Ruptured Ectopic

What is the name of your state?Virginia
Okay here goes. Married 10 years with 2 boys easily conceived. Marriage got bad, really bad, got a tubal ligation (fulguration/burning) in 2000. Then Divorce. Then....... Remarried New Man w/no children......(March 2002)Got a one sided Tubal reversal. Burning was so bad on other side, tube could not be saved. Reproductive Endocrinologist (RE) that did the surgery, checked the repaired tube on 3 separate occasions with HSG (dye in tubes) great flow, good length, "Looks promising". (8/02) Pregnant, levels dropped Methotrexate for ectopic. (12/03) Pregnant, levels drop fast no Methotrexate needed, Possible ectopic. (01/04)
Pregnant, levels sky rocket, so happy terrible pain. Go to the ER sent home, go back in 7 hrs, same pain different Doc. Ob consult Emergency Laparasopy found 200cc blood in my abdomen, ruptured ectopic. Whole tube removed. In vitro (very expensive) only option.

That is the jist, now more significant details:

*Very compliant patient, 34 years old, Love my RE that performed the surgery and then went on to oversee my infertility treatments.

*Paid for the reversal out of pocket 6 grand. Also paid for 2 attemps with Artificial Insemination resulting in the last 2 pregnancies. (Very dedicated to having a baby)2 1/2 hour drive one way to see RE

*Immediately after reversal RE stated several times as soon as + preg. test must check with transvaginal u/s to rule out ectopic and to protect only tube.

*1st 2 pregnancies mentioned above he was all over it, checking hcg levels and u/s. Pleased and confident with RE.

*Last pregnancy when hcg levels came back + I asked for an u/s, RE said via nurse wait and lets check the blood ( he thought it would drop like before so did I) not alarmed.

*1st blood was 167, when levels reached 600 I called for an u/s (reminding the nurse/RE I needed to protect my tube) wait and see if the #'s double ( still thinking they would drop) Im alarmed.

*#'s at 1207 ...2 days later I called and really demanded an u/s, I asked the nurse to please take my chart to the RE and tell him I want an u/s, she called back and said wait til Fri (4 days away)I cant believe this.

*Although you cant see an ectopic on u/s early by 1207 you should at least see a gestational sac in the uterus. She said he wanted to wait and make sure it is not to early to see what he is supposed to friday ( sac, fetal pole ? heart beat) I was more interested in not seeing anything in the uterus, because that would mean it was ectopic.

*Although I work at a hospital and could have had the u/s there. I had confidence in my RE and was overjoyed to be pregnant. No pain, no bleeding....so I was going to wait til friday.

*There are 2 other REs in his group, if he was to busy they could have checked me, they had before.

*Wed 12 mid. bleeding/ pain rush to ER ...Crazy doc only did u/s no blood work nothing in the uterus sent home to rest .....got home 5 am

*2:00 pm next day severe pain back to ER nice knowledgable Doc, got OB consult had emergency surgery as described above.

*At home crying for about 4 days when RE calls himself and says and I quote "I feel responsible, I want to give you a substantial discount on IVF"

*Substantial discount to him was only 20% off.

Bottom line finally~~~ I think the RE should have scanned me before I asked the first time and the 1st ER doc should have not let me leave.

I feel responsible myself. I have been trying to conceive for awhile and am very knowledgable about the correct protocols of high risk care, but I was so blinded by being happy and scared. I was hoping it was just to early to see anything and that this wasnt an ectopic. Maybe I should have argued with them for what I know to be proper treatment.

Sorry this is so long............ I wanted to paint the whole picture! Do you think I have a case?

eikcaJ
Do I think you have a viable claim? Not really.

By your own admission, the pregnancy was too young to show on an ultrasound and the hormone levels were still rising, indicating a successfully progressing pregnancy.

You don't state any specific time-frames, but based on the hormone levels and the normal doubling of values, you are talking about a very short period of time between confirmation of pregnancy and rupture of the tube.

Monitoring of the blood levels (hormone) is all that can be done until something can be visualized. How can you sue an MD for not performing a test to visualize something that as yet can not be seen? How can you expect the other MDs in the practice to visualize via ultrasound something than can not be seen?

Other than surgery, what can be done with an ectopic pregnancy after the time for Methotrexate has passed?

Wednesday night's ER visit with bleeding and pain--at this time, not even a D & C was indicated; suspected spontaneous abortion is usually allowed to progress naturally to resolution UNLESS the patient's condition shows significant changes that indicate the need for medical intervention.

Thursday's ER visit and surgery--your condition showed significant changes and indicated need for medical/surgical intervention which was provided according to acceptable and usual practice (standards of care).

Although you lost 250cc blood before surgery, keep this in perspective with the negative findings on the ultrasound on Wednesday night's ER visit. This blood loss occurred during the interval between ER visits.

I'm sure you feel that if surgery had been done when you had pain and vaginal bleeding that your tube would have survived, fully functional; but, surgeons don't perform surgery for resolution of a spontaneous abortion with negative indicators for an ectopic pregnancy.

It seems to me that your MD is sharing in your loss but I don't believe he is admitting negligence or malpractice. Perhaps if he had seen you in his office earlier, you would have had less stress but you would still have had an ectopic pregnancy yet undetectable on ultrasound and with hormone indicators of a normally progressing pregnancy. Maybe if he had seen you instead of the ER physicians, he would have recognized the presence of the ectopic pregnancy but you would still have had to have surgery. Yet, in the latter circumstance, you would not have had two ER visits, additional pain and suffering, and possibly not the blood loss of 250cc.

From a plaintiff's stance, you must to be able to prove that the MD knew or should have known that by failing to see you in his office and perform the ultrasound earlier that: you would not have suffered the loss of your tube,
you would not have required surgery, the ectopic pregnancy would not have ruptured the tube, you would not have had additional blood loss, you would not have incurred the expense of the ER visits, and/or you would not have suffered from additional pain (physical and emotional).

Best wishes,
EC

I'm sure ellencee is correct in what she said, as she posses far more knowledge than I in malpractice matters.

I do want to say that it seems strange to me an ectopic pregnancy was not the first thing they checked for, especially with your prior medical conditions. I myself had an ectopic earlier this year, was in pain for 8 hours before finally going to the hospital. I was only 4 weeks pregnant, but an ectopic pregnancy was the first thing they checked out when I cried out what was wrong, how long it had hurt, etc. I feel for you. It literally hurts worse than labor, they removed part of my tube, and I probably won't have another child, which I want (someday). I hope your feeling better, and I'm sorry you won't be able to concieve "normally".

Good luck.