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hCG levels will drop sharply following removal of a miscarriage. The tissues taken from the uterus also are examined carefully by a pathologist. If pregnancy tissue is seen, an ectopic pregnancy is very unlikely. However, very rarely a double pregnancy can occur, one in the uterus and the other in the fallopian tube (called a heterotopic pregnancy). If there is no evidence of pregnancy tissue or the hCG levels do not drop sharply following a D&C, the presence of an ectopic pregnancy must be considered.
TREATMENT
Prior to sensitive pregnancy tests and modern pelvic ultrasound, ectopic pregnancies were usually diagnosed after they ruptured and had caused internal bleeding. Surgery was the main treatment. Now, doctors can detect pregnancy by the time a women is due for her menstrual period by measuring blood hCG levels, and the location of a pregnancy usually can be determined within 1 to 2 weeks. As a result, ectopic pregnancies often can be diagnosed very early, even before symptoms develop. This allows some ectopic pregnancies to be treated safely without the need for surgery.
Observation Alone
Some ectopic pregnancies resolve without treatment and can be managed by observation alone. This is referred to as “expectant management” and usually is limited to women with early ectopic pregnancies with no symptoms and low serum hCG levels (usually