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Miscarriage Misdiagnosis

The miscarriage misdiagnosis event that tragically occurred in Our Lady of Lourdes Hospital in Drogheda is a specific example of an unfortunately too common failure in Irish maternity hospitals.

This Firm is aware of at least four specific hospitals where almost identical events have occurred, and therefore it is hoped that a comprehensive and extensive review will now be undertaken by the HSE to protect Pregnant Woman from such potentially catastrophic consequences.

A review conducted by Dr Seosamh O Coigligh and by staff in the Obstetrics and Gynaecology Department at Our Lady of Lourdes Hospital in Drogheda in 2009 found that a pregnancy scanner was "not adequate to accurately assess early pregnancies and their complications."

The review occurred following the misdiagnosis that year of a Drogheda woman, who was wrongly told the eight-week-old baby in her womb was dead.

The report found that the woman visited the hospital's Early Pregnancy Unit on the 22nd of July last year for a scan. She was examined by a junior doctor at obstetric registrar level. "No heartbeat was detected" on the 22nd of July the report said, and a miscarriage was diagnosed.

Arrangements were then put in place for her to be admitted on the 25th July to have the dead foetus removed. She was also given a prescription for Cytotec, an abortifacient, to be taken before being admitted.

The review stated that the registrar on duty was an experienced registrar, who had performed such scans in Dublin maternity hospitals. But, it said "best practice would suggest that another scanner confirm a diagnosis of missed miscarriage."

Cytotec (or, misoprostal) may endanger pregnancy, and may cause abortion. The drug may cause harm to the fetus when administered to a pregnant woman. Cytotec may produce uterine contractions, uterine bleeding, and expulsion of the products of the uterus. Abortions caused by Cytotec may be incomplete, and congenital anomalies sometimes associated with fetal death have been reported subsequent to the unsuccessful use of the drug as an abortifacient, but the drug's ability to disturb the growth and development of the foetus has not been demonstrated. Several reports in the literature associate the use of the drug during the first trimester of pregnancy with skull defects, cranial nerve palsies, facial malformations, and limb defects.

Mr Michael O'Dowd, chairman of the Institute of Obstetricians and Gynaecologists, has stated that if the person carrying out the scan was properly trained, and if they were using a good scanning machine, "they should definitely" be able to give an answer as to whether the pregnancy was ongoing, or not.

He said he believed "the vast majority" of professionals in Ireland followed guidelines developed by the Royal College of Obstetricians and Gynaecologists (RCOG) in London in relation to the diagnosis and clinical management of woman and early pregnancy loss.

He said the Institute of Obstetricians and Gynaecologists at the Royal College of Physicians of Ireland recently decided to develop its own guidelines. He said that while it was not normal practice at this stage to get a second opinion on every scan where a heartbeat could not be found, "in the current circumstances" I'm sure everybody would be keen to have that in place until our own national guidelines are introduced."

The HSE's national director of quality and clinical care, Dr Barry White, said that in most situations, "a mandatory second scan would seem to be the appropriate way to go" in future.

The Lady of Lourdes Hospital's review said that there were no written guidelines relating to the investigation and management of early pregnancy problems, and there "are currently no guidelines in place regarding scanning techniques and views."

The review made eight recommendations, as follows:

Ultrasound equipment needed to be updated "to ensure it is fit for purpose";

• A new examination couch should be provided;
• Staff in the unit should be trained in scanning techniques;
• A dedicated ultrasonographer should be recruited;
• A diagnosis of miscarriage should only be made following a confirmatory scan by an experienced ultrasonographer; and
• Cytotec should not be prescribed until a confirmatory diagnosis is made and evidence based guidelines need to be developed for the unit.

The Health Service Executive stated that the scanner at Our Lady of Lourdes Hospital was replaced in January this year. In addition, it said a dedicated sonographer would be assigned to the unit from 9am to 1pm from next month, and that no patient is to be prescribed Cytotec until a diagnosis of miscarriage has been confirmed by a qualified sonographer.

Seeking Health Law Advice
For further information and advice regarding your legal rights and entitlements, please contact Malcomson Law by calling 01 8744422 or complete an Online Enquiry Form. Your enquiry will be forwarded to a solicitor who specialises in Medical Negligence.

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