Emergency Medicine Physician Misses Diagnosis of Ectopic Pregnancy

This case involves a twenty-nine-year-old female patient who presented to the emergency room with severe abdominal pain and scant vaginal bleeding. She was using an IUD at the time and concern arose that it may have perforated her uterus. After receiving the general workup for abdominal pain that included a negative urine pregnancy test, the patient was sent for a CT-scan of the abdomen. During the diagnostic study, the patient sustained cardiac arrest in the abdominal radiology ward. CPR was initiated and performed for forty-five minutes but a normal rate and heart rhythm were unable to be attained. After further investigation on autopsy, it was determined that the patient fatally suffered from an ectopic pregnancy that ruptured while she was on the CT-scan table. The patient’s cause of death was due to internal hemorrhage and cerebral hypoxia secondary to cardiopulmonary arrest.

Question(s) For Expert Witness

1. What diagnostic criteria are essential to ruling out an ectopic pregnancy?

Expert Witness Response E-000051

Patients with early, normal intrauterine pregnancies often present with signs and symptoms similar to those encountered in patients with ectopic pregnancies and other gynecologic or gastrointestinal conditions. The availability of various biochemical, ultrasonographic, and surgical modalities can aid the healthcare provider today in establishing a definitive diagnosis and differentiating among various conditions. In order to reduce the morbidity and mortality associated with ectopic pregnancy, a high index of suspicion is necessary to make a prompt and early diagnosis. Ultrasonography is probably the most important tool for diagnosing an extrauterine pregnancy, although it is more frequently used to confirm an intrauterine pregnancy.