Ectopic pregnancies can cause catastrophic injuries to women when they go undiagnosed and massive hemorrhage results threatening future fertility and survival. Timely diagnosis in stable patients remains a challenge. Early detection lowers the morbidity and mortality associated with tubal rupture or spontaneous abortion. Unfortunately, approximately 40% of women with ectopic pregnancies are not diagnosed when they first present with symptoms of abdominal pain or vaginal bleeding. A recent study in the Journal of the American Medical Association (JAMA) looked at the clinical tools for assessing women with possible ectopic pregnancy at an early stage before life threatening hemorrhage occurs.
The study found that the patient's history leading up to the ER visit was not useful in diagnosing an ectopic. Cervical motion and abdominal tenderness on physical exam were somewhat associated with an ectopic but not sensitive or specific. Most importantly, a normal physical examination does not rule out or lessen the likelihood of an ectopic pregnancy. Even doing a single lab tests for the presence and amount of serum human chorionic gonadotropin (hCG) was not consistent or reliable in making the diagnosis. However, the demonstration of an adnexal mass without an intrauterine pregnancy on transvaginal ultrasound in a woman with a positive pregnancy test was associated with a high likelihood of ectopic pregnancy.
Transvaginal ultrasound is the single most useful test for the diagnosis of ectopic pregnancy, and clinicians skilled in performing and interpreting the study must be available to prevent the severe injury that can occur if the condition goes undiagnosed. Failure of emergency room physicians and OB/GYNs to diagnose an early ectopic can be a type of medical malpractice that causes catastrophic injury and even death. Britcher Leone & Roth, LLC understands the importance of careful analysis of the care rendered to determine if the injuries resulting from a delayed or missed diagnosis ectopic pregnancy support a claim for malpractice.