Women don't (as often) miss the fact that they are pregnant. The over the counter pregnancy tests are very accurate and easy to come by. But determining whether the pregnancy is healthy, or even in the uterus, often will require a visit to the physician.
1. If you have symptoms of pelvic pain, the visit should be arranged promptly. These symptoms could be an abnormally developing pregnancy such as an evolving miscarriage or a tubal pregnancy.
2. Other causes of pain with a positive pregnancy test can be an early pregnancy accompanied by an ovarian cyst or enlarging uterine fibroids. But the most important symptom gynecologics worry the most about a tubal pregnancy because it can be a serious complication.
3. Ectopic pregnancies still account for 6% of maternal deaths.
4. Although ectopic pregnancy patients may have bleeding or pain with their positive pregnancy test, about 1/2 of patients with a tubal pregnancy have symptoms at all.
5. Only 1-2% of all pregnancies in the US as of 2012 are in the fallopian tube and not in the uterus and called an ectopic pregnancy.
6. If you have had PID before you are more likely to have a tubal pregnancy than the average patient. Other conditions that make ectopic or tubal pregnancies more likely are prior abdominal or tubal surgery, being a smoker, having infertility or ovulation treatments for infertility, having endometriosis or uterine fibroids, or having had a prior miscarriage or spontaneous abortion.
7. Ectopic pregnancy can usually be treated by medication. Women used to get ectopic pregnancies treated by surgery, and maintaining that count on ectopic pregnancies was fairly easy. The first challenge is to have an accurate diagnosis, and again, ectopic pregnancies can be elusive and have just an empty uterus, or worse, some fluid in the uterus that is mistaken for a tubal pregnancy. Now at least a third of these can be safely treated by medication dosages in your doctor's office, and so estimating one's actual risk is hard. Recently however it has come to light that inadvertent exposure of a healthy developing pregnancy to the medicine methotrexate that is used to treat ectopic pregnancy can lead to birth defects. Early and prompt attention to the possible diagnosis is important, but confirmation is important too so these inadvertent treatments do not occur. But gynos will also say early treatment is important to be able to be treated with the medicine.
8. We use blood tests, and ultrasounds and pelvic examinations to determine the diagnosis, but it is well recognized, based on a review of the literature in Fertility and Sterility in November of 2012, that errors in diagnosis still occur because the way we make our diagnosis is not perfect. Ultrasound may have an error rate as high as 1% for the very early pregnancy, prior to 49 days pregnant. Especially if your hormone count is under than an HCG level of 1500 IU. In fact they have coined a new term which is "Pregnancy of Unknown Location" meaning you are pregnant, but the tests are done too early to see exactly how and where that pregnancy is developing.
9. Progesterone values will likely be low in ectopic pregnancies and some doctors use this test to help make that early diagnosis. But learning where the pregnancy is is very important in terms of getting that tubal pregnancy treated. And remember treatment of tubal pregnancies is also important to avoid the known complications of a tubal pregnancy such as future infertility avoiding chronic pelvic pain, another ectopic pregnancy and treatment related side effects or complications.