Pregnancy Misdiagnosis

What is the name of your state? MA

I am pregnant ( 4.5 weeks at the time) and went to the ER with cramping. The OB wanted to rule out ectopic pregnancy so she sent me for ultrasound. The radiologist diagnosed me with ectopic pregnancy, even though my HCG levels were doubling normally and there was "an empty gestational sac." So based upon the radiologist's diagnosis, the OB decided Methotrexate would be the best option for me to dissolve the pregnancy. She recommended I follow up in four days for repeat HCG levels and I did as instructed. Well, my quant went up from 3800 to 12000. They did an ultrasound and found I have an intrauterine pregnancy NOT AN ECTOPIC!!! Now I have to consider whether I want to terminate this baby I wanted so badly because I was given a Category X drug. Do I have a case?? Thank you.

At this early stage the ultrasound may not have detected an IUP while it might detect an EP, it is possible to have both (twins) and the EP is life threatening to you and your future fertility. It is also too early to make a determination if there was any malpractice and there is no way to save a failing pregnancy or transplant an EP into the uterus. At 4.5 weeks LMP the GS on an ultrasound might look empty and a few days later the fetal poles visable. Methotrexate alone might not clear the pregnancy, yet there is a very small window for maternal safety and no way to safely clear an EP and save an IUP that may also exist with any assurance, surgery might be required but also affect your fertility, there are a lot of thigs to consider and no perfect or sure answer. Here is a site where you can learn all you could want to know about OB ultrasounds http://www.ob-ultrasound.net/
Normal bHCG expects increase/decrease double every48-72 hours, a single bHCG is not diagnostic of anything except possible pregnancy, the levels can vary and based on implantation date, so dating a pregnancy by bHCG is not exact (there are other reasons for elevated HCG) Usually, a repeat bHCG is required in 48 hours to monitor the progress of a normal pregnancy if there is a question, so without that one cannot be sure if both pregnancies were failing and the exact times of the test may make a difference in prognosis, in your case it was done in <48?>96 hours expecting your level to drop from 3800 to approx 950 otherwise an additional Rx of Misoprostol to clear the failed pregnancy if the Methotrexate failed to clear it. In your case they rose, which sometimes happens but less than the expected amount which could indicate several things.

You may still have several options since it is still <6weeks LMP, have another bHCG 48 hours after the last one and see which direction the levels are going up and or down and have a repeat ultrasound (at least VUS but not AUS alone) depending upon the results, you will have some decisions to make. Since only Methotrexate was used there is a slight possibility the IUP may remain viable, but even if that is the case, you will still have to be sure that the EP is cleared. I hope this information is helpful and please try to take it easy and not stress, as stress may decrease the chances of saving the IUP if it is at all possible and keep us updated, but at this point as unfortunate as your situation is there does not appear to be malpractice from what information you provided. Please note that depending on age and other factors approx. 20-40% of singleton pregnancies are not viable, risks are greater for multiples.

bonitachica

The radiologist diagnosed me with ectopic pregnancy, even though my HCG levels were doubling normally and there was "an empty gestational sac." So based upon the radiologist's diagnosis, the OB decided Methotrexate would be the best option for me to dissolve the pregnancy.

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From the information that I have, an ectopic pregnancy is not diagnosed when a gestational sac is present in the uterus and the HCG levels are 1500 or >1500. If the patient continues to by symptomatic of a threatening rupture of an ectopic pregnancy, repeat ultrasounds are done, specifically intravaginal ultrasounds, and the HCG levels are monitored daily for evaluating fetal development. Methotrexate is not indicated (for initial treatment) for patients whose ultrasounds show a gestational sac and whose HCG levels are >1500.

If the radiologist misdiagnosed the findings on the ultrasound and as a direct result of the misdiagnosis your pregnancy must be terminated, you may have a viable claim of malpractice against the radiologist.

If the OB did not look at the ultrasound films and confirm the diagnosis, you may have a viable claim of malpractice against the OB (if the pregnancy must be terminated).

There may be no need to terminate the pregnancy. It depends on the amount of Methotrexate that you were given and over what period of time you took the Methotrexate.
Fetal development can be monitored for normal development vs abnormal development and you can make your decision based on actual fetal development and not fear.

I assume you are under the care of a competent OB who will guide you through this.

Best wishes,
EC

Wow

I am sitting here in the same situation.

Was basically bullied into a methotrexate injection this past Monday night...I got dresses, shoes and all and started to leave after inititally agreeing to accept the methotrexate. The story wasnt adding up for me. And when I had to point out my HCG result that I knew was on one of the forms the DR had, then it made me stop and think "I have to point out this VERY important value to him, and it is in black and white, in writing, staring at him from a piece of paper and he got it wrong, yet I am allowing him to decide the fate of my unborn child"

He beacame downright forceful and told me I would probably rupture and die in the night if I didn't allow the procedure....and although I have a history of two ectopics, I also have THREE perfectly healthy children from ages 15 to 3 years. So I felt that I would be a selfish mother to put myself in danger and risk them ALL living a life without me, when there was no way this could ever be a "real" pregnancy anyways...

Well, I found out today this is a REAL INTRUTERINE PREGNANCY. I cannot tell you how saddened I am that I did not listen to my own instinct and knowledge over the blatantly oblivious ER dr. The baby is still in there, I suppose there's a small chance that things will miraculously turn out alright, but I don't think I would be a very smart woman to get my hopes up at this point...

I know, from obvious facts that my husband and I conceived, or at least started the process thereof on September 7th. Hubby's birthday. So it was just a little too soon to see everything they supposedly "needed" to see to confirm a pregnancy (aside from my HCG of 3450) and an absence of ANYTHING visulized in my fallopian tubes whatsoever

The final line of my radiology report says directly:
"The findings are non-specific and may be seen in the setting of an early IUP versus SAB occult ectopic. Close Follow up is needed. "

From *that* the ER Dr decides I should take the chance to kill my child and proceeds to scare me into doing it. I am going to squat in the back yard when and if I ever get pregnant again in CALIFORNIA. I think...no I KNOW my child and I would be all the safer for it.

Oh during the meantime, he was "consulting" with a mystery OB that I have never seen nor heard of via telephone, and they BOTH supposedly came to the educated decision that they should cut short my birthday baby's life before it ever began. Wow...wonderminds at work. Beware. Really beware.

Thanks for any input
A

I'm amazed that your husband conceived and that you resurrected a three year old thread.

You didn't have to take the pill, you know. You chose to take it to shut up a bully.

Anyway, don't panic; one pill is all you took, right?

&quot;CHOSE&quot; to?

If you call it that, yes, I did.

After being detained in the ER till all hours of the night (we got home at nearly 4 a.m.), and being told over and over by an ER doctor that I would die if I chose to go home without treatment, imagining myself dead in a pool of blood, in bed next to my 3 year old and husband, I "chose" to allow this "Doctor" to know what was best. It IS the reason one goes to the hospital, isn't it? To have your care in the hands of a professional?

What amazes ME is that YOU, who obviosly know absolutely NOTHING about pregnancy, methotrexate, TACT or anything else for that matter, CHOSE to post your filthy venomous ignorance on this THREE YEAR OLD THREAD rather than mind your own simple business.

METHOTREXATE is not a pill, at least in my case it wasn't. It was an injection. I have no idea IF it comes in a pill form or not. Why don't YOU look it up. Try Google, it's a wealth of information. And it will give you something better to do than harrass a pregnant woman who has been crying for nearly 5 straight days, and absolutely SICK with worry, not to mention a garden variety of other ailments you will never begin to comprehend the gravity of. ONE injection is usually all it takes to terminate, or at least begin the termination of a pregnancy. It's extremely potent and toxic.

What an evil soul you are. All I have to say to you is, what comes around goes around. (You can Google THAT as well, if you don't understand it's meaning.)

What would posess you to post such a evil intentioned message? Yes, it was a miracle that *I* concieved, with only one intimate night between my husband and I in an entire month. Which is all the more reason I would want to save and protect this pregnancy by ANY means possible.

BTW, My HUSBAND did not concieve, as you posted for the mere fact that MEN DO NOT GET PREGNANT...in case you may not have noticed. Maybe you haven't reached that day in school yet. But I would think a bit of common sense would demonstrate that small fact of life to you plentifully.

Now if anyone has anything HELPFUL to add, I would be most appreciative.

If anyone else wants to get fiesty with me, trust me....I am not afraid to tangle with Satan himself at the moment.

Um, who attached her post to a 3 year old thread to begin with? It wasn't lya.

I did mean to say, "one dose"...gosh, I made a mistake. I suppose that justifies the emotional tirade by the OP.

And, that's all I'm gonna say about the OP's clever response.

That would be ME

Yes, I attached my post to a three year old thread. A fact I noticed just after hitting the reply button, but then I decided "Does it really matter the age of the thread when it contained ALL the information I would've needed to post anyway?

I apologize if it stirred any old emotions for the original poster, that I did not consider. That was cruel on my part and I do truly apologize.

Other than that, I am wondering what the hell I did to deserve yet another helping the 10,000 helping of hot steaming chit I've had served to me these past 5 days? Is this forum generally so damn mean? If so I will hapilly take my catastrophe elsewhere.

Ayla said:

Yes, I attached my post to a three year old thread. A fact I noticed just after hitting the reply button, but then I decided "Does it really matter the age of the thread when it contained ALL the information I would've needed to post anyway?

I apologize if it stirred any old emotions for the original poster, that I did not consider. That was cruel on my part and I do truly apologize.

Other than that, I am wondering what the hell I did to deserve yet another helping the 10,000 helping of hot steaming chit I've had served to me these past 5 days? Is this forum generally so damn mean? If so I will hapilly take my catastrophe elsewhere.

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huh??

Anyhoo, yes, the age of the post does matter. Basically you hijacked another poster's thread. You need to start one of your own.

Lya is a very knowledgable, experienced medical professional. I honestly don't see how you could have misinterpreted her response as "mean". .

The ER Physician consulted with the OB via telephone after obtaining the results of your US. That was appropriate. You could have refused treatment, AMA, and gone home. I wonder....what would you, or your family, have done if you were sent home with an ectopc that eventually ruptured?

Wow

If lya has ANY of you fooled into believing she is a "very knowledgeable, experienced medical professional" then.....I just don't have the words, sorry. Unbelievable. You need to reevaluate what and whom you consider a "knowledgeable, experienced medical professional" before you or your loved ones winds up dead, disabled or otherwise.

I'd love to know what your qualifications are exactly, lya? Please. fill me in.

A trained medical professional SHOULD know that a category X drug in pregnancy is not something to which you would comment "Anyway, don't panic; one pill is all you took, right?"

This ONE DOSE is especially designed to do just that, END a pregnancy. Wouldn't you feel a little freaked out too, were you to find yourself in the situation?

A trained medical professional would also know better than to make a statement such as "I'm amazed that your husband conceived and that you resurrected a three year old thread."

Yep, I'd be amazed if my HUSBAND conceived too. That would be a dandy miracle. Does that happen often in your neck of the woods, or am I missing something?


If it weren't for the very knowledgeable, experienced medical professional(s) that I had the misfortune of dealing with this past Monday, life would be a big stinkin' bowl of cherries for me right now.

Instead, because of a totally oblivious Dr., I now "get" to decide whether to pursue this much desired pregnancy, in hopes of a normal healthy outcome (which the statistics are REALLY dismal) Can you imagine carrying a child inside your body for 9 months, THEN adding to the normal, natural concern any mother endures in regards to her unborn child during that time by increasing the odds of it's demise to about 90%? THAT'S cruel to say the VERY least.


OR, I could just allow them to finish offing my baby right now, and wonder for the rest of my life if it would have been all right.

Not an easy decision to make. I suggest placing yourself or your wife, mother, sister, loved one, etc., in my shoes and take a moment to reconsider your question about why I would take offense to lya's post. It was plain mean. And if I really need to explain WHY then you people are so far beyond help, I won't even BEGIN to waste my time explaining.



As far as resurrecting a 3 year old thread, for Pete's sake shoot me. I googled, it came up. I posted because my situation is identical. Most forums suggest that a user search the archives of any particular subject BEFORE starting redundant threads. If that's not the way things work here, A) I hardly think it mattered. If you all are so anal that something so trivial is going to get you all riled up when I was posting with a real, legitimate, medical NIGHTMARE for myself and my Husband and family then you really need a refresher course in manners. Or is it common practice to bash someone new to your site from all ends over a DATE? If you are all "knowledgable, experienced medical professionals" then I can't say I'm surprised by your bedside manner. Not one bit.

Let's see if this post actually shows. I tried to post similarly at least 3 times today, but mysteriously, none of the posts appeared. I'll save this one in case I need to copy and paste again.

Oh and in response to your query "I wonder....what would you, or your family, have done if you were sent home with an ectopic that eventually ruptured?"


Well, that would be the reason I went to the ER in the first place, to determine if it WAS a bona fide ectopic. Not to murder my perfectly healthy (by all indicators so far) fetus. So I SHOULD have had NO reason to fear any such outcome as rupturing and dying. Or is the medical community on the practice of offing any and all pregnancies they choose, just because of the risk they carry? Even a perfectly normal healthy pregnancy has it's risks, maybe we should abort those too...just in case?


And the snarky remark at the end of your post which I see you have now deleted...what am I here for? Or what am I after? I can't recall your precise wording, but I catch your "subtle hint" I'm here for the same damn reason the rest of you are. It's in the title of the forum, Dear. "Medical and Health Care Malpractice Includes Doctor, Dentist, Druggist, Hospital and Nursing Home Malpractice" I don't understand where that needs clarification.

What I also don't understand is WHY I continue to waste my time and energy posting here. You all are obviously hopeless. But you're making it practically irresistible not to respond...I've never seen such ignorance in my life.

well.....

bonitachica said:

What is the name of your state? MA

I am pregnant ( 4.5 weeks at the time) and went to the ER with cramping. The OB wanted to rule out ectopic pregnancy so she sent me for ultrasound. The radiologist diagnosed me with ectopic pregnancy, even though my HCG levels were doubling normally and there was "an empty gestational sac." So based upon the radiologist's diagnosis, the OB decided Methotrexate would be the best option for me to dissolve the pregnancy. She recommended I follow up in four days for repeat HCG levels and I did as instructed. Well, my quant went up from 3800 to 12000. They did an ultrasound and found I have an intrauterine pregnancy NOT AN ECTOPIC!!! Now I have to consider whether I want to terminate this baby I wanted so badly because I was given a Category X drug. Do I have a case?? Thank you.

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Here is what I see ( I did not read the other posts as there is some sort of argument going on) You state that your numbers were doubling normally. They would do that, even with an ectopic. It sounds like you might have had an interuterine and ectopic pregnancy at the same time. It does happen and I have seen it myself in our ER. If you had an ectopic and it was not taken care of, you might have ruptured, lost a tube or died. The dr acted in your best interest at the time. As far as the pregnancy goes, it is up to you whether to assume the risks of the pregnancy continuing. I wish you luck.

longsally: You quoted the OP, who is no longer a member, AND whose post is 3 years old. This thread was resurrected by some rude person.

well...

why would someone do that? kind of dumb if you ask me. oh well.

Ayla provided us with no information as to why she went to the emergency room. Presenting symptoms and physical findings also direct the course of treatment.

I agree that the HCG level should have suggested a different course of treatment such as follow-up ultrasounds. Though, it has to be asked why she did not tell the physician of her HCG level and her desire to wait.

To point out the obvious, the OP should consult with a medmal attorney if she believes she has suffered damage as the direct result of an act of negligence.

I find it humerous that she and her husband conceived. My bad.