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Ectopic Pregnancy: Misdiagnosis, Complications, and Risks

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Ectopic Pregnancy: Misdiagnosis, Complications, and Risks

When a woman becomes pregnant, her first feeling is usually joy. Unfortunately, with the diagnosis of an ectopic pregnancy, that joy turns to sorrow, and often to fear. The feelings can be even worse if it turns out that it’s a misdiagnosed ectopic pregnancy.

What Is an Ectopic Pregnancy?

An ectopic pregnancy results when the fertilized egg stays in the fallopian tube. If the tube is damaged or blocked and fails to propel the egg towards your womb, the egg may become implanted in the tube and continue to develop there. The majority of ectopic pregnancies occur in a fallopian tube, much less often an egg implants in an ovary, in the cervix, directly in the abdomen or even a C-section scar. Ectopic pregnancies occur in up to 1 of every 50 pregnancies. During a normal pregnancy, the egg is attached to the wall of the uterus, which is designed to nurture and accommodate a developing fetus. It provides nutrients for the placenta and it can grow to create room for the fetus.

Ectopic pregnancy happens within the first few weeks of pregnancy. Doctors usually discover it by the eighth week of pregnancy. The implanted egg cannot survive. It is likely to miscarry or rupture. In addition, as the ectopic pregnancy grows, it begins to push away vital organs. This can cause pain, damage, and other complications when the area around the implanted egg ruptures. Ectopic pregnancies require immediate treatment.

Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including:

  • Severe abdominal or pelvic pain
  • Extreme lightheadedness or fainting
  • Shoulder pain
  • Abnormal vaginal bleeding
  • Low back pain
  • Mild cramping on one side of the pelvis
  • No periods

Complications of Ectopic Pregnancy

This condition may cause serious health complications if not treated. As such, immediate treatment is highly recommended. Early treatment may prevent fertility problems as well as future health complications. Ectopic pregnancy is one of the most serious dangers women face in early pregnancy. Ectopic pregnancy complications are very serious, and include:

  • The area of the ectopic pregnancy ruptures, resulting in life-threatening bleeding
  • Damaged fallopian tube can result in Infertility and/or a higher likelihood to have another ectopic pregnancy in the future.
  • Need for surgery
  • Emotional impact of grief and bereavement.

The most serious complication, a ruptured fallopian tube results in severe abdominal pain and bleeding. This can cause permanent damage to the tube, loss of the tube and with very heavy bleeding, if not treated promptly, can result in death.

Even if an ectopic pregnancy is detected before rupture, early misdiagnosis may cause it to be detected later than it should have been. This puts a woman at risk for ectopic pregnancy surgery complications.

Two Kinds of Misdiagnosed Ectopic Pregnancy

Over the past two to three decades, pelvic ultrasonography and measurement of the serum concentration of human chorionic gonadotropin (hCG)) have become mainstays in the diagnosis and management of early-pregnancy problems. If your symptoms suggest an ectopic condition, your caregiver will do an ultrasound to look for swelling in the fallopian tube, blood clots and tissue left from the embryo. A blood test will be administered to check the level of the pregnancy hormone hCG. Depending on the level, an ectopic pregnancy may be suspected. Your caregiver should closely monitor you if the results are not definitive.

In the past, doctors were very concerned about the false negative misdiagnosis. In the 1870s, nearly 70% of women with ectopic pregnancies died. Today, less than 0.05% (that is, less than 1 in 2000) women with an ectopic pregnancy die. But our diagnostic systems are designed to prevent false negatives, potentially resulting in numerous false positives.

The difficulty in diagnosing ectopic pregnancy is that the symptoms can be nonspecific. Abdominal pain is the most common symptom, but there are many potential causes of abdominal pain. Often, women will experience vaginal bleeding unrelated to an ectopic pregnancy. A woman may feel tender in the abdomen, but it is very rare for to have a palpable mass. Doctors rely on the combination of detecting high levels of pregnancy hormones combined with the inability on an ultrasound to detect an embryo in the uterus.

By the time a woman experiences symptoms of very extreme abdominal pain and fainting, it is likely that the ectopic pregnancy has already ruptured.

Ectopic Pregnancy Surgery Complications

If a misdiagnosis of ectopic pregnancy forces you to need surgery, you may experience additional complications from the surgery to treat your ectopic pregnancy. These include:

  • Ongoing pain
  • Scar tissue that causes pain or impairs normal function
  • Bleeding
  • Infection
  • Infertility

Although these complications are uncommon, they can be serious, and they are the result of an ectopic pregnancy misdiagnosis: the ectopic pregnancy should be detected before surgery is necessary.

False Positive Misdiagnosis of Ectopic Pregnancy

Although doctors have successfully worked hard to reduce the number of false negative misdiagnoses, they have created an epidemic of false positive misdiagnoses. This can be as tragic, if not more so, than a false negative. Ectopic pregnancy is a “can’t miss diagnosis” for all clinicians. It is a life threatening condition complicating 1 in 80 pregnancies presenting to emergency departments. The incidence of ectopic pregnancies has risen over the past several decades, but improved modalities of diagnosis and management have decreased the case fatality rate. Despite the improved diagnostic modalities, ectopic pregnancy is still frequently misdiagnosed on initial presentation with up to 40-50% of patients correctly diagnosed on repeat visits. Overall, it accounts for about 9% of all pregnancy-related maternal deaths, and is one of the leading causes of maternal death in the first trimester. Early diagnosis and treatment is essential in reducing maternal mortality and preserving future fertility.

The normal treatment of an early detection of an ectopic pregnancy is to administer methotrexate. Methotrexate will cause the body to reabsorb an early-stage ectopic pregnancy. Methotrexate is the most successful method to medically manage a patient with ectopic pregnancy and may preserve fertility better than surgical interventions. However, it can have a similar impact on a healthy pregnancy. It can cause a woman to miscarry her healthy child. Or, if it does not lead to a miscarriage, it can cause serious birth defects.

According the The New England Journal of Medicine “Although these tests have indisputable benefits, their misuse and misinterpretation can lead to interventions that inadvertently damage pregnancies that might have had normal outcomes. There are well-documented instances of women with intrauterine pregnancies treated with intramuscular methotrexate for suspected ectopic pregnancy, leading to failure of the pregnancy (“miscarriage”) or the birth of a malformed baby. Furthermore, considerable evidence suggests that mistakes such as these are far from rare. Malpractice lawsuits related to this type of error constitute a rapidly increasing source of medical liability action.” The New England Journal concludes, “Recent research has shown the need to adopt more stringent criteria for the diagnosis of nonviability in order to minimize or avoid false positive test results.”

Avoiding False Positives of Ectopic Pregnancy

Researchers have recently begun trying to get doctors to recognize the very serious danger of a false positive misdiagnosis. The main reason why false positives occur is that the diagnosis of ectopic pregnancy often depends on not being able to locate the intrauterine pregnancy (IUP).

However, an IUP can be very hard to detect at the stage when women present to their doctor with nonspecific symptoms that may be an ectopic pregnancy. The doctor decides to err on the side of caution and get rid of the possible ectopic pregnancy.

Researchers now urge that doctors should pause before recommending methotrexate. A short pause (on the order of a few days) is generally safe in women who don’t have acute symptoms. Then a second ultrasound should be conducted to attempt to identify a uterine pregnancy. Even a few days can make a huge difference in the ability to detect a healthy uterine pregnancy.

Board Certified Diagnostic Radiologist and Professor of Radiology at Harvard Medical School, Dr. Peter Doubilet, in an interview with Common Health answered a question about diagnosis of ectopic pregnancies: “with modern medical care, the risk of serious harm from waiting a couple of days in a woman who has an ectopic pregnancy but is stable is very low…when you balance that very small risk against the terrible possibility of seriously damaging a normal intrauterine pregnancy, the balance is very clearly in favor of waiting if there’s any uncertainty.”

Can You File an Ectopic Pregnancy Lawsuit?

If you have suffered serious injury as a result of your doctor’s ectopic pregnancy misdiagnosis and the treatment provided was incorrect and/or inappropriate, you may be able to file an ectopic pregnancy claim against your doctor and others who were responsible for your misdiagnosis.

If one of these situations occurred, you should seek legal advice from a medical malpractice attorney:

  • You exhibited symptoms, but an ectopic pregnancy misdiagnosis occurred.
  • You exhibited symptoms, but no further tests were administered.
  • An ultrasound does not reveal a fetus in the uterus and no further tests were conducted.
  • The doctor diagnoses ectopic pregnancy, but delayed treatment, causing complications.

However, the only way to know for sure whether your ectopic pregnancy misdiagnosis is grounds for a negligence claim is by consulting with an experienced medical malpractice lawyer, who can research your case and determine from experience and knowledge about the likelihood of winning your claim.

“9-Week Human Embryo from Ectopic Pregnancy” by Global Panorama is licensed under CC BY-SA 2.0

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