A woman says she feared she would die in her hospital bed when her ectopic pregnancy led to emergency surgery at a regional hospital in Western Australia.
The WA Country Health Service (WACHS) is investigating after the woman said she waited almost 24 hours from when Broome Hospital suspected an ectopic pregnancy to when she underwent surgery.
The woman, who has asked to remain anonymous, said she was experiencing severe abdominal pain in early July, but Broome Hospital staff told her they were not able to perform the necessary tests because it was a weekend, and the equipment and staff were not available.
An ectopic pregnancy is caused when a foetus develops outside the uterus, usually in the fallopian tube, and can be life-threatening if left untreated.
The woman presented to Broome Hospital on Saturday, July 7 with a bad cough and some abdominal pain.
She said she was discharged but presented to hospital again on Sunday when the pain worsened.
The hospital suspected an ectopic pregnancy after a urine test revealed she was pregnant, but a bedside ultrasound could not detect a foetus.
“I didn’t know what an ectopic pregnancy was,” she said.
“My pain was horrible, and it was just getting worse.”
Woman told she would have to wait for staff to be available
For an ectopic pregnancy, bedside ultrasounds are not adequate, with diagnosis requiring an internal ultrasound that needs to be performed by a trained medical professional.
Broome Hospital is a regional hospital in the remote north of WA. (ABC Kimberley: Emily Jane Smith)
The woman said hospital staff insisted she would have to wait until Monday for the right medical equipment and staff to become available.
She was discharged, but returned when the pain became unbearable.
“I was puzzled, scared and I was helpless,” she said.
The woman said her pain became so excruciating on the Sunday night she made a video call to her parents to explain the situation, asking them to make inquiries into her care if she died.
She was eventually diagnosed on the Monday morning, when doctors realised her fallopian tube had ruptured.
Doctors then rushed her into emergency surgery to treat the ruptured fallopian tube and internal bleeding.
In an email to the woman sighted by the ABC, WACHS said they were investigating an “apparent delay in diagnosis of the ruptured ectopic pregnancy” and apologised to the woman for the traumatic experience.
In response to ABC inquiries, the service said it would not comment on the woman’s specific case due to patient confidentiality.
But a WACHS spokeswoman said the Broome Health Campus offered plain x-ray and CT scanning 24-hours-a-day, seven-days-a-week, while doctors and gynaecologists could also perform transabdominal ultrasounds.
“Obstetric and gynaecological support on weekends is provided by suitably qualified general practitioners who have undertaken a Diploma of Obstetrics,” she said.
“This service is further supported by an on-call specialist obstetrician.
“The WA Country Health Service is committed to providing high-quality health care.”
Exacerbated risks in rural setting
Another woman, Veronica Campbell, died from a ruptured ectopic pregnancy after waiting hours for an ambulance in regional Victoria in 2008.
The 38-year-old bled to death in a case a coronial inquest found had been preventable.
WA Rural Doctors Association president Andrew Kirke said the availability of experienced staff and equipment remained a persistent challenge in regional hospitals, particularly when dealing with a situation such as an ectopic pregnancy.
“The fallback position is that if you expect an ectopic pregnancy, you might be committed to going ahead with the surgery,” Dr Kirke said.
“That’s a difficult decision and a difficult position to be in.”
Dr Kirke said weekend staffing was an issue in all hospitals, but one particularly exacerbated in regional areas.
He said flying patients to metropolitan hospitals remained a backup option, but carried its own risks.
“It’s not an excuse for things to be missed, but it’s one of those tricky areas where sometimes things fly under the radar despite people’s best efforts,” Dr Kirke said.
“A 24/7 service needs four to five people to maintain it and that may not be viable in some towns. That is a challenge in our rural areas.”
The dangers of ectopic pregnancies
There are three ways a woman can present with an ectopic pregnancy: abnormal bleeding, abnormal pain, or a pregnancy that is not visualised.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists spokeswoman Philippa Costley said ectopic pregnancies were common and women should understand the risks.
“It may only occur in 1 to 2 per cent of pregnancies, but that is a lot of people when hundreds of babies are born everyday,” Dr Costley said.
She said the timeline of treatment could depend on how long the woman had been pregnant and resources available.
“For emergency procedures you need a doctor who is experienced who knows how to perform the procedure, you need a theatre available and theatre staff, and in some circumstances you need a blood transfusion,” she said.
“There can be many different presentations of an ectopic pregnancy.”