Tuesday 6 December 2016

Expert tells inquiry consultant wrong to make ectopic pregnancy diagnosis

Alan O'Keeffe

Published 16/09/2016 | 02:30

Laura Esmonde leaving the Medical Council. Picture: Caroline Quinn
Laura Esmonde leaving the Medical Council. Picture: Caroline Quinn

A gynaecologist has said a doctor at the centre of a medical inquiry was "not entitled" to recommend medication that would end a mother's early pregnancy.

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Methotrexate - a drug used to end an ectopic pregnancy - should only be advised if the consultant is certain the pregnancy is not viable.

Dr Philip Owen, a leading British obstetrician and gynaecologist, said poor professional performance was shown by a Clonmel-based consultant who administered methotrexate to Laura Esmonde in 2013.

A Medical Council inquiry heard claims that mother-of-three Ms Esmonde (38), from Tipperary, was wrongly diagnosed as having an ectopic pregnancy when she attended the South Tipperary General Hospital in Clonmel on January 6, 2013. The consultant, an obstetrician-gynaecologist, faces allegations of poor professional performance.

He has been referred to as 'Doctor A' during the course of the inquiry which was adjourned yesterday to resume on November 14.

The inquiry heard that Ms Esmonde had gone to the hospital after suffering a blood clot in her leg.

She was told an ultrasound scan revealed she was pregnant but that it was probably an ectopic pregnancy, a non-viable pregnancy outside the womb.

She told the inquiry Doctor A gave her three options: surgery or the use of drugs to end the pregnancy, or letting the pregnancy end naturally.

She said he had warned against surgery and he told her she could die in her sleep if there was a rupture.

She opted to take methotrexate, and had a miscarriage on February 2.

It was claimed at the inquiry that Doctor A misinterpreted ultra sound scans by concluding the woman's pregnancy was outside the womb.

The inquiry was told earlier an ultrasound scan done on January 26 in Cork University Hospital showed a possible presence of a gestational sac inside the womb or else a "pseudo sac".

Dr Owen said yesterday Doctor A could not have reached the level of certainty required to diagnose an ectopic pregnancy.

He should not have ruled out a pregnancy within the womb at that stage and he should have kept her in hospital before coming to any final conclusion.

Ms Esmonde did not show symptoms of an ectopic pregnancy, said Dr Owen.

Earlier, Dr John Coulter, consultant obstetrician and gynaecologist at Cork University Maternity Hospital, said the first time he saw Ms Esmonde was on January 27 and found no evidence of an ectopic pregnancy.

Following a scan, he said it was not possible to determine if there was a viable pregnancy in the womb.

Irish Independent

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