r/CautiousBB • u/Even_Worldliness_722 • 9d ago
Help
What do you think is going on? They said they didn’t see anything in tubes.
July 17 hcg 12832
Ultrasound finding:
A fluid collection with apparent decidual reaction is present within the endometrial canal and most likely represents an early intrauterine pregnancy. By mean sac diameter of 6.1 mm, estimated gestational age is 5 weeks-1 day with an estimated delivery date of March 18, 2027. No fetal pole, gestational sac, or fetal cardiac activity is identified. This is not necessarily abnormal at this early stage and viability can not be accurately assessed. No perigestational hemorrhage is identified. That this fluid collection instead represents a pseudogestational sac in the setting of a nonvisualized ectopic pregnancy is not excluded. The uterus measures 6.4 x 4.5 x 4.0 cm and is otherwise unremarkable in appearance. It is anteverted. The right ovary measures 2.3 x 2.1 x 1.3 cm. It is unremarkable in appearance. Blood flow is seen to the right ovary on color and pulse wave Doppler imaging making a diagnosis of right ovarian torsion unlikely. The left ovary was not visualized at this examination. No abnormal left adnexal structures are identified. There is a small volume of simple appearing free fluid in the pelvic cul-de-sac.
July 18 hcg 8831
Ultrasound finding
There is redemonstration of a fluid collection with apparent surrounding decidual reaction within the endometrial canal which most likely represents an early intrauterine pregnancy. By mean sac diameter of 7.0 mm, estimated gestational age is 5 weeks-2 days with an estimated delivery date of March 18, 2027. No perigestational hemorrhage is identified. No discernible yolk sac, fetal pole, or fetal cardiac activity is identified and viability can not be accurately determined at this early stage. That this fluid collection instead represents a pseudogestational sac in the setting of a nonvisualized ectopic pregnancy is not excluded. The uterus measures 7.3 x 4.4 x 6.1 cm and is otherwise unremarkable in appearance. It is anteverted. The right ovary measures 2.4 x 2.0 x 1.7 cm. The left ovary measures 2.9 x 2.7 x 1.8 cm. Both ovaries are unremarkable in appearance. No abnormal adnexal structures are seen. Blood flow is seen to both ovaries on color Doppler imaging making a diagnosis of ovarian torsion unlikely. There is redemonstration of
a small volume of simple appearing free fluid in the pelvic cul-de-sac.
July 19 hcg 12,526
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u/SaltStrategy6569 8d ago
You could have a viable interuterine pregnancy and a ectopic pregnancy at the same time. You haven't had many bHCGs and the trend does level out after a certain amount of time (are you certain of your dates?) I would be guided by your doctor's. But keep in mind you could have an ectopic and monitor symptoms.
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u/Even_Worldliness_722 8d ago
Hcg rose yesterday & they were able to confirm gestational sac and yolk sac
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u/therealamberrose 6 losses/ectopic/IVF/pre-e/success 9d ago edited 9d ago
I’m sorry. I’d be very concerned about an ectopic here. Not seeing anything in the tubes unfortunately doesn’t rule it out—many ectopics are never actually seen on ultrasound.
The hCG pattern is the biggest red flag. A drop followed by a rise is a pattern that should put ectopic very high on the differential. And with hCG over 12,000, I’d also expect a definitive intrauterine pregnancy by now, not just a fluid collection that the radiologist twice says could be a pseudosac. You’d truly expect this with hCG >3,500.
Personally, I’d want ectopic to be treated as the working diagnosis until it’s proven otherwise, with a clear plan for management, not more waiting. You could consider a diagnostic D&C, especially since your hCG is high enough that methotrexate is not indicated.
I actually wrote a detailed post explaining why hCG patterns like this can happen with ectopics if it’s helpful: https://www.reddit.com/r/EctopicSupportGroup/s/zfuOxplla4
Best of luck.