Muiris Houston: On misdiagnosed miscarriage at Midland Regional Hospital

The experience of the mother referred to Portlaoise hospital with a suspected miscarriage is most unfortunate. The emotional rollercoaster of being told your baby is dead followed days later by the admittedly good news that the baby is in fact growing healthily in the womb is hard to imagine.

From the family's description of events, it seems the mother was initially assessed in an obstetric emergency room. Although she had not experienced vaginal bleeding or abdominal pain – the main symptoms of a threatened miscarriage – the doctor who assessed her could not detect a foetal heart beat when an ultrasound scan was carried out. With the advent of advanced ultrasound, delayed or missed miscarriage in the absence of symptoms is more easily diagnosed.

Technology

However, no test in medicine is 100 per cent accurate, something that is easily forgotten as technology rapidly advances. It is routine practice in the situation of suspected miscarriage for a second assessment to take place before any definitive management decisions are made.

Consultant obstetrician

This more detailed assessment takes place in an early pregnancy unit, where an experienced sonographer repeats the scan, using a more sophisticated machine. And as the family has described, a

consultant obstetrician

will review the patient also. Under guidelines introduced following a similar incident in Drogheda in 2010, this unit should also be equipped with a transvaginal ultrasound machine, which allows the probe to be placed close to the neck of the womb, thereby increasing accuracy.

Some 20 per cent of confirmed pregnancies end in miscarriage. Most are single events that don't affect the chances of a future viable pregnancy.

Issues that may have contributed to the initial misdiagnosis include the quality of the ultrasound machine in the emergency room and the experience of the non-consultant doctor who carried out the test. But it has to be said that even an experienced consultant will occasionally, for a variety of reasons, fail to detect a foetal heartbeat.

Once the mother reached the early pregnancy unit, she appears to have been looked after in an exemplary fashion. At no point did she come close to having an inappropriate termination of her pregnancy.