This patient safety investigation explores the diagnosis of ectopic pregnancy.
An estimated 12,000 women experience an ectopic pregnancy each year in the UK. Ectopic 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. Ectopic pregnancy may also impact on a woman’s fertility.
Most ectopic pregnancies can be diagnosed by a transvaginal ultrasound scan (TVUS). These scans are commonly undertaken in hospital-based early pregnancy units (EPU).
National incident data from the NHS shows that between April 2017 and August 2018 there were 30 missed ectopic pregnancies leading to ‘serious harm’.
The reference event in this investigation follows the care of a 26-year-old woman who experienced a delayed diagnosis of an ectopic pregnancy.
She first went to a local minor injuries unit with abdominal pain on a Saturday morning. She was then advised to go to the emergency department with a suspected urinary tract infection. Following a positive pregnancy test, she was suspected by a doctor to have a problem in early pregnancy and was referred to an EPU for a TVUS within 24 hours and discharged home.
She followed up with the EPU over the weekend but, although she remained in a lot of pain, didn’t have a scan until Tuesday. By then she was found to have a ruptured ectopic pregnancy that required emergency surgery for significant blood loss.
The investigation looks at:
- Referral from emergency departments to early pregnancy services.
- The provision of early pregnancy services to diagnose and manage ectopic pregnancy.
- Information that women receive on discharge from the emergency department.
We’ve made four safety recommendations as a result of this investigation. Safety recommendations have been made to the National Institute for Health and Care Excellence, the Royal College of Emergency Medicine, the Royal College of Obstetricians and Gynaecologists, and the Care Quality Commission.
We expect a response to our safety recommendations within 90 days of publication of the investigation report. The responses will be shared here when they’re available.
National Institute for Health and Care Excellence (NICE)
It is recommended that the National Institute for Health and Care Excellence should review and revise the clinical knowledge summary for ‘urinary tract infection (lower) – women’ to include ectopic pregnancy as a category under ‘alternative or serious diagnoses’.
Royal College of Emergency Medicine
It is recommended that the Royal College of Emergency Medicine should provide standardised discharge information for clinicians to offer to women following discharge from the emergency department with a problem in early pregnancy and while awaiting further assessment by early pregnancy services.
Royal College of Obstetricians and Gynaecologists (RCOG)
It is recommended that the Royal College of Obstetricians and Gynaecologists should provide guidance on the information that should be provided during referral to early pregnancy units to standardise and improve the flow of information required to identify those most at risk from ectopic pregnancy and any consequent deterioration.
Care Quality Commission (CQC)
It is recommended that the Care Quality Commission Services Framework for Gynaecology and Termination Services includes an assessment of early pregnancy services, using as a reference the National Institute for Health and Care Excellence Guideline 126, Ectopic pregnancy and miscarriage: diagnosis and initial management.
Find out more by reading our report launch news story.
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