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GP fails in care of woman in early pregnancy

Health and Disability Commissioner Morag McDowell today released a report finding a general practitioner (GP) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in their care of a woman in early pregnancy.

The woman, in her twenties, received a positive pregnancy test result. She experienced pain and bleeding, which are signs of a possible ectopic pregnancy. At around five weeks pregnant she saw her GP. The woman stated that she reported her pain to the GP, but the GP did not recall the woman mentioning pain and there is no mention of pain in the woman’s medical notes.

The GP arranged tests for urinary tract infection, sexually transmitted infections and rising pregnancy hormone level, but did not organise an ultrasound as she did not think it would add any helpful information given the woman’s early stage of pregnancy. The GP did not examine the woman’s abdomen or take her blood pressure or pulse, and did not offer any safety netting advice about what the woman should do if things got worse. When the woman’s hormone results were received, the GP appeared to have misinterpreted them as being reassuring.

Two days later, the woman presented to the emergency department of her local hospital with severe abdominal pain. The woman was diagnosed with severe internal bleeding secondary to a ruptured ectopic pregnancy. She required emergency surgery to remove a fallopian tube.

The Commissioner found several deficiencies in the care provided by the GP to the woman. In particular, she considered that the GP’s failure to directly inquire about whether the woman was experiencing pain in the initial appointment, and her failure to record the woman’s pain history, were departures from accepted practice.

"A common symptom of ectopic pregnancy is abdominal pain, and its presence alongside vaginal bleeding should raise a red flag for doctors to consider ectopic pregnancy," said Ms McDowell.

"It’s clear that the GP should have questioned the woman specifically about abdominal pain and documented her answer. Her failure to inquire about the pain directly impacted the course of the woman’s subsequent management."

Ms McDowell recommended that the medical centre undertake a review of all patients who experience PV bleeding in early pregnancy over the three month preceding the date of the report, to assess whether staff have actively questioned women about abdominal pain, documented this and conducted appropriate examinations. She also recommended that the GP attend an education workshop.

The full report of case 20HDC00477 is available on the HDC website.

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