Some women were diagnosed as having placenta previa when they didn't, while others had the condition but it wasn' t detected, writes FIONA GARTLAND
IN THE AFTERMATH of the miscarriage misdiagnosis controversy earlier in the year, dozens of women contacted helplines about other experiences of misdiagnosis in Ireland’s maternity hospitals.
Speaking to helplines set up by the Health Service Executive (HSE) and by voluntary organisations, some women claimed the hospitals where they had their babies diagnosed them as having a condition called placenta previa when they did not have it.
Others said they had the condition but the diagnosis was missed, putting their lives and the lives of their unborn children at risk. All were told that the hospitals involved would examine their cases.
But what is placenta previa and why can it be “tricky” to diagnose?
Placenta previa is a complication of pregnancy in which the placenta is attached to the wall of the uterus close to or covering the cervix.
Its seriousness is graded on four levels depending how close to the cervix the placenta is. Type I means the placenta is low lying, but does not infringe on the cervix, Type IV means the cervix is completely covered.
The condition is usually accompanied by bleeding in pregnancy. It affects less than 1 per cent of all pregnancies, but can have serious consequences for mother and baby, chiefly related to haemorrhaging, if left undiagnosed.
Maria (not her real name) said she attended a midlands hospital in 2005 as a private patient on her first pregnancy and was diagnosed with a low placenta at 12 weeks. At 20 weeks, she had a second scan and was told she was fine.
But by 38 weeks she was experiencing bleeding. She attended the hospital, was given a third scan, kept in overnight and was then sent home. The following day when the bleeding had become much worse she returned to the hospital.
She was given a fourth and a fifth scan and was told they did not know why she was bleeding. A decision was made to induce her with an oxytocin drip. There was an attempt to break her waters, but this was unsuccessful. By this stage she was haemorrhaging severely and had to have an emergency Caesarean.
“Afterwards, they said I had grade four placenta previa, that was why I was haemorrhaging,” Maria says. “They said in hindsight it was visible and I should never have been induced. If I had gone into labour naturally it could have been curtains for both of us.”
When the miscarriage misdiagnosis controversy story broke, Maria phoned the hospital. She has been told her case will be reviewed.
“I think they put too much faith in machinery,” she says. “I felt the head was too high. It never dropped because obviously it couldn’t with the placenta in the way. I tried to tell them, but I didn’t have the vocabulary to explain how I felt.”
Another woman, who had been diagnosed as having placenta previa at another midlands hospital, says she narrowly avoided a Caesarean section after seeking a second opinion. Louise (not her real name) was told she would need a Caesarean section last November after a scan diagnosis of placenta previa.
She transferred to another hospital so she could be nearer her home for what would be a longer stay. She was told she would need a Caesarean at 38 weeks.
“I was emotionally distressed and it didn’t sit right with me,” she says. Accompanied by her husband she went to a private maternity hospital in Dublin, where she had another scan nine days later. The ultrasonographer there, who also sought a second opinion from colleagues, told her she was “nowhere near” needing a C-section.
She delivered her baby naturally in January having waited to go into labour before attending. She has since made a complaint and her case is also being reviewed.
Master of the Rotunda Hospital, Dr Sam Coulter-Smith, says what happens in most situations is that the scan given at 12 weeks is used to detect a heart beat, assess how many babies there are and to check dates.
An “anomaly” scan is carried out at 20 weeks to make sure the pregnancy is normal and to check the placenta.
“Many will be low lying at that stage, but only a very small proportion remain low lying,” he says.
A follow-up scan at around 34 weeks should highlight if the placenta is still too low.
The diagnosis of placenta previa can be tricky, Dr Coulter-Smith says, and it is vital that it is carried out by fully trained individuals.
An ultrasound scan is only two dimensional . . . we need to see all around the whole placenta and if the patient has an empty bladder or is overweight it is more difficult,” he said.
The Rotunda has a dedicated ultrasound unit with experienced ultra sonographers and so is less likely to run into problems, he says. They also make use of a trans-vaginal scanner, which is a useful additional tool to help clarify an unclear diagnosis. But not all hospitals in Ireland use it, he says. And there are also issues around training.
“It is important that the people using the equipment are trained appropriately. It is not appropriate for a young doctor with one or two years’ experience to be saying this is not placenta previa. You need to have people trained, and in appropriate numbers to do the scans.”
An additional issue is if you have 9,500 deliveries in a hospital designed for a lot fewer, Dr Coulter-Smith says. “That puts a huge strain on the system and that is when you can have difficulties,” he says.
