A Clinical Risk Case Study- The Importance of Early Diagnosis and Management of Ectopic Pregnancies

A Clinical Risk Case Study- The Importance of Early Diagnosis and Management of Ectopic Pregnancies

Setting the Scene

The patient, who had previously had an ectopic pregnancy, took the morning-after contraceptive pill following unprotected sex. A few weeks later, the patient went to see her GP complaining of back and neck pains. She also informed her GP that her period was a few weeks late and had lasted longer than usual. A pelvic infection was suspected, and the patient was prescribed antibiotics. No pregnancy test was undertaken.

The patient subsequently attended A&E after developing severe abdominal pain. Tests identified an ectopic pregnancy which required surgical treatment. This article focuses on the issues in preventing the accurate and timely diagnosis of ectopic pregnancies.

The main learning points from this review stem from the following events:

  • Minimal consideration given to the patient’s medical history of a previous ectopic pregnancy.

  • A missed opportunity in conducting a pregnancy test, in light of the patient’s prior history.

Recommendations to Prevent Incident Recurrence and Improve Patient Safety

TMLEP’s recommendations to reduce recurrence and enhance patient safety are as follows:

  • When a sexually active female, of reproductive age, presents to a GP with symptoms of pregnancy but denying pregnancy, a further detailed history as to the reason for the patient believing that they are not pregnant should be undertaken and clearly noted within the clinical record, with the clinician being satisfied by those reasons.

  • Clinicians should be mindful to the FSRH guidelines which indicates that if a period is more than seven days late following the use of the emergency contraception, a pregnancy test should be carried out. GPs should always think about the possibility of a diagnosis of an ectopic pregnancy and then exclude this diagnosis before discounting it. FSRH guidance should be provided to GPs to raise awareness of the risks of ectopic pregnancies and form a part of GP education.

  • It would be sensible to have an automated alert for clinicians for this category of patient. Such that if any of the list of possible symptoms of ectopic pregnancy are entered into the medical record in a female of reproductive age, as per the similar alerts for Sepsis on the SystmOne clinical records system, the clinician would be immediately alerted of this potential diagnosis.

To Summarise

An ectopic pregnancy happens in 1 out of 50 pregnancies. This case has outlined some of the key problems which have been frequently identified as the leading issues in preventing the accurate and timely diagnosis of ectopic pregnancies. The main point which needs to be emphasised is the importance of GPs considering the possibility of an ectopic pregnancy in all sexually active females of reproductive age presenting with the relevant symptoms and signs. A ’checklist’ style system, as used with Sepsis, could be implemented to help improve the diagnosis of ectopic pregnancies.

References

  • Fsrh.org. (2017). Standards & guidance - Faculty of Sexual and Reproductive Healthcare. [online] Available at: https://www.fsrh.org/standards-and-guidance/current-clinical- guidance/emergency-contraception/ [Accessed 27 Dec. 2019].
  • Co-written by The TMLEP Clinical Risk and Patient Safety Publishing Group, Charlotte Wilson-Holliday, TMLEP Analyst and Dr Duncan Blake, GP Appraiser and Trainer.. (2020). A Clinical Risk Case Study- The Importance of Early Diagnosis and Management of Ectopic Pregnancies . TMLEP Clinical Risk Case Studies. 3 (5), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact admin@tmlep.com or call +44 (0) 203 355 9796.