Misdiagnosed ectopic pregnancy considered the norm?

I read an article this morning on ectopic pregnancy, it was reprinted in Australia in 2005 in the Australian Family Physician, Volume 34 #3.

You can read the article here.

One statistic in particular stunned me, it is estimated that up to 50% of ectopic pregnancies are misdiagnosed at the initial presentation. This information was taken from the book  

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Ectopic pregnancy: ten common pitfalls in diagnosis.

Abbott J, Emmans LS, Lowenstein SR.

Source

Department of Surgery, University of Colorado Health Sciences Center, Denver 80262.

Abstract

Ectopic pregnancy (EP) is a common, life-threatening complication of pregnancy. Modern technology (ultrasonography and improved pregnancy tests) should facilitate the diagnosis of EP. However, in a retrospective review of 65 cases of confirmed EP managed over 18 months at an urban teaching hospital, only 37 of 65 patients (57%, Cl95 = 44%, 69%) received prompt diagnosis and treatment; delays occurred in 28 patients (43%). In 10 of the 27 delayed cases, the diagnosis of EP was not even considered at the time of the first visit. In patients with a delayed diagnosis, morbidity (transfusions, cardiovascular instability, progression of illness) did occur. Diagnostic pitfalls that resulted in delayed care were reviewed, delays most commonly occurred in patients with a benign examination or "atypical" pain. Risk factors for EP were missed (7 patients, 25%), subtle clues to blood loss were often ignored (10 patients, 36%), and passage of tissue was thought to exclude EP (2 patients). Ultrasound was only helpful for half of the diagnoses and was misinterpreted in 27%. A dry or serous culdocentesis occurred frequently. In five patients, a falling or low quantitative human chorionic gonadotropin level was believed to indicate a completed abortion. The authors conclude that almost half of EPs are still missed on the first physician visit; errors and pitfalls in diagnosis are still common in the 1980s.
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It was common in the eighties, the nineties, the naughties and now.

I was misdiagnosed, not only at the initial presentation, but every visit after until eventually I ruptured and nearly bled to death in front of a nurse that thought I was having a dramatic miscarriage.

It is clear that we need to educate young people on the risks of ectopic pregnancy because more and more ectopic pregnancies are occurring which will equate to more misdiagnosed EPs and the possibility of more ectopic pregnancy related deaths.

Were you misdiagnosed? What happened to you? What was missed, the risk factors, internal bleeding signs, bad ultrasound? Given methotrexate when the baby was in the uterus? You name it....someone has suffered from it. Let us know your story.............



Think Pink

Janey.