medical negligence

Ectopic pregnancy, medical negligence claims

Hispanic nurse comforting her patient who about ectopic pregnancy - misdiagnosis nhs

Failure to diagnose, or misdiagnosing an ectopic pregnancy can be very distressing for an expectant mother. If left untreated, an ectopic pregnancy can tear or rupture the fallopian tube, which is not designed to accommodate a growing embryo. An ectopic pregnancy can sometimes lead to severe, life-threatening internal bleeding.

National incident data from the NHS shows that between April 2017 and August 2018 there were 30 missed ectopic pregnancies leading to ‘serious harm’.  The Healthcare Safety Investigation Branch (HSIB) carried out a national investigation into the diagnosis of ectopic pregnancy which considered referral from emergency departments to early pregnancy services; the provision of early pregnancy services to diagnose and manage ectopic pregnancy; the information that women receive on discharge from the emergency department and made four safety recommendations.

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Ectopic pregnancy misdiagnosis medical negligence claim

Doctors owe a duty of care to diagnose ectopic pregnancies and provide treatment in a professional and timely manner. An ectopic pregnancy misdiagnosis claim may arise whenever this duty is breached and the patient suffers injury as a result. Here are some examples of events that may give rise to a claim for ectopic pregnancy misdiagnosis:

  • misinterpretation of pregnancy test results such as blood tests and scans
  • misdiagnosis, for example, mistaking an ectopic pregnancy for a uterine miscarriage
  • failure to diagnose the condition when a woman presents with symptoms pointing to a possible ectopic pregnancy
  • a delay in diagnosing the condition causing a woman to undergo more invasive surgery than would have been necessary.

Gwyneth Munjoma, solicitor in Tees’ clinical negligence team, looks at the risk factors and associated symptoms - and what to do if you suffered from an ectopic pregnancy and believe that the condition could have been managed better by the doctors or nurses who attended to you.

What is an ectopic pregnancy?

An ectopic pregnancy occurs when a fertilised egg (embryo) implants and grows outside the cavity of the uterus (womb). Where an ectopic pregnancy occurs within the fallopian tube it is called a tubal pregnancy. A tubal pregnancy is the most common type of ectopic pregnancy. This happens when a fertilised egg gets stuck in the fallopian tube on its way to the uterus. 

Normally, a fertilised egg travels down the fallopian tube to the uterus where it embeds itself and grows. An embryo stuck in the fallopian tube will not develop into a baby and your health may be at risk if the pregnancy continues.

In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year. Depending on the stage at which the ectopic pregnancy is diagnosed, it can be treated using a drug called methotrexate or by an operation to remove the fallopian tube.

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What problems can occur with an ectopic pregnancy?

Fallopian tubes can be damaged by inflammation or can be misshapen. Once an egg is fertilised it starts to grow rapidly. If a fallopian tube is damaged or misshapen, the rapidly growing embryo is unable to continue its journey to the uterus and gets stuck within the fallopian tube. 

An embryo stuck in the fallopian tube cannot progress to a successful pregnancy, because it is restricted by the lack of space within the fallopian tube. As the embryo grows, the tube stretches and eventually may rupture; this can cause life-threatening internal bleeding, if not treated promptly.

Sometimes, an ectopic pregnancy will occur in other sites of the abdomen such as in the ovary, in the abdominal cavity or in the cervix.

What are the symptoms to look out for?

In most cases of an ectopic pregnancy, a woman will experience the early signs or symptoms of pregnancy, i.e. misses a period, breast tenderness and nausea. A pregnancy test will be positive. The first sign of an ectopic pregnancy may be pain in the pelvic area sometimes accompanied by light vaginal bleeding. Where there is internal bleeding the woman may feel shoulder pain as the pooling blood irritates the nerves.  Symptoms may be variable, and a high index of suspicion should be exercised. 

When should I seek help?

Seek emergency medical help if you think you are pregnant and experience any of the following:

  • severe abdominal or pelvic pain
  • vaginal bleeding
  • extreme lightheadedness or fainting
  • other concerning symptoms, especially if you have risk factors for an ectopic pregnancy.

What doctors have to consider

Ectopic pregnancy must be excluded for all women presenting with abdominal pain in early pregnancy. Successive reports into maternal deaths have highlighted the perils of not excluding an ectopic pregnancy in the circumstances.

Some things that make you more likely to have an ectopic pregnancy are:

  • Previous ectopic pregnancy. If you've had this type of pregnancy before, you're more likely to have another.
  • Inflammation or infection. Sexually transmitted infections, such as gonorrhea or chlamydia, can cause inflammation in the tubes and other nearby organs, and increase your risk of an ectopic pregnancy.
  • Fertility treatments. Some research suggests that women who have in vitro fertilization (IVF) or similar treatments are more likely to suffer an ectopic pregnancy. 
  • Tubal surgery. Surgery to correct a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy.
  • Choice of birth control. The chance of getting pregnant while using an intrauterine device (IUD) is rare. However, if you do get pregnant with an IUD in place, you may be at increased risk of suffering an ectopic pregnancy. Tubal ligation, a permanent method of birth control commonly known as "having your tubes tied," also raises your risk, if you become pregnant after this procedure.

Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. The more you smoke, the greater the risk. 

What is the treatment for an ectopic pregnancy?

The management of ectopic pregnancies has shifted towards medical rather than surgical intervention. The drug methotrexate has been successfully used for many years now. Methotrexate kills the pregnancy cells and any pregnancy tissue is then progressively absorbed.  

In the event that it is too late to use methotrexate, the affected fallopian tube can be removed through keyhole surgery (laparoscopic surgery). However, in cases where it is not possible to successfully remove the fallopian tube through keyhole surgery, the abdomen is opened (laparotomy) and the tube is removed.

Tees are here to help

We have many specialist lawyers who are based in:

EssexBrentwoodChelmsford, and Saffron Walden
HertfordshireBishop's Stortford and Royston

But we can help you wherever you are in England and Wales.

Chat to the Author, Gwyneth Munjoma

Senior Associate, Medical Negligence, Chelmsford office

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