I'm Pregnant !

Sarah Meacham, RN
Tubal Reversal Nurse

Follow-up care

Congratulations on your positive pregnancy test! We know you have been waiting for this moment since your tubal reversal with Dr. Berger. And we share your excitement and concerns now that you are pregnant. Part of our long term follow-up care after your tubal reversal is following your early pregnancy along with you and your local physician.

Early pregnancy monitoring

Dr. Berger recommends monitoring your early pregnancy with quantitative serum HCG assays and scheduling a vaginal ultrasound exam when your HCG level reaches 1500. HCG is the pregnancy hormone.

When serum HCG reaches 1500, a vaginal ultrasound exam will show a gestation sac within the uterus in a normally developing intrauterine pregnancy. The dark appearing fluid in the sac is surrounded by a white ring or halo (the trophoblastic tissue).

If your ultrasound exam does not unequivocally (without doubt) reveal a gestation sac in your uterine cavity, you should have a repeat HCG level and have another vaginal ultrasound exam within 2 or 3 days. Sometimes the gestation sac may not be seen until HCG is about 2500 depending upon the quality of the equipment and experience of the person performing your US examination.

In a normally developing uterine pregnancy, a follow-up ultrasound exam will show the presence of a yolk sac (the small circle within the gestation sac) within a week of the appearance of the gestation sac.

In a normal pregnancy, the serum HCG levels will double every 2 or 3 days until about 10 weeks from the last menstrual period. If the gestation sac is not seen in the uterine cavity when the serum level of HCG is above 1500-2500, then either a tubal pregnancy or a "blighted ovum" (an abnormally developing uterine pregnancy) is likely to be present.

Because of the risk of tubal pregnancy (approximately 10-15 percent) following tubal surgery, it is important to notify your obstetrician-gynecologist and Chapel Hill Tubal Reversal Center as soon as you have a positive pregnancy test. You can use the Pregnancy Report Form to report your pregnancy to us. A tubal pregnancy cannot lead to live birth and must be interrupted. Following the recommended early pregnancy monitoring protocol is the best way to prevent the risk of tubal rupture.

Rationale for early pregnancy monitoring

The rationale for early pregnancy monitoring is to prevent a tubal pregnancy from progressing to the point of rupturing the fallopian tube. Rupture of the fallopian tube results in internal bleeding and requires emergency surgery, often resulting in loss of the fallopian tube. In the absence of ultrasound evidence of an intrauterine pregnancy, early treatment with Methotrexate is recommended to terminate the pregnancy. After Methotrexate administration, serum HCG levels should be monitored until the HCG level returns to less than 10 mIU/dL.

Keep us informed

Dr. Berger wants to be kept informed about your early pregnancy results and is available at any time by pager if you have questions or concerns. You can also reach our nurses seven days a week by e-mail or cell phone.

When you complete and submit the Pregnancy Report Form, I will receive your response. If you do not hear back from me within 24 hours, please send me an e-mail (SarahM@tubal-reversal.net) or call (919) 968-4656 Monday - Friday or (919) 656-8204 on weekends, or page Dr. Berger.

Pregnancy Information

• Pregnancy Signs and Symptoms - in collaboration with the American Pregnancy Association.
• Pregnancy Tests - detect the presence of the hormone human chronic gonadotropin (hCG).
• Calculate your pregnancy due date - from ovulation or last menstrual period.
• Pregnancy Report Form - Send this when you have a positive pregnancy test.
• Early Pregnancy Monitoring - Why tubal reversal patients require this!
• Weekly TR Pregnancy Report - Forum on the Tubal Reversal Message Board.
• Pregnancy Announcements - weekly updates from Dr. Berger's tubal reversal patients.

Call 919 968-4656 to speak with a Tubal Reversal Nurse.