Doctor may have mistaken ‘ovary for ectopic pregnancy’

A doctor likely mistook a woman’s ovary for an ectopic pregnancy before giving her medication to terminate it, an expert has said.

Philip Owen also said it was more than likely that the woman had a continuing normal pregnancy in her womb when she was given the medication.

It is alleged at a Medical Council inquiry that a consultant obstetric and gynaecologist, Dr A, wrongly diagnosed an ectopic pregnancy in the case of Laura Esmonde at South Tipperary General Hospital in January 2013 when the pregnancy was actually in the womb.

The Medical Council inquiry previously heard Dr A advised the woman the safest course of action was to take two courses of methotrexate, a medication used to stop ectopic pregnancies growing.

On the evening of January 8, Ms Esmonde took her first dose. On January 17, she was readmitted for a second dose. No further ultrasound was conducted before this second dose, she said, although her husband requested one.

On January 26, she was transferred to Cork University Hospital for treatment of a leg clot, where a scan indicated her pregnancy was not ectopic. A further scan showed a normal intrauterine pregnancy but it was no longer viable. Ms Esmonde miscarried on February 2.

On day five of the hearing, Dr Owen, a consultant obstetrician and gynaecologist in Glasgow, said he could not say for sure an ectopic pregnancy did not exist but that it was “extremely unlikely”.

He said he could not be certain the woman had an ongoing normal pregnancy, as no one detected a heartbeat, but that it “seems overwhelmingly likely” she did.

The inquiry heard the woman underwent four ultrasounds and that three medical professionals said they believed they were “at least suspicious of an ectopic pregnancy”. The committee asked Dr Owen about the assertion by one doctor that one of scans showed a “right tubal ectopic pregnancy”.

“My interpretation is he was looking at small fluid area within the right ovary and mistook it for an ectopic pregnancy,” Dr Owen said.

Counsel for Dr A, Simon Mills, asked Dr Owen about the decision by his client not to review the diagnosis between the first and second doses of methotrexate. Dr Owen said he would have but could not point to guidelines or practise rules which mandate it. He said if there was a pregnancy in the womb, the “uncomfortable question” is why it was not detected.

“The likelihood, I’m reluctant to say, is that the scan technique in the ultrasound was not up the appropriate standard,” said Dr Owen.

The inquiry continues on Wednesday when Dr A will present his case.


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