Scan showed ‘possible’ pregnancy, medical inquiry told

An inquiry into alleged misdiagnosis of an ectopic pregnancy has been told a scan carried out 18 days later showed a “possible” pregnancy in the womb.

Laura Esmonde was referred to Cork University Hospital (CUH) from South Tipperary General Hospital (STGH) in January 2013 with a history giving the impression she had an ectopic pregnancy, Dr Siobhan Corcoran said.

Dr Corcoran, a specialist registrar in obstetrics at CUH at that time, said when she conducted a scan on Ms Esmonde on January 26th 2013, it indicated a “possible” intrauterine gestational sac” [a pregnancy in the womb] or a “pseudosac”.

Dr Corcoran said she only saw a gestational sac and she estimated the pregnancy at three to four weeks.

There was also “a mass” on Ms Esmonde’s right pelvis, she said. There had been a query at STGH whether that mass was part of, or separate from, her right ovary.

A statement from Dr Corcoran was read to the continuing inquiry into claims that a consultant obsetrician and gyanecologist at STGH, who can be identified only as Dr A, had wrongly diagnosed an ectopic pregnancy in the case of Ms Esmonde (38), a mother of three from near Tipperary town, when there may have been a viable pregnancy in the womb.

Maria Carrigan, a staff midwife at STGH , said she had recorded in notes Dr A as having said "probable ectopic pregnancy" and "empty uterus" on January 8th 2013 after reviewing a scan of Ms Esmonde.

Ms Carrigan agreed with Simon Mills BL, for Dr A, that if the doctor had said there was a “definite” ectopic pregnancy, she would have recorded that in the note.

Wednesday is the third day of the continuing hearing before the Medical Council’s Fitness to Practice Committee over allegedly misdiagnosis by Dr A of an ectopic pregnancy in the case of Ms Esmonde, a mother of three, when she presented at the hospital on January 6th 2013 with a swollen leg.

It is claimed Dr A misinterpreted Ms Esmonde’s ultrasound scans as indicative of an ectopic pregnancy while ruling out a normal pregnancy in the womb.

It is also claimed he failed to consider her rising levels of a hormone used to evaluate pregnancy in the early stages and failed to reconsider a diagnosis of “pregnancy of unknown location” and to recommend conservative management of the patient.

It is also claimed he directed administration of the drug methotrexate — which stops growth of cells — when he was not entitled to exclude a viable pregnancy in the womb.

Ms Esmonde (38) has told the inquiry Dr A had on January 6th 2013 given her three options: surgery, medical management using drugs, or letting the pregnancy end naturally. She said he advised against surgery and warned her if no action was taken, she could die in her sleep if there was a rupture.

She opted for administration of methotrexate to end the pregnancy and was discharged on January 12th 2013. When her blood levels did not fall as quickly as expected for an ectopic pregnancy, she was given a second dose of the drug on January 17th and transferred eight days later for treatment of the clot.

Ms Esmonde returned to CUH on February 2nd 2013 when she said her pregnancy came out in a doctor’s hand during a vaginal examination.

The inquiry continues on Thursday.