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Ectopic pregnancies, pregnancies that develop outside the uterus, can be more difficult to diagnose than many realize. What do you do if you suspect you are dealing with one, but your doctor has missed it?

It was Ann Marie's first pregnancy. Ann Marie and her husband had been trying to conceive for eight months when she got her positive pregnancy test. Like many women, she was hoping that it would happen a little sooner. Trying to pass the time, she was an active member of several "TTC" forums on the web, as well as an avid reader of everything conception and pregnancy. By the time she was finally expecting, Ann Marie was a well-informed woman. So when, in the very early stages of her pregnancy, she experienced abdominal cramping, she already knew that not every physical symptom that happens to take place when you're pregnant is necessarily pregnancy-related. Ann-Marie chalked her symptoms up to the spicy pizza she had eaten a day before. 

When the cramps didn't go away, she thought she was getting a stomach bug. Her husband, however, pressed Ann Marie to make an appointment with her OBGYN. She did, reluctantly, and the appointment was scheduled a week later when she experienced a pain so bad she could hardly walk or talk; the worst pain she had experienced in her life. A colleague rushed her to the ER. An ultrasound revealed that she was experiencing an ectopic pregnancy and would require immediate surgery, surgery that would remove the fallopian tube in which the pregnancy had been developing. That intense pain was, in hindsight, the moment at which her tube ruptured.

Ann Marie's dramatic story is indeed what most people envision when they hear the word "ectopic pregnancy".

Around one in every 50 pregnancies is ectopic, meaning that the fertilized egg has implanted somewhere outside the uterus, and most of those are tubal pregnancies. The tell-tale signs are often there:

  • Vaginal bleeding
  • Nausea and vomiting
  • Feelings of dizziness, light-headedness and general weakness
  • Sometimes shoulder pain, neck pain, or rectal pain
  • Of course, abdominal pain and cramping, often on one side, and if a tube ruptures, so severe that you may faint

Not every ectopic pregnancy presents in the same way, however, and not all countries operate under the same treatment guidelines either. While Ann Marie is American, Emma is from the UK, where reactions to symptoms are often slightly more relaxed. Having already had three healthy children as well as four first-trimester pregnancies, she checked in with her healthcare provider when she started bleeding at six weeks.

A quick ultrasound revealed that Emma's uterus was already empty. Knowing that she had miscarried, she went home and waited for the bleeding to stop. 

It didn't. In fact, the bleeding was of an altogether different nature than the bleeding she had experienced during her last miscarriages — and Emma had already had plenty of experience! What's more, her pregnancy symptoms didn't go away, and neither did the pain. She went back to her doctor, because she suspected she might be experiencing an ectopic pregnancy. The ultrasound tech did not find a pregnancy within her tubes, and though her hCG levels were still high, she was told that happens sometimes. A little anxious, Emma once again went home. It wasn't until a week later than she found out that her hCG levels were still rising, after another test. and her gut instinct told her that she was dealing with an ectopic pregnancy — all she was experiencing was pain, bleeding, and nausea, but she could not get the idea out of her head.

Finally, after yet another ultrasound, Emma's ultrasound tech found the ectopic pregnancy — in a hard-to-spot location, her right ovary. 

After her ectopic pregnancy was finally discovered, she was given a choice between methotrexate and surgery. She chose the former. It saved her life.

Emma's story isn't a dramatic, textbook, case, but a case of gut feelings and the insistence on being checked out again and again proving that she was right. If she had been less persistent and confident, who knows what would have happened? Emma's story makes it painfully clear to what extent patients need to be involved in their own care. It shows, too, that not all ectopic pregnancies present in the same way as Ann Marie's. 

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