Missed or delayed diagnosis of ectopic pregnancy

An ectopic pregnancy is a serious early pregnancy complication which can become life-threatening if it is not diagnosed and treated promptly. Although some cases are difficult to identify in the very early stages, warning signs should not be dismissed without proper assessment, investigation and follow-up.

Patients who attend a GP, NHS 111, A&E, an Early Pregnancy Unit or a gynaecology department with abdominal pain, bleeding, dizziness or other concerning symptoms are entitled to expect appropriate care. Where ectopic pregnancy is not considered, tests are not arranged, scan findings are misinterpreted, or follow-up is inadequate, there may be grounds for a clinical negligence claim.

A missed or delayed diagnosis can lead to rupture, internal bleeding, emergency surgery, removal of a fallopian tube, loss of pregnancy, psychological trauma and concerns about future fertility.

What is an ectopic pregnancy?

An ectopic pregnancy occurs when a pregnancy implants outside the normal lining of the womb. Most develop in the fallopian tube, although they can rarely occur elsewhere. It cannot usually continue safely. As it grows, it can cause the fallopian tube to stretch and rupture, leading to severe pain and internal bleeding requiring emergency treatment.

Symptoms of ectopic pregnancy

Symptoms can vary and may be mistaken for miscarriage, a urinary tract infection, gastrointestinal pain or normal early pregnancy symptoms. They often occur between the 4th and 12th week of pregnancy and may include one-sided abdominal or pelvic pain, vaginal bleeding or brown watery discharge, shoulder tip pain, dizziness, fainting, collapse, pain when passing urine or opening the bowels, sudden severe abdominal pain, or looking pale, clammy or shocked.

A ruptured ectopic pregnancy is a medical emergency. Sudden severe pain, dizziness, fainting, shoulder tip pain, collapse or signs of shock require urgent hospital assessment.

When should ectopic pregnancy be considered?

Ectopic pregnancy should be considered in any patient of reproductive age who presents with abdominal pain, pelvic pain, vaginal bleeding, collapse or unexplained symptoms where pregnancy is possible. This is particularly important where the patient has a positive pregnancy test, missed period, previous ectopic pregnancy, fertility treatment, history of pelvic infection or surgery, or worsening pain or bleeding after being reassured.

A common issue in negligence claims is that symptoms are treated as “normal”, “probably a miscarriage”, “a urine infection” or “stomach pain”, without ectopic pregnancy being properly excluded.

When can delayed diagnosis of ectopic pregnancy be negligent?

Not every delayed diagnosis is negligent. Some ectopic pregnancies are genuinely difficult to diagnose, particularly very early on. However, a claim may arise where care fell below a reasonable standard and caused avoidable harm.

Examples may include failing to take a proper history, arrange a pregnancy test, refer urgently to an Early Pregnancy Unit or gynaecology team, arrange blood tests or ultrasound, interpret scan findings correctly, provide follow-up or safety-netting advice, or act when symptoms worsen.

In many cases, the issue is not that ectopic pregnancy was missed once, but that several opportunities to investigate, review or refer the patient were missed.

GP, A&E and Early Pregnancy Unit failures

GPs are often the first point of contact. They are not expected to diagnose every ectopic pregnancy immediately, but they should recognise when further assessment is required. A claim may arise where a patient reports pain, bleeding, dizziness or possible pregnancy symptoms and the GP fails to arrange a pregnancy test, consider ectopic pregnancy, refer for specialist assessment, advise urgent A&E attendance or give clear safety-netting advice.

A&E and urgent care services should also consider ectopic pregnancy where pregnancy is possible. Potential failures include discharging a patient despite a positive pregnancy test and concerning symptoms, failing to arrange gynaecology review or ultrasound, failing to act on abnormal observations, or failing to recognise internal bleeding.

Early Pregnancy Units arrange scans, blood tests and follow-up where the diagnosis is uncertain. A claim may arise where abnormal or inconclusive results are not followed up, a pregnancy of unknown location is not managed safely, scan findings are missed or misinterpreted, or clear written and verbal safety-netting advice is not provided.

Consequences of delayed diagnosis

A delayed diagnosis can cause rupture of the fallopian tube, internal bleeding, emergency surgery, removal of part or all of a fallopian tube, blood transfusion, severe pain, loss of pregnancy, reduced fertility prospects, psychological trauma and anxiety about future pregnancies.

How is a clinical negligence claim proved?

To succeed, it is usually necessary to prove breach of duty, causation and loss. Breach of duty means care fell below the standard expected of a reasonably competent healthcare professional. Causation means the negligent delay or failure caused avoidable injury or made the outcome worse. Loss may include pain, suffering, additional treatment, loss of earnings, care needs or fertility-related consequences.

Causation can be complex. The key question may be whether earlier diagnosis would have avoided rupture, prevented emergency surgery, preserved the fallopian tube or reduced the physical and psychological harm.

Evidence, compensation and time limits

Ectopic pregnancy claims usually depend heavily on medical records, including GP records, NHS 111 or urgent care records, hospital notes, scan reports, blood test results, witness evidence and independent expert evidence.

Compensation may include damages for pain, suffering and loss of amenity, emergency surgery, loss of a fallopian tube, fertility consequences, psychiatric injury, care, loss of earnings, travel expenses, private treatment or counselling and future fertility investigations or treatment, where legally recoverable.

In most clinical negligence cases, the usual time limit is three years from the date of negligent treatment or from the date the patient first knew, or ought reasonably to have known, that the injury may have been caused by negligence. Different rules apply for children and adults who lack mental capacity.

Speak to a clinical negligence solicitor

If you suffered a ruptured ectopic pregnancy, emergency surgery, loss of a fallopian tube or psychological trauma after delayed diagnosis, you may be entitled to bring a clinical negligence claim. A specialist clinical negligence solicitor can review the records, obtain expert evidence and advise whether earlier investigation or treatment should have taken place.

If you believe you have suffered a missed ectopic pregnancy, contact Scott and his team for a confidential initial review.