Approximately 1 in 5 pregnancies lead to miscarriage, with over fifty thousand admissions following miscarriage occurring in the UK per year.
One in a hundred pregnancies (roughly 2,500 per year) is ectopic: ie. a fertilised egg settles not in the womb, but elsewhere such as in either of the fallopian tubes.
At ovulation, an egg sets off from the ovary and combines with a successful sperm so an embryo can develop. The fertilised egg usually settles in the womb (uterus). However in an ectopic pregnancy, the fertilised egg adheres to other tissues e.g. to the wall of one of the fallopian tubes, or even within the abdomen. These are not sites that are conducive to developing an embryo, for example there is limited space for expansion within the fallopian tubes - and rupture can occur.
There is a risk to the mother with an estimated risk of death of 2 in a 1,000 pregnancies. Other consequences include loss of future fertility owing to fallopian tube damage or even removal.
There are key questions which should be considered when looking at cases of ectopic pregnancy, i.e. these are essential ones that should be asked.
These include:
Did you have abdominal pain, absent or irregular periods, vaginal bleeding with or without clots?
Were there any of these features: pain in the abdomen, pelvis or vaginal area?
Did you have a pregnancy test and if so, when?
If there is vaginal bleeding in a pregnancy under 6 weeks of age (without abdominal pain), the pregnancy test is usually repeated 7-10 days later and if positive, the patient should be asked to return.
Other important questions relating to the possibility of ectopic pregnancy include asking about less common symptoms, such as:
- Breast tenderness
- Gastrointestinal symptoms
- Dizziness
- Fainting
- Syncope (fainting caused by loss of blood pressure)
- Shoulder tip pain
- Urinary symptoms
- Pain on passing stool
Finally, the following represent symptoms and signs that are of concern and mandate emergency care:
Was there pain on coughing, pallor, abdominal distension/tenderness, enlarged uterus, collapse, hypotension, fast heart rate?
These features are associated with severely ill patients and need urgent gynaecological input.
The interval between the initial symptoms or signs to when help was first sought, and the interval between the initial consultation and the diagnosis being made are very important aspects to tease out from the medical accounts.
Medicolegal Aspects
Women with miscarriage often present with non-specific pain and discomfort, and if the diagnosis is not considered, there is a significant morbidity, a risk of not being able to have children in the future and even mortality. When looking at a case, these questions should help in thinking if there had been negligence.
If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim for Clinical Negligence - or indeed any other type of injury, please contact the Dutton Gregory Clinical Negligence Team on (01202) 315005, or email contact@duttongregory.co.uk
NB This article does not constitute legal advice and should not be relied on as such. No responsibility for the accuracy and/or correctness of the information and commentary set out in the article, or for any consequences of relying on it, is assumed or accepted by any member of Dutton Gregory..
