HSE apologises for miscarriage misdiagnoses

Inadequate staff training and over-reliance on ultrasound led to 24 women being wrongly told they had suffered a miscarriage, an inquiry has found.

Inadequate staff training and over-reliance on ultrasound led to 24 women being wrongly told they had suffered a miscarriage, an inquiry has found.

The Health Service Executive (HSE) has apologised after the national miscarriage misdiagnosis review revealed there had been no mandatory training in ultrasound in half of the cases examined.

Two of the women suffered miscarriages after undergoing a medical procedure to remove the foetus, while 22 went on to give birth.

The inquiry was launched in June 2010 when Dublin mother Melissa Redmond revealed she had a baby boy after she was informed she had miscarried and was told to have a procedure known as dilation and curettage, carried out after a miscarriage, and an abortion-inducing drug.

The review of 24 cases of misdiagnoses in June 2010 showed:

:: Consultants and registrars accounted for 79% of health professionals who made the false diagnoses.

:: Medication to aid the miscarriage of a foetus was prescribed to eight women.

:: Six women underwent an operative procedure.

:: Formal training in early pregnancy ultrasound was reported by only three of the clinicians who made an initial diagnosis.

:: In 12 cases there was no mandatory training in ultrasound within the hospital at the time the case occurred.

:: Eight hospitals did not have an early pregnancy assessment unit at the time of the diagnoses.

:: In six cases the scanning machine was more than five years old.

Professor William Ledger, who chaired the review, said the 24 misdiagnoses occurred at the very early stages of pregnancy, when ultrasound diagnosis alone is unreliable due to the risk of missing a tiny foetus or heartbeat.

“Over-reliance on ultrasound to diagnose a miscarriage in very early pregnancy has been repeatedly highlighted since the introduction of the technique in the 1970s and we have made recommendations that caution against the use of ultrasound alone to detect a pregnancy before eight weeks gestation,” he said.

The HSE revealed more than 400 concerned women across the country called helplines in maternity hospitals when the scandal broke last year.

The review found while 95% of the cases were not misdiagnoses of miscarriage, 24 cases were – 18 from the previous five years and six that were older.

Dr Philip Crowley, HSE national director of quality, risk, and clinical care, said: “The HSE would like to sincerely apologise to the women involved, and their families, for the shortcomings in care provided to them and for the distress that this will have caused them.”

The review group had found the diagnosis of miscarriage, where a drug or surgical treatment was recommended to a woman, was made in 16 out of 19 maternity hospitals nationwide.

No one consultant or doctor was involved in the cases.

The 24 cases, which happened at the early stages of pregnancy, were out of a total birth rate of approximately 375,000 live births, during which time 70,000 miscarriages would have naturally happened to women.

Recommendations being implemented include developing and implementing national guidelines for the management of early pregnancy complications and ensuring emergency gynaecological care has a dedicated early pregnancy assessment unit.

Guidelines have also been circulated on the provision of a second ultrasound scan to confirm a diagnosis of miscarriage when the initial examination is performed out of hours or by a trainee doctor.

Prof Ledger, head of the department of obstetrics and gynaecology at the University of Sheffield, said it was important that women going through a miscarriage can have confidence in their healthcare providers.

“Miscarriage is the most common complication of early pregnancy, occurring in one in five of all pregnancies, and for many people is a source of enormous distress and grief,” he added.

“The misdiagnoses which were identified as part of the review will undoubtedly have amplified that distress for the women involved.”

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