Page 12 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

On May 24th, the pathology report came back on the
appendix and it was identified as an early acute appendicitis
which could have accounted for the patient’s pain. The

patient’s HCG level on May 29th, had increased to 12.375.

A repeat ultrasound showed a 6.1-week pregnancy with a
fetal heart rate of 115. This along with the rising HCG was
discussed with the patient and the plan was to follow up

with weekly ultrasounds.

The patient was next seen in the emergency room on
June 2nd, with bleeding and cramping. Her HCG level

at that time was 15.620. Ultrasound showed a 6-week,
5-day intrauterine pregnancy with fetal heart rate of 122.

The emergency room physician noted that the patient
was “very upset that she had been given methotrexate”.

On the following day, the patient met with her OB who
discussed with the patient the possibility of a “viable

intrauterine pregnancy after methotrexate”. The patient
was discharged home later that day.

Another ultrasound was performed on June 7th which

showed a 7-week, five-day intrauterine pregnancy with
fetal heart rate of 160. Based upon her last menstrual
period, she would have been at six weeks, one day.

The patient was referred to a maternal fetal medicine

specialist to evaluate and discuss the methotrexate she
had been given. On June 11th, the patient presented to
the emergency room again with cramping. An ultrasound

showed a fetal heart rate of 161. She was discharged

home.

Page 12