It is claimed that mother-of-three Laura Esmonde was wrongly diagnosed by a consultant obstetric and gynaecologist working at South Tipperary General Hospital when she presented on January 6, 2013.
The consultant, whose name has been anonymised for the inquiry, was referred to as Dr A throughout proceedings yesterday, which took place at the Medical Council’s headquarters.
Ms Esmonde (38), from just outside Tipperary town, attended the A&E department at South Tipperary General Hospital with a swollen leg.
A number of years previously, she had suffered from a clot in her lung. A routine urine test revealed that she was pregnant, which she had not known.
“It was a lot to take in, but I was happy to be pregnant,” Ms Esmonde told the inquiry.
The following day, an ultrasound of her leg showed she had a clot. Ms Esmonde also asked for an ultrasound of her pelvis, because she wanted to see the baby and her husband was due into the hospital shortly.
The stenographer said she couldn’t see anything and called in a consultant radiologist.
He also performed a scan and Ms Esmonde said he told her there was a possibility that she had an ectopic pregnancy.
On January 8, Dr A performed a transvaginal scan, and, according to Ms Esmonde, told her she had “an ectopic pregnancy of unknown location”. Dr A advised that she take methotrexate, which is used to stop cells from growing and to treat ectopic pregnancies.
On January 8, 2013, Ms Esmonde took her first dose of methotrexate. She was discharged on January 12. On January 17, she was readmitted to the hospital for a second dose of methotrexate, which she took the following day. No further ultrasound was conducted before this dose, she said, even though her husband requested one.
On January 26, Ms Esmond was transferred to Cork University Hospital for the treatment of the clot in her leg – but a scan that day indicated her pregnancy was not ectopic. A further scan showed an intrauterine gestational sac, but the pregnancy was no longer viable.
“I was very upset. It was the eeriest of things. It was very distressing,” Ms Esmond said.
On January 29, a consultant came in to discuss the possibility of holding off on a DNC procedure.
“For one split second, I thought maybe everything was going to be okay but I thought about the two doses of methotrexate and the damage that had been done to the baby,” said Ms Esmonde. “I was so angry.”
She was successfully treated for the clot and discharged from Cork University hospital. She then returned on February 2, suffering from abdominal cramping and bleeding.
A nurse did a scan and an internal exam and the pregnancy came out in the nurse’s hand.
Ms Esmonde later made a complaint about Dr A to the Medical Council.
Legal counsel for Dr A, Simon Mills, said that Dr A, when he performed the scan on January 8, claims he said she had “a pregnancy of an unknown location that is most likely ectopic”.
Mr Mills argued that four separate ultrasounds were conducted and none of them showed a pregnancy in her womb. He said he would be calling Fergal Malone, master of the Rotunda, as a witness.
Dr A faces the allegation of poor professional performance, based on eight allegations relating to his alleged diagnosis of an ectopic pregnancy.
What is an ectopic pregnancy?
An ectopic pregnancy happens when the fertilised egg implants itself outside the womb, usually in one of the fallopian tubes.
If an egg gets stuck in a tube it won’t develop into a baby.
It is a potentially life-threatening complication for the pregnant woman.
Symptoms can develop between the fourth and 12th week of pregnancy.
They include pain and vaginal bleeding. Diagnosis is usually confirmed with a transvaginal ultrasound scan or blood test.
The scan should show whether the fertilised egg has become implanted in a fallopian tube, although occasionally it is difficult to spot.
Blood tests to measure the pregnancy hormone human chorionic gonadotropin may also be carried out twice, 48 hours apart. This can be a help if the scan is not clear.
An ectopic pregnancy must be ended through surgery or medication.