Wrongly diagnosed with an ectopic pregnancy

[Rayne07]

What is the name of your state (only U.S. law)?
Wisconsin

I found out i was pregnant August 2012. I am a high risk pregnancy due to blood disorders. I also have major infertility issues and do NOT get pregnant easily. The week after I found out, I had an ultrasound with my perinatologist. He said that he did not see anything in my uterus. But when he checked my pregnancy hormone levels (hcg) they were high. So he rechecked them in a few days and they had doubled...as they should have in a normal pregnancy. I believe they were about 3500 and he called me a few days after that, telling me that I needed to go to the ER right away. He told me that he should have seen something in my uterus...and that at about 1000 for an hcg level you should definately see something. So the fact that my level was WELL above 1000, he thought I was having an ectopic pregnancy. (I have miscarried 6 times before). But this was different. And I told him that. I knew what it felt like to miscarry. I wasn't bleeding, no cramping, and I felt pregnant. But I proceed to the ER anyways. Once there I had an ultrasound. I prodded the ultrasound technician in tears. This was a very desired pregnancy! She told me that she could see "something" in my uterus, but wanted the radiologist and the OB that was on for my regular OB to look at it first. I waited in the ER waiting room....they didn't even put me in a patient room...and my husband and I were rightfully upset and I was crying. When the OB finally called us into a room after 2 hours, she said that she saw the baby in my left Fallopian tube. She said that I had two options. 1. I could have surgery to remove the fetus, and my left tube, because the tube was "damaged", and would pose problems for any future pregnancies, or 2. I could get the methotrexate injection. And she strongly urged me to get the methotrexate. My husband and I talked about it and decided it would be best to have the surgery and remove the tube. She was not happy about the decision, and let us know that. But I stuck to my decision. She put me in the hospital overnight as i was to have surgery early the next morning. Still no bleeding, and no cramping...felt great, and pregnant. The next morning, another OB came in and told me that the OB on call from the night before got "sick". So she would be performing the surgery. They prepped me and put me under anesthetic for surgery. When I woke up, the OB that did the surgery said, "I should have looked at the ultrasound before I operated, because I didn't find anything in your tubes, and I DO see something in your uterus!!!! I was SHOCKED! So she left my tube, and stitched me up. I had to go back 2 days later for another ultrasound, and they found TRIPLETS!!!!! The on call OB said that the reason they couldn't see anything in my uterus prior was because there were so many, and they were too small. She said that she was shocked, and thought from the ultrasound prior to my surgery, that there was just one fetus. But they were all wrong again! Now about 8 weeks later I am pregnant with only 2. One did not make it. When my regular OB got back she said that anesthetic is very dangerous for fetuses. But that it was an all or nothing thing...it would either kill all of them, or they all would be fine!!!!! But I wonder if the one that did not make it was affected by it. I don't know though. Either way I am extremely angry that they put me through this, and then admitted that the ultrasound should have been looked at prior to putting me under anethesia. So I don't know if there is anything I can do about this or not?

 

[jiggy78]

Do you have a legal question?

Also please provide the name of your State.

 

[ecmst12]

Congrats on your pregnancy! I know the loss of the 3rd fetus is still a loss and still painful, but it was most likely related to a chromosomal problem or other defect and couldn't have been prevented. Your 2 remaining babies now have a much better chance of making it to full term and coming out healthy than if you had continued with the triplet pregnancy. I would say you are VERY lucky that your surgeon was able to recognize what was going on and avoid doing damage to your pregnancy.

You should also recognize that looking at an ultrasound is not like looking at a TV picture, even with trained experienced pros there is a lot of interpretation that goes on and 2 radiologists won't always interpret the same way. But when the surgeon was actually looking at your insides, it was a lot easier to see what was really going on. A very early pregnancy is a tiny, tiny speck on an ultrasound and a heartbeat isn't visible for about 6 weeks (counting from the last menstrual period), so it is harder to confirm IF a pregnancy is there until that point, WHERE it is, and how many there might be. And the chance of miscarriage prior to heartbeat is about 20%, after heartbeat it goes down to 5%.

In other words, even though you had a wrong diagnosis that doesn't necessarily mean there was malpractice, and you currently have about the best possible outcome that you could ask for in this situation. I wish you luck with the rest of your pregnancy!

 

[anearthw]

Congrats on your pregnancy and sorry you went through that ordeal.

You can file a complaint with the hospital so that the ultrasound technicians/radiologists are aware of the mistake and will be able to review their procedures/practices.

As for any relation between the loss of the 3rd triplet and the anesthesia, there is really no way you could hope to prove that. Triplet pregnancies are very high risk, from conception to birth, it is very common to lose one, two, or all of them at any moment, without any reason known (most likely from a chromosome defect).

I understand that it is painful to lose part of a multiple pregnancy (I am currently pregnant with a singleton but lost the twin), but there is just too much instability with multiple pregnancies and one cannot prove anything at that stage. If it had been at 32-36 weeks (ie. when most triplets are born) then a cause of death may have been determined, but not in the first trimester.

Good luck and congratulations on your twins.

 

[betachains]

Of the common imaging modalities, ultrasound provides the fuzziest images. Yes, in later pregnancy you can see the fetus with heartbeat and movement. But for small structures (as in your case), the smudges on the screen are not that clear cut.

The reasons for trying to avoid anesthesia during pregnancy are several-fold. The dangers in modern-day practice are pretty low, and cannot be separated from the surgical manipulation and peri-op stress response. I doubt that your laparoscopy had any effect on the future course of your pregnancy.

What should you do? You can always run it by a med-mal attorney and his panel of experts, but I don't think you have a good claim. However, you should ask your hospital to review the case, since obviously 2 OB's interpreted your original ultrasound differently. Perhaps there is a pattern of errors, or perhaps a remote 3-rd party (like a radiologist) should review questionable images. It may not help you directly, but it is useful for future patient care.