Early Pregnancy Monitoring
Decreasing Risk of Ectopic Pregnancy
The best way to determine the location of an early pregnancy is with blood testing for the pregnancy hormone (quantitative serum HCG). Using this testing the location and health of an early pregnancy can often be determined before a pregnancy is seen during an ultrasound exam.
We recommend monitoring your early pregnancy with quantitative serum HCG blood tests every 48 hours and having a vaginal ultrasound exam when your HCG (pregnancy hormone) level reaches 2000. This testing should be started soon after you first detect pregnancy and can be stopped as soon as the location of the pregnancy is determined.
When the pregnancy hormone level reaches 2000, a vaginal ultrasound exam will show a gestational sac (early pregnancy) within the uterus in a normally developing intrauterine pregnancy.
If your ultrasound exam does not reveal a pregnancy inside your uterus, you should have a repeat HCG level and have another vaginal ultrasound exam within 2 or 3 days. Sometimes the early pregnancy may not be seen until HCG level is about 2500 depending upon the quality of the equipment and experience of the person performing your ultrasound examination.
If the early pregnancy is not seen inside the uterus when the HCG level is above 2000, then the pregnancy is abnormal and likely to be either a tubal pregnancy or a pregnancy that will eventually miscarry.
Because the risk of tubal pregnancy is approximately 10-15% after tubal surgery, it is important to notify your obstetrician-gynecologist and follow the Early Pregnancy Monitoring protocol to determine the location and health of the early pregnancy.
A tubal pregnancy cannot lead to a live birth and must be treated. Following the recommended Early Pregnancy Monitoring Protocol is the best way to minimize the risk of tubal rupture, preserve the health of your fallopian tubes, and avoid surgery to remove the tubal pregnancy.
Reason 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 end the tubal pregnancy pregnancy. After Methotrexate administration, serum HCG levels should be monitored until the HCG level returns to less than 10 mIU/dL.
Early Pregnancy Monitoring: Key Concepts
The key concepts to understanding HCG pregnancy hormone testing and ultrasound exams are:
- In a normal pregnancy the HCG levels should double every 48 hours
- In a normal pregnancy the pregnancy should clearly be seen inside the uterus when the HCG level is above 2000
- If the HCG levels are not doubling or the pregnancy is not seen inside the uterus when the HCG levels are above 2000 then the pregnancy is abnormal, possibly in the fallopian tube, and will not lead to a live birth