Page 13 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

The patient met with the maternal fetal medicine
specialist on June 21st and an ultrasound at that time
showed a positive fetal pole, heart rate 175, and 9-week,

1-day gestational age. No abnormalities were seen. The

patient was counseled regarding methotrexate exposure
and the strong possibility of birth defects. The specialist
recommended anatomic survey at 18 weeks and noted

that the patient was uncertain about whether to continue

the pregnancy. On the same day, the patient also saw
her OB and it was documented that she was extremely
upset about the strong possibility of fetal abnormalities.

After a lengthy discussion with her OB, the patient stated

that she elected to terminate the pregnancy. Because
methotrexate does not have a definite guarantee of defects
in all pregnancies, the Ethics Committee at the hospital

would not approve termination locally and the patient

had to go out-of-state for the abortion on June 28th. A
lawsuit for malpractice was filed against the obstetrician.

Weak Points identified:

1. The gestational sac seen in the uterus at the first

emergency room visits was essentially ignored.

2. There was no repeat ultrasound as recommended

prior to administering methotrexate.

3. The diagnosis of ectopic pregnancy was made after
laparoscopy clearly did not confirm same.

4. Administering the methotrexate put the fetus at high
risk of fetal abnormalities and the patient’s decision

to abort followed.

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