A 35-year old woman presented to her GP, an MDU member, with vague intermittent lower abdominal pain. She had not opened her bowels for several days which was unusual for her. She said that her previous period had been normal, and the current one had started late and was lighter, longer and more intermittent than usual. She had three children, was taking the oral contraceptive pill and did not think she could be pregnant.
The GP spent some time with her taking a history, but as she was not in pain at the time he did not examine her. He diagnosed constipation, advised diet change and that she should take laxatives for the next two or three days. He advised her to come back if the pain persisted, or if the vaginal bleeding did not settle.
In the event the patient did not come back to see the GP but was admitted to hospital as an emergency a week later with severe pain. Appendicitis was initially considered as there was rebound tenderness in the right iliac fossa. However, a serum pregnancy test showed an elevated beta HCG compatible with early pregnancy. A possible diagnosis of ectopic pregnancy was made and laparoscopy revealed a ruptured right sided cornual ectopic pregnancy. Unfortunately, it was necessary to do a total hysterectomy as a life-saving procedure and a right salpingo-oophorectomy. The left ovary was preserved.
Two years after the event, the patient brought a claim for damages against the GP. She alleged that the GP member should have referred her for assessment following the consultation and that if he had done so, it would have been possible to resect the ectopic pregnancy and so preserve her fertility, at any time prior to the rupture. It was alleged that as a consequence of the hysterectomy she then suffered a period of depression as she had not completed her family.
The MDU instructed an independent GP expert who advised that a pregnancy test should have been carried out, and a positive result would have resulted in referral to an early pregnancy assessment clinic. If negative, it should have been repeated and the patient advised to return if the symptoms did not settle completely. Advice was also sought from a consultant gynaecologist as to whether, given the cornual site of the ectopic, resection and salpingectomy would have been possible. She advised that although it is very finely balanced, on the balance of probability she considered that with earlier referral the claimant would probably not have required a hysterectomy.
The expert also observed that unruptured ectopic pregnancy can be an immensely difficult diagnosis and it is well recognised that a patient is very likely not to have the diagnosis made on first consultation, particularly when the ectopic pregnancy is at the cornual site. In the circumstances, the member accepted the MDU’s advice that the claim should be settled. Damages were negotiated and agreed at £50,000 in respect of general damages for loss of fertility, for the depressive illness which followed, as well as some loss of earnings. In addition the claimant’s legal costs were in the region of £35,000.
This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.