A SCANNER which produced images which were “not adequate to accurately assess early pregnancies and their complications” was being used at Our Lady of Lourdes Hospital in Drogheda when a woman was wrongly told the eight-week-old baby in her womb was dead, a review has found.
It also found that when Melissa Redmond from Donabate, Dublin, visited the hospital’s early pregnancy unit for a scan on July 22nd last year she was examined by a junior doctor at obstetric registrar level.
She had a history of multiple miscarriages and was consequently advised to attend the unit for early scans. “No heartbeat was detected” on July 22nd, the report said, and a miscarriage was diagnosed. Arrangements were made for her to be admitted on July 25th to have her dead foetus removed. She was also given a prescription for Cytotec, an abortifacient, to be taken before being admitted.
Prior to returning to the hospital however she went to her own GP as she “still felt pregnant”. Her GP confirmed her baby was alive.
The review stated that the registrar on duty was an experienced registrar who had performed such scans in Dublin maternity hospitals. But it said “best practice would suggest that another scanner confirm a diagnosis of missed miscarriage”.
It further stated that the ultrasound machine used “is now six years old and is subjected to a heavy workload seven days a week. Although it is regularly serviced, the images obtained are suboptimal for very early pregnancy.
“The monitor displays evidence of fatigue with poor grey/white contrast. The images obtained . . . were grainy and of poor resolution. While the machine may be adequate for the assessment of later pregnancies, the image resolution is not adequate to accurately assess early pregnancies and their complications”.
The review, completed last December and made public now by the Redmond family so lessons can be learned, also says the examination couch in use did not split which can make it awkward to obtain “optimal views”.
Furthermore it found there are “no permanent trained scan staff” attached to the early pregnancy unit with medical staff “provided from the registrar complement”.
It said the scanning ability of staff providing the service can therefore vary from one six months to another, as junior doctors rotate posts every six months, “with some staff requiring on the job training”. It also said there was no written guidelines relating to the investigation and management of early pregnancy problems and there “are currently no guidelines in place regarding scanning techniques and views”.
The review, carried out by staff within the hospital’s obstetrics and gynaecology department led by Dr Seosamh Ó Coigligh, made eight recommendations.
It said the ultrasound equipment needed to be updated “to ensure it is fit for purpose”; a new examination couch should be provided; staff in the unit should be trained in scanning techniques; a dedicated ultrasonographer should be recruited; a diagnosis of miscarriage should only be made following a confirmatory scan by an experienced ultrasonographer; Cytotec should not be prescribed until a confirmatory diagnosis is made and evidence based guidelines need to be developed for the unit.
The Health Service Executive said a consultant has instructed all junior doctors in the correct methodology of scanning for early pregnancy. It said the examination couch was replaced last August and the scanner replaced in January this year. It said a dedicated sonographer will be assigned to the unit from 9am to 1pm from next month and no patient is prescribed Cytotec until a diagnosis of miscarriage has been confirmed by a qualified sonographer.