HSIB report: The diagnosis of ectopic pregnancy (5 March 2020)

Summary

Prompt referral to early pregnancy services can make the difference between life and death in the diagnosis of ectopic pregnancies.

This Healthcare Safety Investigation Branch (HSIB) report into the diagnosis of ectopic pregnancy found that differing levels of provision and a mismatch between capacity and demand in early pregnancy units (EPUs) heightens the risk that the diagnosis of this time-critical condition is delayed or missed.

Content

In the case that HSIB examined, 26-year old Abby presented at her emergency department (with a suspected urinary tract infection and unable to pass urine) on Saturday. Following a positive pregnancy test, she was referred to an EPU for scan on the same day and discharged home. Abby didn’t have a scan until Tuesday (after following up with the EPU over the weekend). By then, she was found to have a ruptured ectopic pregnancy requiring emergency surgery for significant blood loss.

The report sets out four safety recommendations in response to the findings. They are focused on:

• Updating clinical information to include ectopic pregnancy as a possible alternative/serious diagnosis to lower urinary tract infection.
• Standardising the information that women receive on discharge from the emergency department.
• Providing expert guidance on the type and level of information that EPUs should collect to identify those at risk.
• Including assessment on early pregnancy services especially relating to potential complications in CQC inspections.