An inquiry into a doctor who allegedly misdiagnosed an ectopic pregnancy has been told that an obstetric expert saw a gestational sac inside the woman’s womb.
Dr Keelin O'Donoghue said she found evidence of the intrauterine sac when she performed a scan on Tipperary woman Laura Esmonde at Cork University Maternity Hospital on January 27th, 2013.
Dr O'Donoghue, the lead clinician for obstetric ultrasound and foetal medicine at the hospital, told a Medical Council inquiry she saw no mass signifying an ectopic pregnancy.
She said she did not see anything clearly within the sac, such as an embryo “but, for me, it looked like an intrauterine pregnancy”.
Dr O’Donoghue told Ms Esmonde (38), of her findings and that the pregnancy might have been intrauterine all along. She said 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 investigating claims that a consultant obstetrician and gynaecologist working at South Tipperary General Hospital (STGH) - referred to as Dr A - wrongly diagnosed an ectopic pregnancy in the case of Ms Esmonde, a mother-of-three, when she presented at the hospital on January 6th, 2013 with a swollen leg. Dr A 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.
Sharp contrast
Dr O’Donoghue’s findings contrasted with conclusions seemingly drawn by Dr A and his colleagues.
Senior radiographer Niamh Lonergan, who worked at STGH in 2013, told the inquiry she was asked to conduct a scan on Ms Esmonde’s left leg, to confirm whether she had a clot, on January 7th, 2013.
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 Ms Esmonde’s womb, which would be consistent with pregnancy, but she could not see any sign of an embryo in her uterus.
Ms Lonergan spoke to 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.
‘Pregnancy noted’
In other evidence, consultant Isweri Pillay, who also works at STGH, said she understood Ms Esmonde had an ectopic pregnancy.
Dr Pillay took charge of the care of Ms Esmonde when she presented at the hospital on January 6th, 2013. Dr Pillay said she saw Ms Esmonde two days later and “there was a definite right tubal pregnancy noted” in her records.
On Monday, the inquiry heard Dr A performed a transvaginal scan on January 8th, and, according to Ms Esmonde, told her she had “an ectopic pregnancy of unknown location”.
Dr A advised that she could take methotrexate, a drug used to end early pregnancies. She took her first dose that evening, and a second dose on January 18th.
On January 26th, Ms Esmonde was transferred to Cork University Hospital for the treatment of the clot in her leg - but, as Dr O'Donoghue said scans there suggested an intrauterine pregnancy.
Ms Esmonde suffered a miscarriage on February 2nd.
The inquiry continues.