Ectopic Pregnancy Blunder

It has been reported that a woman had her healthy fallopian tube removed by mistake after suffering from an ectopic pregnancy. She was admitted to Walsall Manor Hospital with the pregnancy in her right tube in March last year. During an operation, the surgeon removed the left fallopian tube instead. She realised the wrong tube had been removed by mistake during a post-surgery scan when the baby’s heartbeat could still be heard.

Naturally, she is devastated and will be unable to have children naturally.  She said it had ‘destroyed everything.’

The ectopic pregnancy was discovered after she experienced bleeding and went to hospital. She underwent surgery the same day, where her healthy fallopian tube was removed. She told the surgeon the scan showed the pregnancy in her right tube but was told: ‘I’m a doctor, you should trust me.’ But a week later, when she was still in excruciating pain, she returned to hospital where the blunder was discovered. She had to have her remaining fallopian tube removed.

The hospital apologised and admitted an error was ‘regrettably made’. Dr Matthew Lewis, the medical director at Walsall Healthcare NHS Trust, admitted surgeons made a mistake and said, ‘Our care fell below the standard that we would expect’.

He said the Trust worked with ‘patients and their families, our own clinicians and staff to learn lessons and put systems in place to try and avoid such incidents’.

If you feel you or a member of your family may have been affected or have any concerns then please contact Kiran Jalota, Head of Medical Negligence, or any other member of our experienced Medical negligence team on 01926 356072.

What is an Ectopic Pregnancy?

• An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes
• If an egg gets stuck in them, it will not develop into a baby and the mother’s health may be at risk if the pregnancy continues
• In the UK, about one in every 90 pregnancies – about 11,000 a year – is ectopic.

An ectopic pregnancy is when a fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes.

The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won’t develop into a baby and your health may be at risk if the pregnancy continues. Unfortunately, it’s not possible to save the pregnancy. It usually has to be removed using medicine or an operation. In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year.

Symptoms of an ectopic pregnancy

An ectopic pregnancy doesn’t always cause symptoms and may only be detected during a routine pregnancy scan. If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.

Symptoms can include a combination of:

• a missed period and other signs of pregnancy
• tummy pain low down on one side
• vaginal bleeding or a brown watery discharge
• pain in the tip of your shoulder
• discomfort when peeing or pooing

But these symptoms aren’t necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug.

Contact your GP or call NHS 111 if you have a combination of any of the above symptoms and you might be pregnant – even if you haven’t had a positive pregnancy test.

An ectopic pregnancy can be serious, so it’s important to get advice right away. Your GP will ask about your symptoms and you’ll usually need to do a pregnancy test to determine if you could have an ectopic pregnancy.

You may be referred to a specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood tests may be carried out to confirm the diagnosis.

It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions.

Your GP may examine you and offer a pregnancy test.

If you have the symptoms of an ectopic pregnancy and a positive pregnancy test, you may be referred to an early pregnancy assessment service for further testing.

Some of the tests you may have are outlined below.

Vaginal ultrasound

An ectopic pregnancy is usually diagnosed by carrying out a transvaginal ultrasound scan.

This involves inserting a small probe into your vagina. The probe is so small that it’s easy to insert and you won’t need a local anesthetic. The probe emits sound waves that bounce back to create a close-up image of your reproductive system on a monitor.  This will often show whether a fertilized egg has become implanted in one of your fallopian tubes, although occasionally it may be very difficult to spot.

Blood tests

Blood tests to measure the pregnancy hormone human chorionic gonadotropin (hCG) may also be carried out twice, 48 hours apart, to see how the level changes over time.

This can be a useful way of identifying ectopic pregnancies that aren’t found during an ultrasound scan, as the level of hCG tends to be lower and rise more slowly over time than in a normal pregnancy.The results of the test can also be useful in determining the best treatment for an ectopic pregnancy.

Keyhole surgery

If it’s still not clear whether you have an ectopic pregnancy or the location of the pregnancy is unknown, a laparoscopy may be carried out.

This is a type of keyhole surgery carried out under general anesthetic (where you’re asleep) that involves making a small cut (incision) in your tummy and inserting a viewing tube called a laparoscope. Your doctor uses the laparoscope to examine the womb and fallopian tubes directly.

If an ectopic pregnancy is found during the procedure, small surgical instruments may be used to remove it to avoid the possible need for a second operation later on.

Unfortunately, the fetus (the developing embryo) cannot be saved in an ectopic pregnancy. Treatment is usually needed to remove the pregnancy before it grows too large.

Treatment

The main treatment options are:

• expectant management – your condition is carefully monitored to see whether treatment is necessary
• medication – a medicine called methotrexate is used to stop the pregnancy growing
• surgery – surgery is used to remove the pregnancy, usually along with the affected fallopian tube.

These options each have advantages and disadvantages that your doctor will discuss with you.

They’ll recommend what they think is the most suitable option for you, depending on factors such as your symptoms, the size of the fetus, and the level of pregnancy hormone (human chorionic gonadotropin, or hCG) in your blood.

Expectant management

If you have no symptoms or mild symptoms and the pregnancy is very small or can’t be found, you may only need to be closely monitored, as there’s a good chance the pregnancy will dissolve by itself.

This is known as expectant management.

The following is likely to happen:

• You’ll have regular blood tests to check that the level of hCG in your blood is going down – these will be needed until the hormone is no longer found.
• You may need further treatment if your hormone level doesn’t go down or it increases.
• You’ll usually have some vaginal bleeding – use sanitary pads or towels, rather than tampons, until this stop.
• You may experience some tummy pain – take paracetamol to relieve this.
• You’ll be told what to do if you develop more severe symptoms.

The main advantage of monitoring is that you won’t experience any side effects of treatment.

A disadvantage is that there’s still a small risk of one of your fallopian tube splitting open (rupturing) and you may eventually need treatment.

Medication

If an ectopic pregnancy is diagnosed early but active monitoring isn’t suitable, treatment with a medicine called methotrexate may be recommended.

This works by stopping the pregnancy from growing. It’s given as a single injection into your buttocks.

You won’t need to stay in hospital after treatment, but regular blood tests will be carried out to check if the treatment is working. A second dose is sometimes needed and surgery may be necessary if it doesn’t work. You need to use reliable contraception for at least 3 months after treatment. This is because methotrexate can be harmful for a baby if you become pregnant during this time.

It’s also important to avoid alcohol until you’re told it’s safe, as drinking soon after receiving a dose of methotrexate can damage your liver.

Other side effects of methotrexate include:

• tummy pain – this is usually mild and should pass within a day or two
• dizziness
• feeling and being sick
• diarrhea

There’s also a chance of your fallopian tube rupturing after treatment. You’ll be told what to look out for and what to do if you think this has happened.

Surgery

In most cases, keyhole surgery (laparoscopy) will be carried out to remove the pregnancy before it becomes too large.

During a laparoscopy:

• you’re given general anesthetic, so you’re asleep while it’s carried out
• small cuts (incisions) are made in your tummy
• a thin viewing tube (laparoscope) and small surgical instruments are inserted through the incisions
• the entire fallopian tube containing the pregnancy is removed if your other fallopian tube looks healthy – otherwise, removing the pregnancy without removing the whole tube may be attempted.

Removing the affected fallopian tube is the most effective treatment and isn’t thought to reduce your chances of becoming pregnant again.

Your doctor will discuss this with you beforehand, and you’ll be asked whether you consent to having the tube removed. Most women can leave hospital a few days after surgery, although it can take 4 to 6 weeks to fully recover.

If your fallopian tube has already ruptured, you’ll need emergency surgery.

The surgeon will make a larger incision in your tummy (laparotomy) to stop the bleeding and repair your fallopian tube, if that’s possible. After either type of surgery, a treatment called anti-D rhesus prophylaxis will be given if your blood type is RhD negative.

This involves an injection of a medicine that helps to prevent rhesus disease in future pregnancies.