MISCARRIAGE IS an unfortunate reality of early pregnancy, with about 20 per cent of confirmed pregnancies ending in miscarriage in the first 12 to 14 weeks. And while the diagnosis of miscarriage can be difficult in certain circumstances, the least a pregnant woman can expect is that the viability of her pregnancy is properly assessed when the symptoms of a possible miscarriage occur.
The National Miscarriage Misdiagnosis Report published this week follows an investigation prompted by the experience of Melissa Redmond while pregnant with her son Michael. Last June it emerged that she was mistakenly advised by doctors at the early pregnancy assessment unit of Our Lady of Lourdes Hospital, Drogheda, that her pregnancy was no longer viable. This was done following a single ultrasound scan. However, Ms Redmond sought a second scan which showed that the baby was alive and well, and so the planned procedure to evacuate her womb was no longer appropriate.
Carried out under the expert leadership of Prof William Leger, vice-president of the Royal College of Obstetricians, the report into 24 cases of misdiagnosed miscarriages throughout the State found that most were due to human error. Initial investigation of the Redmond case had pointed to a six-year old, heavily used ultrasound machine as the likely cause for the error. Although the independent review group found that some scanners in use in maternity units were more than five years old, it concluded they had been well maintained. It found the lack of training in early pregnancy ultrasound was the key problem for many hospitals.
Just three senior clinicians surveyed had formal training in this form of ultrasound. However, given the 24-hour need for such assessments, it is unsurprising that doctors in training made an erroneous diagnosis of miscarriage in 18 of the 24 cases analysed. This finding, more than any other, emphasises the importance of offering women a second scan, to be carried out by a doctor with specialist training, in the assessment of early pregnancy viability. Remarkably, of the 24 women whose cases were examined, 22 went on to have healthy babies. However two women had unwarranted surgical procedures and subsequently suffered a miscarriage.
The HSE has indicated that many of the report’s recommendations are in train. It must confirm their completion. In particular, the promise by the Minister for Health that all ultrasound machines more than five years old will be replaced within weeks must be fulfilled.