Risk of Ectopic Pregnancy
Tubal surgery is associated with an increased risk of ectopic pregnancy (a pregnancy outside of the uterine cavity). The risk of ectopic pregnancy is 2-3% in the general population. After tubal ligation and tubal ligation reversal, the risk is approximately 10%. Therefore, every woman who is pregnant following tubal reversal should be considered at risk for ectopic pregnancy until proven otherwise. This is the rationale for the early pregnancy monitoring protocol that I recommend to all of my patients.
Early pregnancy monitoring
Early pregnancy monitoring begins when a woman has a positive home pregnancy test confirming that she is pregnant. Following this, serum quantitative HCG assays should be performed twice a week. These measure the blood levels of the pregnancy hormone, human chorionic gonadotropin. The HCG doubling time in early pregnancy is normally 2-3 days. In a healthy pregnancy, the HCG level will double with each successive blood test.
When the HCG level reaches 1500 mIU/dL, a vaginal ultrasound exam should be performed to identify an intrauterine gestation sac. The gestation sac appears as a black circle or oval surrounded by a bright white “halo”.
If no gestation sac is seen, the HCG assay and ultrasound should be repeated 1 or 2 days later. If the HCG is rising and still no gestation sac is seen, the pregnancy is progressing – but not normally – and is either an intrauterine pregnancy that will miscarry (a “blighted ovum”) or is outside of the uterus. In either case, we recommend ending such a pregnancy with an injection of methotrexate in order to prevent the possible complication of tubal rupture.
Tubal rupture occurs when an ectopic pregnancy grows through and tears the fallopian tube. When this happens, intra-abdominal bleeding is likely to occur. A ruptured ectopic pregnancy is considered a surgical emergency and often results in removal of the ruptured tube. Fortunately, tubal rupture can be prevented by adhering to our early pregnancy monitoring protocol.
What To Do When You Become Pregnant
When you have a positive pregnancy test, please alert us and complete the Pregnancy Report Form that is shown as a link at the bottom of the I’m Pregnant page. We will follow your testing with you to be sure you are having the proper tests done at the right time and that they are being interpreted correctly. We follow-up on all pregnancies with each of our tubal reversal patients.
An easy way to remember the early pregnancy monitoring testing protocol is to read the I’m Pregnant page on the A Personal Choice website when you become pregnant. This page can be printed and taken to your local doctor. If your doctor has any questions about my recommendations, please give the doctor my pager number. I am available at all times by pager for urgent medical concerns and/or communication with your doctor.
