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.

Side serving of Ectopic Pregnancy awareness anyone?

Im not a health professional, but I know a lot about my body. Im not going to be naive enough to say I know everything, but when you go through something like I have, you begin to understand that you can not trust in every health professional that comes your way either. I read these notes and articles and it scares me. It scares me a lot, because where is the awareness? They all mention a need for an increase in awareness for ectopic pregnancy with general practitioners, but what about the general public, what about every woman of child bearing age? How many women find themselves in an emergency department hours away from death only to be sent home with a diagnosis of gastroenteritis. The only reason I am alive today is because I grabbed my nurses arm, I looked her in the eye and I said, "This doesn't feel like a miscarriage okay, it feels like my bowel is twisted and I am about to explode!" I saw the light bulb switch on in her head and she then and only then called for the doctor. Its all here in black and white, mostly in general practitioner blogs, journals, articles and fundraiser forums but how many young girls who have just started having unprotected sex read these? How many women who have had abdominal surgery, or c sections or  treated for chlamydia are told that now they have an increase chance of ectopic pregnancy? 

 Ectopic pregnancy is about baby loss and it is horribly sad but I cant help but think that we aren't informed of just how deadly it is. It seems to be dealt with under the baby loss umbrella, which is not allowing women to identify with the mortality risk associated with this event.Don't get me wrong, I mourn for my baby that I lost but I also think about how close I came to losing everything and it didn't necessarily have to be that way, if I had been  informed and if the health practitioners who treated me had been properly educated in ectopic pregnancy it may have been a very different story.

Here are a few facts that every woman should know.
"Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities."

"Ectopic pregnancy was the fourth most common cause of maternal death in the most recent Confidential Enquiry into Maternal Deaths (CEMD) the United Kingdom 2000–2002; accounting for 11 out of 15 (73%) early pregnancy deaths.

In the last triennial report, the mortality rate for deaths from ectopic pregnancies had not declined since the previous triennial report, and was still an increase on the rates described 10 years ago. Two-thirds of women who died from ectopic pregnancy were misdiagnosed in primary care or ED settings."

Drife J, Lewis G. eds. Why mothers die. Triennial report 2000–2002.Confidential enquiries into maternal deaths. UK: RCOG, 2004.

Im sorry what? Two thirds of these women who died were misdiagnosed once they were treated by their health practitioners? They didn't faint on their couch, alone not knowing they were pregnant and bleeding out..blaming last nights vindaloo.... none the wiser....they were within the health system....right there amongst the thick of it...with all the resources needed to save their lives and the health system failed them!

"Performing qualitative urine dipstick testing for human chorionic gonadotrophin (hCG) with appropriate use of transvaginal ultrasound scan (TVS) on all women with unexplained abdominal pain certainly has cost implications, however this is one simple way to decrease death rates from ectopic pregnancy."

Drife J, Lewis G. eds. Why mothers die. Triennial report 2000–2002.
Confidential enquiries into maternal deaths. UK: RCOG, 2004.

Cost implications, I wonder how much it costs? In comparison to how much of our tax dollars go towards fixing "preventable" illnesses. A pregnancy test is surely a pitance I bought 40 sensitive tests off ebay for $8.00 (AU)!! I doubt if the results are negative that any patients would be followed up on with a transvaginal ultrasound anyway.This is where it would be getting costly.

Like I say if you have a positive pregnancy test result....

"Dont be suicidal, Get a transvaginal!"

"The IUCD is the only contraceptive method associated with increased risk after discontinuation of use."

Mol BW, Ankum WM, Bossuyt PM, Van der Veen F. Contraception and the risk of ectopic pregnancy. Contraception 1995;52:337–41.

13% of women in the world opt for an Intrauterine contraceptive device, how many of these women are screened for the likelihood of ectopic pregnancy prior to insertion. Without the knowledge that their chances increase whether or not they still have the device in when they fall pregnant??????

I could go on forever,the list is astounding. The only reason I have this knowledge, is because I trusted my health practitioners with my life and they nearly lost it so now I research and research and research.

 How many women and girls for that matter will lose their lives this year because they were not aware of the risk factors of an ectopic pregnancy, or will present at hospital with lower abdominal pain only to be sent home diagnosed with a stomach upset.

 I find it hard to sleep at night knowing this is happening all the time. I wonder how many women die and are pronounced dead via heart failure or organ failure with everyone neglecting to notice a foetus in their tubes. uhh........too scary!!

Please take the time to read this full article by George Condous.

We can not rely solely on the health system to stop women dying from this, we need to increase ectopic pregnancy awareness. The UK has a trust and an association and the US has a foundation, what does Australia have?


Think Pink

Janey