Safety body highlights ‘devastating impact’ of missed ectopic pregnancy
referral to early pregnancy services can make the difference between life and
death in the diagnosis of ectopic pregnancies, a report reveals today.
investigation carried out by the Healthcare Safety Investigation Branch found
that differing levels of provision and a mismatch between capacity and demand
in early pregnancy units (EPUs) heightens the risk that the diagnosis of the
time-critical condition is delayed or missed.
pregnancy occurs when the fertilised egg implants outside the uterus, usually
in the Fallopian tube. If it’s left untreated, it can rupture and cause
internal bleeding putting women at risk of severe harm and death. National
incident data from the NHS shows that between April 2017 and August 2018 there
were 30 missed ectopic pregnancies leading to ‘serious harm’.
In the case
that HSIB examined, 26-year old Abby presented at her emergency department (with
a suspected urinary tract infection and being unable to pass urine) on
Saturday. Following a positive pregnancy test, she was referred to an EPU for
scan on the same day and discharged home. Abby didn’t have a scan until Tuesday
(after following up with the EPU over the weekend). By then, she was found to
have a ruptured ectopic pregnancy requiring emergency surgery for significant
around 12,000 cases of ectopic pregnancy a year in the UK, but the symptoms are
non-specific and can be hard to differentiate from a range of other
gynaecological conditions or bladder, bowel, gastrointestinal problems. They
can only be reliably diagnosed in an EPU via a transvaginal ultrasound scan
(TVUS) and the investigation found that this places pressure on services.
Trusts are struggling to meet the seven-day cover needed and provide the level
of skilled and experienced sonographers needed to carry out and accurately
interpret the scan.
The lack of
consistent information is also a key risk factor in delayed diagnosis. Women
cannot normally self-refer to EPUs, making it even more important that the
information shared in the referral from emergency departments aids EPU staff to
assess risk and prioritise patients. The investigation found that currently information
given to women on discharge from the emergency department (whilst waiting to be
assessed by an EPU) is varied across the country and can create confusion – In
Abby’s case, she was given a leaflet about ‘bleeding in early pregnancy’ which
didn’t highlight the signs and symptoms to look out for when suffering a
ruptured ectopic pregnancy.
HSIB’s report sets out several safety
recommendations in response to the findings. They are focused on:
- Updating clinical information to include ectopic pregnancy as a possible alternative/serious diagnosis to lower urinary tract infection.
- Standardising the information that women receive on discharge from the emergency department.
- Providing expert guidance on the type and level of information that EPUs should collect to identify those at risk.
- Including assessment on early pregnancy services especially relating to potential complications in CQC inspections.
Kay, Deputy Medical Director at HSIB said: “Ectopic pregnancy is a common
cause of death in early pregnancy and, as Abby’s case highlighted, even if not
fatal the effects are distressing and far reaching. Women can suffer with
long-term psychological trauma and it can impact on their future fertility.
“If an ectopic pregnancy is diagnosed early,
it is likely it can be treated effectively and perhaps avoiding the need for invasive surgery. That’s why it’s
important that our investigation focused on the factors that lead to delays and
highlights where improvements can be made. We recognise that early pregnancy
units are stretched, and that Trusts are doing what they can to deliver a good
level of care to their patients. Through our investigation we offer a national
view and our safety recommendations have been made to help improve consistency
in care across England. Aiding that diagnostic process will help to reduce the
risk of delays and reduce the devastating risk of severe harm or death in early
Alex Peace-Gadsby, Chair of The Ectopic Pregnancy Trust, said: “The EPT
welcomes HSIB’s findings which highlights key information gaps in ectopic
pregnancy. We often hear of women being misdiagnosed and taking action on the
safety recommendations on diagnosis and discharge information in particular will
make a big difference in ensuring women get the right care quickly. Together
with effective information gathering and CQC assessment, these recommendations
can be game-changing for ectopic pregnancy care”.
The post Safety body highlights ‘devastating impact’ of missed ectopic pregnancy appeared first on The Ectopic Pregnancy Trust.
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