Doctor faces inquiry over ‘wrong diagnosis’ of ectopic pregnancy

A Tipperary woman whose pregnancy was allegedly misdiagnosed has recalled how she responded to the news by wanting to "kill" anyone who harmed her baby.

Laura Esmonde, a married mother of three, recalled being very upset and distressed on being told that her pregnancy in 2013 was normal and not outside the womb, as she believed.

She said doctors in South Tipperary General Hospital had previously told her she had an ectopic pregnancy, which is not viable, but subsequent tests in Cork University Hospital found that the pregnancy was in fact in the womb. By then, however, she had been administered two doses of methotrexate, a drug used to end early pregnancies. She miscarried shortly after.

Ms Esmonde was giving evidence at a disciplinary hearing at the Medical Council into a consultant obstetrician at South Tipperary, identified as Dr A, who is accused of poor professional performance.

Dr A denies the allegation and says he told Ms Esmonde she had a "pregnancy of unknown location, most likely to be ectopic," according to his barrister, Simon Mills.

Pulmonary embolism

Her health had been good prior to attending hospital, Ms Esmonde told the fitness-to-practise hearing. She had suffered a pulmonary embolism after giving birth to her second child in 1999, but recovered well. She said she woke in pain in the early hours of January 6th, 2013. Her leg was badly swollen and had turned a deep purple colour. She went to the hospital in Clonmel where deep vein thrombosis was diagnosed. Tests also revealed she was pregnant and the nurse congratulated her. "I was shocked. It was a lot to take in but I was happy about being pregnant."

However, Dr A told her the pregnancy was ectopic after an ultrasound was performed. He said she had three options – surgery, medical management using drugs or letting the pregnancy end naturally. Dr A told her surgery was not an option because she was on blood thinners and she could “bleed to death”, she said. Ms Esmonde said Dr A warned that if no action was taken she could simply die in her sleep if there was a rupture.

“He was very nice and sympathetic. I was tearful and crying, I had trust in him. I said ‘I can see what you’re saying’. I said I was happy to take his advice.”

Neasa Bird, barrister, for the chief executive of the council, said Ms Esmonde agreed to the administration of methotrexate to end the pregnancy and was discharged on January 12th but her blood levels did not fall as quickly as might be expected for an ectopic pregnancy.

She was given a second dose on January 17th. On January 25th, she was transferred to Cork University Hospital for treatment of the clot. In Cork, the maternity unit performed a scan.

The result was not consistent with an ectopic pregnancy but with an intra-uterine pregnancy that was now not viable. Ms Esmonde said she wandered around the halls of the hospital in distress.

“I was so angry. I remember saying ‘I can cope with anything happening to me but, if anyone hurts my baby I just want to kill him’.”

She was discharged on January 31st but miscarried days later. Simon Mills, barrister, for Dr A, said Ms Esmonde was unwell throughout this period as a result of her clot and was at significant risk if she bled.

He said she underwent four separate ultrasounds by four different people and none disclosed a pregnancy in the womb. Mr Mills said he planned to call expert witnesses who would say this was never a viable pregnancy.

Weeks after Ms Esmonde miscarried, Dr A wrote to a colleague in Cork saying he had diagnosed a pregnancy of unknown location in her case. This was later amended to “possible ectopic pregnancy” following complaints by the patient. Before the hearing, Mr Mills sought to have the hearing held in private, but the committee refused this request. It agreed that Dr A would not be referred to by name.

Misinterpreting

Dr A is accused of misinterpreting her ultrasound scans as being indicative of an ectopic pregnancy while ruling out a normal pregnancy in the womb. Ectopic pregnancies occur outside the womb and are not viable; they also pose a serious risk to the health of the mother.

It is alleged Dr A failed to consider Ms Esmonde’s rising levels of a hormone use to evaluate a possible pregnancy in the early stages. It is alleged he failed to reconsider a diagnosis of a “pregnancy of unknown location” and to recommend the option of conservative management of the patient. He directed the administration of methotrexate in circumstances where he was not entitled to exclude a viable pregnancy in the womb, it is also alleged.