This case in North Carolina involves a pregnant female patient in her thirties. On the day the pregnancy was identified, sonography did not reveal the development of a fetus within the woman’s uterus. The woman continued to follow up with her OB/GYN, who detected elevated levels of hCG but was unable to visualize the developing pregnancy on ultrasound. The woman’s hCG levels continued to increase over subsequent visits, and an ectopic pregnancy was strongly suspected. The woman was started on medication to treat the ectopic pregnancy, however treatment was generally conservative. Eventually, the woman presented to the emergency room with extreme abdominal pain. The patient was taken for surgery, where it was discovered that her ectopic pregnancy had ruptured her fallopian tube. As a result of her injuries, the woman now suffers from significantly reduced fertility.
Question(s) For Expert Witness
- 1. How frequently do you diagnose and treat patients with ectopic pregnancies?
- 2. What are the typical beta HCG levels and ultrasound findings that steer your treatment of ectopic pregnancies?
- 3. How long after a suspected ruptured ectopic pregnancy occurs should you initiate treatment?
- 4. If treatment of a ruptured ectopic pregnancy is delayed, how could that affect a patient and your treatment of such a patient?
Expert Witness Response E-000171
I frequently see patients with ectopic pregnancy. I see these patients through my primary practice which is a Family Medicine Residency Training program with a large population of patients who are high risk for ectopic pregnancy. In addition, I operate a pregnancy termination clinic where I see thousands of women in early pregnancy. The majority of them have not seen a doctor prior to coming to my practice and therefore do not have a confirmed diagnosis of intrauterine pregnancy. It is up to me (and my medical staff) to sort out which of them have intrauterine and which may have ectopic pregnancies. The ratio of approximately one pregnancy in 100 is ectopic holds to be true in my practice. When evaluating a patient, a combination of a quantitative Beta HCG over 6000 and the absence of a gestational sac in the uterus on ultrasound is presumptive evidence of ectopic pregnancy. Ruptured ectopic pregnancy is an emergency and requires immediate medical attention. Delay of treatment for a ruptured ectopic pregnancy can be fatal. I have personally reviewed several cases of misdiagnosis or mistreatment of ectopic pregnancy and I consider early pregnancy issues to be one of my areas of expertise. In this specific case, the doctor did not have a firm diagnosis. The advice to come to the hospital by private conveyance under these circumstances (suspected ectopic pregnancy, signs of hypotension), was inappropriate and dangerous.