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Dr. C.
Dr. C., Board Certified
Category: OB GYN
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Experience:  30 years of experience and an award-winning educator.
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I am 42 years old and found out I was pregnant 3 wks ago. 10

Customer Question

I am 42 years old and found out I was pregnant 3 wks ago. 10 days ago I took mysoprostil to end the pregnancy. I havd been bleeding moderately since then. I had an internal wsbd ultasoubd 4 nights ago which convluded that there was no IUP. Today I found out that my hcg hormone is still rising- meaning I am still pregnant. I am leaving for Peru in 3 days to trek matchu piccu. I just got a tetanus/diphtheria shot today as well. Is it safe for me to take another dose if mysoprostil to release the remaining pregnancy out if my body?
Submitted: 5 years ago.
Category: OB GYN
Expert:  Dr. C. replied 5 years ago.
Dr. C. :

I am glad to help you. Answers are intended to provide general medical information only.

Dr. C. :

Usually methotrexate is used along with misoprostol to terminate a pregnancy.

Dr. C. :

Mefipristone is also used. So with a medical abortion the medications are used in combination to increase effectiveness.

Dr. C. :

The recommendation is to use misoprostol AND methotrexate OR misoprostol AND mefipristone.

Dr. C. :

It would be safe to try again this combination.

Dr. C. :

Because there is no IUP noted and the HCG is still rising, this raises the possibility that there is an ectopic or tubal pregnancy. In that case it would be best to err on the side of using the methotrexate combination. Methotrexate by itself is used to treat ectopic pregnancies.

Dr. C. :

The problem with the timing is that 3 days is a short time for this all to get safely resolved.

Dr. C. :

The medications would need to be taken as soon as possible but even then I would be concerned as a doctor about a woman going on a remote trek where if there was heavy bleeding there would not be access to medical care.

Dr. C. :

Please ask questions if you think of any. I'd like to provide additional detail if needed so that you can get the most helpful information possible.

Dr. C. :

Questions?

Dr. C. :

I saw that you were typing but don't see what you typed. Can you please type again?

Dr. C. :

Chat is not working well it seems. I will switch to QA format. We can continue that way until you questions are answered.

Expert:  Dr. C. replied 5 years ago.
Chat is not working for us. I saw that you were typing but can't see what you typed. Please type it again so that I can continue to answer.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience: 30 years of experience and an award-winning educator.
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Customer: replied 5 years ago.
I did take 4 birth control pills 12 hrs prior to increase the effectiveness of the misoprostil. If I were to take another dise today does the tetanus shot pose any risk to me? I have no abdominal pain or cramping so doesn't that indicate that it is not an ectopic Pregnancy? Wouldn't that gave shown up in pelvic ultrasound?
Expert:  Dr. C. replied 5 years ago.
No the tetanus shot doesn't factor into any of this at all. Ectopic pregnancies aren't easily seen on ultrasound until they have reached a larger size. Usually we diagnose ectopics before the stage they are visible on ultrasound. The smaller they are, the easier they are to treat with methotrexate. But if the gestational age from time of conception is in the 1-2 weeks range, there would not be an IUP visible either most likely. Do you have an idea of when conception occurred? If the periods are regular knowing the last period would be helpful too.

It is also important to know that taking the extra birth control pills are not likely to do much additional. Methotrexate is a medication that stops cell division while mefipristone blocks progesterone action. That way the pregnancy is disrupted. The combination of birth control pills, even at high dosage, along with the misoprostol cannot be said to be a particularly effective way of performing a medical abortion.

Please continue to ask questions. I'm sorry that chat wasn't working well but I do want you to get the answers that you want.
Customer: replied 5 years ago.
The first day of my last menstrual cycle was march 30. What are the risks if u do nothing and continue with my trek as planned? What is the risk if I take the misoprostil just to stimulate uterine contraction with hopes to empty whatever is left of pregnancy? What is the chance that the hormones just hzven't gone down yet? How can I find out if it is sn ectopic pregnancy?
Expert:  Dr. C. replied 5 years ago.
If the cycles are regular about 28 days apart, that would put the pregnancy at 7 weeks. This is a gestational age at which an intrauterine pregnancy is seen. In that case there are 3 possibilities.

1. ectopic pregnancy - usually diagnosed by following the beta-HCG numbers every 48 hours and not seeing them rise normally and not seeing an IUP

2. an earlier gestational age then expected, if the ovulation occurred 2-4 weeks later then usual, this can sometimes happen especially as women get into their 40s, the ovulation can sometimes come later then usual randomly

3. a non-viable pregnancy, this is the most likely situation; at age 42 the risk of a non-viable pregnancy is about 30-40%, sometimes the beta-HCG will continue to rise despite the embryo not growing normally

If nothing further is done and trek continues the risks for each of those situations would be as follows:

1. ectopic pregnancy becomes symptomatic and ruptures

2. pregnancy continues and is dealt with upon return from the trip

3. miscarriage occur at some point

Yes it is quite possible that the beta-HCG can still rise some even after the pregnancy is not viable or disrupted.

It would be helpful to have the dates the beta-HCGs were drawn and the results for further analysis of the situation.
Customer: replied 5 years ago.
Hcg level of 2358 was taken may 13 at 9pm
Hcg level of 2900 (approx) was taken may 15 at noon.
Any way ti know if it is ectopic pregnancy before I leave. If it is, and it ruptures on trail could it be life threatening?
First positive pregnancy test was. Taken April 21st.
Customer: replied 5 years ago.
Relist: Answer came too late.
Expert:  Dr. Owen replied 5 years ago.
Hello, and I am pleased to help, use of my answers are for educational purposes only.
Have you had an ultrasound yet?
Expert:  Dr. C. replied 5 years ago.
This is not a normally rising Beta HCG. It is either a non-viable pregnancy or an ectopic. So from the possibilities I listed above, #2 is eliminated. It would be helpful to get one more Beta HCG as soon as possible. If the number is ***** rapidly than more likely non-viable. If holding steady or still increasing it could still be either.

Ectopic pregnancy that ruptures can absolutely be life threatening. Factors that elevate the risk of ectopic pregnancy include a history of previous ectopic pregnancy, history of chlamydia, gonorrhea or pelvic inflammatory disease, history of any surgery in the pelvis and appendectomy, especially if ruptured.