Ectopic pregnancy diagnosis challenged

Laura Esmonde: Clot on leg. Picture: Don Moloney/Press 22

A top obstetric expert said she saw a gestational sac inside a mother’s womb — in sharp contrast to prior evidence given at the inquiry into a doctor who allegedly misdiagnosed an ectopic pregnancy.

Dr Keelin O’Donoghue said she found evidence of an intrauterine gestational sac, when she performed a scan on Laura Esmonde at Cork University Maternity Hospital on January 27, 2013.

Dr O’Donoghue, the lead clinician for obstetric ultrasound and foetal medicine at CUMH, told the Medical Council inquiry yesterday that she saw no mass signifying an ectopic pregnancy.

She did not see anything clearly within the sac, such as an embryo “but, for me, it looked like an intrauterine pregnancy”, she said.

Dr O’Donoghue told Ms Esmonde, 38, of her findings and that the pregnancy might have been intrauterine all along.

She added that, at that point, the viability of the pregnancy was uncertain.

She told the hearing that three of her colleagues also saw evidence of an intrauterine gestational sac.

The inquiry is looking into claims that a consultant obstetrician and gynaecologist working at South Tipperary General Hospital — referred to as Dr A — wrongly diagnosed an ectopic pregnancy in the case of the mother of three who presented at the hospital on January 6, 2013, with a swollen leg.

Dr O’Donohue’s findings contrasted sharply with conclusions seemingly drawn by Dr A and colleagues at STGH.

During her evidence, senior radiographer Niamh Lonergan, who worked at STGH in 2013, said she was requested to conduct a scan on Ms Esmonde’s left leg, to confirm whether she had a clot, on January 7.

The scan showed an extensive clot down Ms Esmonde’s thigh, so the radiographer continued to scan her pelvis. She said she noticed an unusual mass on the right side, near the fallopian tube or ovary. Ms Lonergan said she could also see the thickened endometrium in the womb, which would be consistent with pregnancy, but she could not see any sign of an embryo in her uterus.

Ms Lonergan then consulted consultant radiologist John Hynes, who told the inquiry: “We didn’t see anything within the uterus but it was a very early pregnancy.” He said they raised the possibility that it could be an ectopic pregnancy, and recommended further investigation in the form of a transvaginal scan.

“What’s important to understand is that this patient had two potentially fatal conditions — that, thankfully, did not occur,” he said.

In other evidence yesterday, consultant Isweri Pillay, who also works at South Tipperary General Hospital in Clonmel, said she understood Ms Esmonde was also suffering from an ectopic pregnancy.

Dr Pillay became in charge of the care of Ms Esmonde when she presented at the hospital on January 6, 2013, with a swollen leg. Dr Pillay said she saw Ms Esmonde on January 8 and “there was a definite right tubal pregnancy noted” in her records.

On January 8, Dr A performed a transvaginal scan, and, according to Ms Esmonde, told her she had “an ectopic pregnancy of unknown location”.

Dr A advised that she take methotrexate, which is used to stop cells from growing and can be used to treat ectopic pregnancies. She took her first dose that evening, and a second dose on January 18.

On January 26, Ms Esmond was transferred to Cork University Hospital for the treatment of the clot in her leg — but, as Dr Donoghue said, scans there suggested an intrauterine pregnancy.

On February 2, Ms Esmonde suffered a miscarriage.

The inquiry continues.


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