Missed Ectopic Pregnancy Leads to Hysterectomy


This case involves a twenty-five-year-old female who was using an IUD, but became pregnant and wished to terminate her pregnancy. She had three visits with her doctors who recommended a medical abortion. The patient took the prescribed pills and came back for a two-week follow up with significant complaints of weakness, nausea, and intractable vaginal bleeding. It was determined that the patient had an extra-uterine pregnancy that went undiagnosed due to misinterpreted ultrasound imaging. The patient retained a large blood mass around her cervix and an emergency hysterectomy was required as the patient developed a vaginal cuff complication along with an evolving uterine hemorrhage.

Question(s) For Expert Witness

  • 1. What are the accepted complications of a medical abortion?

Expert Witness Response E-000528

Sometimes, a medical abortion does not succeed in terminating the pregnancy. In such cases, a surgical abortion procedure is necessary because the initial attempted abortion will cause severe harm to the developing fetus. In some cases, particularly if Mifepristone was used, this can also be a sign of a tubal pregnancy, which may require hospitalization, abdominal surgery, and, in rare cases, a hysterectomy due to uncontrollable bleeding.

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