Ms S, a 44-year-old shop assistant, was seven weeks pregnant. She didn’t feel able to continue with the pregnancy and booked an appointment at a clinic for a termination of pregnancy (TOP).
At the clinic, Ms S was seen by Dr F where a full history was taken – Ms S mentioned she had had one miscarriage – before tests were carried out. A pregnancy test proved positive, but an ultrasound scan showed no evidence of a gestation sac. Ms S was treated with mifepristone orally, followed by misoprostol (inserted vaginally) several hours later. Later that day, Ms S was discharged and given a post-treatment leaflet for reference. She was advised to contact the clinic 48 hours later to discuss her treatment, though she did not do so. She assumed that the termination had occurred by the next day.
Three weeks later, Ms S woke in extreme pain and was taken by ambulance to the local Emergency Department (ED). Here, it was discovered that Ms S had an ectopic pregnancy, which had ruptured. As a result, her left fallopian tube had to be removed.
Ms S brought a claim against both the clinic and Dr F, stating that she had been unable to conceive since the event, which had exacerbated her pre-existing depressive disorder. Ms S alleged that Dr F was negligent in failing to investigate the fact that no gestation sac could be seen on the scan prior to performing early medical abortion. She also alleged Dr F was negligent in failing to consider the possibility of ectopic pregnancy and refer her to hospital for further investigation.
The clinic admitted liability to Ms S at the complaints stage, without contacting Dr F or seeking his opinion. MPS sought expert opinion on behalf of Dr F, which concluded Dr F’s actions were likely to have caused, or materially contributed to, Ms S suffering the loss of her left fallopian tube with some consequent pain and suffering.
However, expert opinion maintained that the loss of one fallopian tube does not necessarily prevent conception, as the probability of pregnancy is not substantially reduced. GP records confirmed that Ms S had been trying to conceive for 18 months and she was still ovulating. Her inability to conceive would at least partly be due to her age (44). Dr F’s actions did not necessarily cause Ms S’s infertility.
GP records indicated that Ms S had an extremely complex, long-standing psychiatric history. She had been taking antidepressants for more than ten years, and had been diagnosed with a mild form of bipolar disorder three years previously. Expert opinion suggested that Dr F’s breach of duty in his actions may have exacerbated Ms S’s long-standing psychiatric condition.
The claim was therefore settled for a moderate sum.
- Make sure adequate safety-netting is in place for follow-up of patients. Ms S was advised by Dr F to contact the clinic 48 hours later but did not do so. Follow-up may have made a difference to the outcome.
- Clear communication and sharing information is important when handling complaints, especially when a claim involves more than one healthcare professional. In this case, Dr F was not informed the clinic had admitted liability.
- It is important to carefully consider scans – in this case the ultrasound scan found no evidence of a gestational sac, but this was not acted upon.
- For more information see the RCOG’s guidance, The Care of Women Requesting Induced Abortion: www.rcog.org.uk/womens-health/clinicalguidance/care-women-requesting-induced-abortion