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

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
   7   8   9   10   11   12   13   14   15   16   17