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High HCG levels, pregnant. Chances of ectopic pregnancy? History of miscarriage, ectopic pregnancies and laparotomies

I am 40 years old. I have had 4 pregnancies. First one ending in a live birth at 25 weeks. Second one was a miscarriage at 11 weeks. I then had multiple laporatomies and laporostomies and scar tissue removed. I had one tube removed and the other one did not let dye go through it. Since that test, I have had 2 ectopic. In 2002, I had one in my tube, and in 2010, I had one in my ovary . I just found out that I am pregnant. I am 6 weeks and 3 days. My HCG levels yesterday were 63,000. Is it still possible with my numbers this high that this pregnancy could be ectopic?
Asked On : Mon, 1 Oct 2012
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OBGYN 's  Response
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An ectopic pregnancy should be considered when there is abdominal pain or vaginal bleeding with positive pregnancy test. An ultrasound showing a gestational sac with fetal heart in the fallopian tube is clear evidence of ectopic pregnancy.
An abnormal rise in blood β-human chorionic gonadotropin (β-hCG) levels may indicate an ectopic pregnancy. The threshold of discrimination of intrauterine pregnancy is around 1500 IU/ml of β-hCG. A high resolution, transvaginal ultrasound showing no intrauterine pregnancy is presumptive evidence that an ectopic pregnancy is present if the threshold of discrimination for β-hCG has been reached. An empty uterus with levels higher than 1500 IU/ml may be evidence of an ectopic pregnancy, but may also be consistent with an intrauterine pregnancy which is simply too small to be seen on ultrasound. If the diagnosis is uncertain, it may be necessary to wait a few days and repeat the blood work. This can be done by measuring the β-hCG level approximately 48 hours later and repeating the ultrasound. If the β-hCG falls on repeat examination, this strongly suggests a spontaneous abortion or rupture of ectopic pregnancy.

In your case you are having no pain or bleeding. But i want to know if you got an ultrasound done. Incase you have done and there was no visualization of pregnancy in uterus with these high beta hcG levels then there might be a risk of pregnancy elsewhere( ie ectopic).
Also by 6weeks 3days , pregnancy is usually visible on a transabdominal ultrasound. Incase you want to be absolutely sure, go for a transvaginal ultrasound. But do get a scan done as early pregnancy scan is a must in every pregnant female especially in those who have repeated history of ectopic pregnancy and multiple surgeries.
Answered: Tue, 2 Oct 2012
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