The Press

Sent home unable to walk from pain during ectopic pregnancy

A West Coast woman says she was left for days in severe pain and distress fearing she would die from an ectopic pregnancy, after a doctor failed to inform her of treatment options.

Gemma Parkin had surgery, which included removal of one of her fallopian tubes, nine days after a scan first showed signs of an ectopic pregnancy in December 2020.

Parkin said she wanted to speak out to encourage others to advocate for better care after her experience at six weeks pregnant with a much-wanted baby she and her partner had been trying for a year to conceive.

Health and Disability deputy commission­er Rose Wall found an obstetrici­an/gynaecolog­ist failed in his management of Parkin’s ectopic pregnancy, failed to provide her with informatio­n on her treatment options including on how best to preserve her fertility, and did not document their consultati­on.

An ectopic pregnancy– where the fertilised egg implants itself outside of the womb, usually in the fallopian tube – can cause life-threatenin­g loss of blood if not treated before the tube ruptures.

In her decision, Wall was unable to determine conclusive­ly whether there was a delay in the doctor’s diagnosis – due to different accounts of what was discussed and lack of documentat­ion. Wall said while the doctor’s plan of waiting for four days for further testing before deciding whether surgery was required was “a clinically appropriat­e option”, Parkin was unable to make an informed choice about associated risks and benefits. Parkin said if the doctor had explained all the options, she would have declined to wait for treatment.

“I had extreme difficulty walking, was unable take a full breath in, I hadn’t eaten or slept properly in days. I was left in that condition for five days ... If I needed surgery, why wait?”

She said her presentati­on four days after the first scan to Greymouth’s Emergency Department (ED) in considerab­le pain and bleeding was not recorded at all in the hospital system.

Her midwife’s notes recorded the visit and documented the obstetrici­an as saying he still believed Parkin’s pregnancy might have been in the womb. The doctor told the commission­er the midwife’s notes were an “inaccurate recollecti­on of the conversati­on [they] had” and he did diagnose the ectopic pregnancy that day.

Parkin said the doctor did not consider the level of pain she was in and did not listen to her midwife’s serious concerns before sending her home. The doctor also did not explain the use of methotrexa­te as a treatment option, which is a drug that can be used to treat an ectopic pregnancy.

Wall said, in her decision, the lack of documentat­ion was a severe departure from accepted practice. She was concerned about clinicians using different guidelines that may be contrary to those set out by the district, and she was concerned about patient privacy and safety in small assessment spaces in ED. “My case was discussed in the main waiting area of ED between two triage nurses and a doctor in full earshot of waiting patients, including clients and friends while I stood in agony, bleeding heavily and visibly upset,” Parkin said.

After Parkin was sent home, she had acute bouts of pain in her ribs, shoulder and passed large blood clots. By the time she had surgery five days later she was extremely unwell. She was told she might wake up in Christchur­ch if she deteriorat­ed further.

“There was no grief support, there was no considerat­ion given to the fact this was a much wanted pregnancy that we were now miscarryin­g,” she said. “At no point was I offered support, a kaiawhina and even my request to contact Maori services within the DHB fell on deaf ears,” she said.

An obstetrics and gynaecolog­y consultant who reviewed Parkin’s complaint for Health NZ said ideally treatment would have started five days earlier and the delay led to significan­t stress, but was unlikely to have changed the outcome.

Parkin’s complaint to the commission­er questioned whether earlier treatment could have saved her tube and improved her chances of conceiving another baby.

She said she now accepted the outcome could not have been avoided, but “the journey getting there could have been a million times kinder”. She had a second ectopic pregnancy in March 2021, in which her remaining fallopian tube ruptured during a transfer to Christchur­ch Hospital, but she was given prompt treatment, informatio­n and was shown empathy and kindness.

Health NZ told the commission­er the doctor had been educated how to document consultati­ons and it was in the process of making changes including a planned upgrade to electronic records.

Wall recommende­d Health NZ provide more staff training on documentat­ion and that the doctor undertake further training and provide a written apology to Parkin.

She also recommende­d that Health NZ consider establishi­ng a space for the safe and private review of patients with suspected early pregnancy complicati­ons.

In 2021, ACC accepted a treatment injury claim for the delayed diagnosis and treatment, causing the loss of her right fallopian tube.

Parkin said her midwife repeatedly went above and beyond for the couple, including through the subsequent IVF process and when her son Archie was born 14 months later.