HSE review into ectopic pregnancy misdiagnosis claim

The HSE is conducting an external review into the care of a woman who claims she was wrongly diagnosed with an ectopic pregnancy and given a drug to halt the development of the foetus.

The medical notes of Laura Esmonde, seen by the Irish Examiner, show that scans carried out at South Tipperary General Hospital (STGH) in January 2013 record a diagnosis “suggestive of ectopic pregnancy”.

Laura, 35 at the time, was treated for an ectopic pregnancy and given a drug, Methotrexate, to bring it to an end, because this type of pregnancy is life-threatening for the mother.

However, when Laura was subsequently transferred to Cork for treatment of another, separate condition later that month, a scan carried out at Cork University Maternity Hospital recorded “a visible intrauterine sac”.

The report compiled on foot of this scan notes that she had been treated for an ectopic pregnancy.

However, the CUMH scan appeared to show the pregnancy had been in the womb (intrauterine) rather than ectopic or “extrauterine” (outside the womb). The CUMH report also reported “non viable gestation now”.

Other medical notes from CUMH refer to “non viable intrauterine sac and fetal pole but no fh [foetal heartbeat]”. A fetal pole is the term used for the earliest signs of a baby in an early pregnancy ultrasound. In other words, the notes record that there was a gestational sac in the uterus, and there were early signs of a baby, but no heartbeat. At this point, Laura’s medical notes refer to a “long discussion with the patient”.

Laura contends that this discussion was on foot of being told at CUMH that she had an intrauterine, and not an ectopic, pregnancy.

If this was the case, then she should not have been given Methotrexate, she claims.

Laura, a mother of two daughters from Old Monastery Rd outside Tipperary Town, complained in March last year to STGH. The preliminary findings of a confidential internal review of her case, instigated after she made the complaint, made no findings in relation to her claim of a misdiagnosis. It noted that an ectopic pregnancy was diagnosed by three separate ultrasound scans performed by three separate staff.

It said the ectopic pregnancy was confirmed using a best practice clinical guideline drawn up by the Institute of Obstetrics and Gynaecology for the Ultrasound Diagnosis of Early Pregnancy Miscarriage.

There is no analysis or mention of a different pregnancy diagnosis at CUMH because the review is confined solely to her treatment at STGH.

When the Irish Examiner asked the HSE if there had been any discussion or follow-up between CUMH and STGH in relation to the differing diagnoses, we received the following response: “As part of the HSE’s serious incident protocol, an external review of Ms Esmonde’s care in STGH in 2013 is under way. Staff in South Tipperary General Hospital are co-operating fully with this review as are clinicians in Cork University Maternity Hospital who are sharing any information required.

“Ms Esmonde is involved in this review process and will be presented with the findings, once finalised.

“It is not possible to comment further as this review process is not yet complete.”

A National Misdiagnosis of Miscarriage Review was carried out in Ireland in 2010/2011 after a number of women publicly claimed to have been wrongly told their pregnancies were not viable following ultrasound testing, yet they went on to have a live birth. Of 24 cases investigated, the review found 22 women went on to give birth. In five cases women had live births after taking medications to induce miscarriage.