Failed MTX treatment 3 weeks later
Dx with ectopic july 23, given MTX july 24th and discharged home from hospital. Hcg has always downtrended well, 4300, 3400, 2100, 1100, 322, then 262. However, all along having random sudden bursts of the most horrendous pains. The worst cramping, ectopic right sided pain radiating into back, lightning bolt sensations in vagina and rectum and simply couldn't escape the pains. Bleeding would ramp up during, then let up in between on my "good days". Though I was constantly tired, dizzy, weak. I would go a few days in between these pain episodes but when they struck they came out of nowhere and were completely debilitating. Even oxycodone did nothing. I was seen in the ED for one such episode August 2nd and told basically my US at that point was unchanged, and I was likely having mass effect and reabsorption pain and it was normal.
So the following several episodes i toughed out at home thinking it was still normal until the latest caused me to pass several clots and tons of blood and at this point i was at the 3 week post treatment mark. So i went in to the ER thinking i possibly had retained clots or tissue. Nope, my ectopic over doubled in its original size, despite the hcg downtrend, and needed same day surgery to remove my right tube.
All this to say, even if your hcg is going down....if you're still having significant pain events in the weeks following your MTX treatment advocate for repeat US as well. I was lucky to have not ruptured but the delay in finding this caused a lot of scarring to my ovary and uterus wall. Prayers for everyone walking through this. After a month I can finally close this chapter definitively and start to heal and move forward.