Belfast Telegraph

Thursday 2 October 2014

Carla’s death highlights ectopic pregnancy danger

Details of the death of a Bangor woman who died after suffering an ectopic pregnancy may be published in medical journals to warn doctors of the dangers of the condition.

The inquest into the death of Carla McAdam (28), who was seven months pregnant when she died in September 2008, heard the doctor who performed her first ultrasound scan “didn't know what to look for”.

A leading consultant told the inquest that to have carried an ectopic pregnancy to seven months was so rare that she was considering publishing it in a medical journal to highlight the issue to other medical professionals, locally and nationally.

Senior coroner John Leckey said he hoped such a move “would go some way to providing comfort to the family that the lessons from Carla's death will be passed throughout the |country”.

Giving evidence on Monday, clinical director of the South Eastern Health and Social Care Trust Dr Ann Hamilton, a consultant obstetrician, said trainee sonographers are not told how to identify a woman's uterus when checking if a pregnancy is viable. Instead they are taught to see if a foetus “looks like it's in the uterus”.

It was revealed that senior house officer Dr Elizabeth McElrea had only four to five weeks' experience when she carried out the initial scan.

Dr Hamilton was reluctant to say the ectopic pregnancy would have been picked up had a more senior doctor carried out the scan.

“I certainly accept it might have been different,” she said. “But the scan picture Dr McElrea took was shown around and everyone said they would have accepted that it was a uterine pregnancy.”

Dr Hamilton said a number of changes have been implemented at the Ulster Hospital in Dundonald following an internal review into Carla's death, and that an ectopic pregnancy is now listed as a possible diagnosis on every pregnant woman's chart, at any stage in the pregnancy.

“I think everything has been covered,” she said. “I think I have to say again how rare this case is.”

During the hearing, Mr Leckey said doctors who released Carla from hospital just one month before she died, should be “ashamed of themselves”.

Carla was admitted to hospital in August 2008 after she collapsed in the shower with severe abdominal pain. Doctors initially examined her for signs of a placental abruption or premature labour, but later believed she was suffering from a urinary tract infection and sent her home with antibiotics.

She was kept in the maternity unit of the Ulster Hospital for two nights and discharged when her symptoms appeared to have subsided, despite laboratory results coming back two hours before she was sent home showing no signs of a urinary infection.

“I think that's shocking,” said Mr Leckey. “If anyone thinks that's good medical practice then I think they should be ashamed of themselves.”

He also lambasted the hospital for having “an obsession” with urinary tract infection diagnoses, while Carla's ectopic pregnancy went unnoticed.

He added: “It's a common theme that seems to be going through this (inquest); everyone seems to be talking about urinary tract infections.

“I get the impression that it's an obsession in the hospital; everyone seems to be saying urinary tract infection because of a lack of diagnosis of anything else.”

He added: “Carla comes in after a collapse; that to me, as a lay person, is not suggestive of a urinary tract infection. It seems to me strange that you would say a collapse is a urinary tract infection.”

Dr Karen Woods, a specialist registrar in obstetrics and gynaecology, defended her position to discharge Carla, saying: “She was well, it appeared that whatever had caused the pain was resolved.”

The inquest continues.

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