Missed Diagnosis of Incomplete Abortion

This case involves a thirty-two-year-old female who became pregnant and wished to terminate the pregnancy and induce an abortion immediately after hearing the results of a serum pregnancy test. The patient took the prescribed medical abortion pills and presented for a two-week follow up with significant complaints of weakness, nausea, and intractable vaginal bleeding. It was determined that the patient had an ectopic pregnancy that went undiagnosed due to the poor quality ultrasound imaging study. The patient required an emergency hysterectomy as the patient developed complications including severe uterine hemorrhage.

Question(s) For Expert Witness

1. How does this condition occur and what is the importance of a timely diagnosis?

Expert Witness Response

To diagnose ectopic pregnancy early on, the physician should measure the levels of beta HCG (b-HCT) and also perform a transvaginal ultrasound. These are diagnostic tests done early in order to prevent tubal rupture. Ectopic pregnancy presents a major health problem for women of childbearing age. In a normal pregnancy, the blastocyst (the conceptus) implants itself in the uterine cavity and a developing fetus matures in the uterus. Ectopic pregnancy happens when the blastocyst implants and matures outside the endometrial cavity (the most common place is in the fallopian tubes) which ultimately can become a life-threatening situation for the patient. If managed early on, ectopic pregnancy can be managed with medical treatment such as methotrexate. On the other hand, when the patient presents with hemodynamic instability, severe abdominal pain, and high β-HCG levels (>200) must be managed surgically.