concept of the discriminatory HCG zone. Today, modern guidelines say that if the HCG level is more than 1000 mIU/ml and the sonographer cannot see a sac inside the uterine cavity, this means the diagnosis is ectopic pregnancy, until proven otherwise. However, doctors who do not understand this concept believe that the fact that no sac is seen in the fallopian tube on the scan means the patient does not have an ectopic pregnancy. This is a false and dangerous assumption, because they then continue to monitor the pregnancy. They allow the ectopic to grow and it can finally rupture. A ruptured ectopic can be a life-threatening complication.
The biggest tragedy is the fact that if the diagnosis had been made in a timely fashion, it's easy to treat the ectopic pregnancy with medical treatment - a simple injection of methotrexate can kill it when it is diagnosed early!
The problem is compounded by the fact that serial scans and blood tests need to be done in order to make the diagnosis early, and you may not report for followup testing, because you do not understand the need for doing multiple tests.
In order to overcome this problem , we've created www.hcgexpert.in. This allows you to enter your hCG data as well as your scan results, and the website uses an intelligent algorithm , which helps suggest the right diagnosis . You can then discuss the possibility of your having an ectopic pregnancy more intelligently with your doctor !
HCG Expert reassures you when your pregnancy is progressing well; and provides alerts when it is not. It does not bypass or overrule your doctor – it simply suggests when you need to seek medical attention from your doctor. This helps to reduce false alarms; and also improves patient compliance.
Please check out www.hcgexpert.in , so you can track and monitor your pregnancy. This is a free service.
Our hope is that HCG Expert will allow patients and their doctors to make an early diagnosis of an ectopic, so that it can be treated medically , without risking any damage to the fallopian tube , or the possibility of a catastrophic rupture , which can be potentially life-threatening.
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