Doctor ‘not free’ to treat ‘ectopic’ pregnancy

A gynaecologist says a doctor at the heart of an inquiry was “not entitled” to recommend medication that would end a mother’s early pregnancy.

Methotrexate is a a drug used to end an ectopic pregnancy. It should only be advised if a consultant is completely certain of this diagnosis, expert witness and gynaecologist Philip Owen told the Medical Council inquiry in Dublin yesterday.

The hearing 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 mother-of-three Laura Esmonde, 38, when she presented at the hospital on January 6, 2013 with a swollen leg. Dr A then advised methotrexate to end the pregnancy, which Ms Esmonde took on January 8.

Dr Owen, an obstetrician and gynaecologist based in Glasgow, said yesterday that he believed an ultrasound taken on January 7, 2013, by Dr A’s registrar indicated a fluid- filled cyst on the right ovary, rather than an ectopic pregnancy.

Following this scan, Dr A conducted a transvaginal scan, at which point, said Ms Esmonde, he told her she had “an ectopic pregnancy of unknown location”. He then recommended methotrexate.

Dr Owen yesterday said Dr A did not have enough information to confirm a diagnosis of an ectopic pregnancy, and should not have recommended methotrexate.

“In my opinion, he did not have enough information to advise methotrexate. He didn’t have enough information to exclude an intrauterine pregnancy — quite the opposite, in fact,” said Dr Owen. “If everything fits, you can make a diagnosis with confidence, but if everything doesn’t fit, you can’t make a diagnosis with confidence. What it boils down to is this: the entitlement to recommend the administration of methotrexate. Have you met this criteria? No [in this case].”

Dr Owen said Dr A did not note Ms Esmonde’s lack of symptoms for an ectopic pregnancy, nor discuss her potential risk for these pregnancies with her.

“This is important because ectopic pregnancies account for 1% of pregnancies,” he said.

Earlier yesterday, the consultant at Cork University Maternity Hospital, John Coulter, told the inquiry he saw evidence of a pregnancy inside Ms Esmonde’s womb in late January 2013.

Mr Coulter, a consultant gynaecological oncologist, said he performed abdominal and vaginal exams on Ms Esmonde on January 27, 2013. These exams showed no symptoms of an ectopic pregnancy, he said.

Mr Coulter prescribed Ms Esmonde folic acid in case the pregnancy was viable, and arranged for a scan the week after. However, before the scan took place, Ms Esmonde returned to hospital, on February 2, 2013, suffering from a miscarriage.

Pathologist Peter Kelehan, who examined a sample of tissue from Ms Esmonde’s miscarriage, also gave evidence yesterday, which appeared in contrast to Dr Coulter’s testimony.

Dr Kelehan, based in Barringtons Hospital, Limerick, only found evidence of tissue from the womb lining, but no evidence of chorionic, or placental, tissue. A lack of chorionic tissue often signals an ectopic pregnancy, but does not exclude an intrauterine one, Dr Kelehan said.

Under cross-examination, Simon Mills, BL, who is representing Dr A, asked Dr Kelehan whether there was any evidence of an intrauterine pregnancy, at a pathological level.

“No,” said Dr Kelehan.

Dr A denies the allegations against him. The inquiry adjourned until November.