TUBAL PREGNANCY

Delay in diagnosis and treatment of tubal pregnancy may result in additional complications and medical negligence enquiry.

If the fallopian tube is damaged, typically from Pelvic Inflammatory Disease earlier in life, the fertilised egg may fail to reach the uterus, and may implant in the lining of the tube. Such pregnancies are not viable and will usually give rise to symptoms of irregular vaginal bleeding and abdominal pain, accompanied by persistently positive pregnancy tests.

The probability of fallopian tube rupture increases with increasing gestation. Early tubal pregnancy can be managed without surgery: the drug methotrexate^{[1], [2]} may terminate the pregnancy without additional injury to the fallopian tube.

With somewhat later diagnosis, the unruptured products of gestation can be removed by linear salpingostomy^{[3], [4]}, surgery which conserves the tube, albeit more scarred than previously. However, this procedure has an 11-12% failure rate, and failures cannot be predicted^[4a]. 

After further advancement of the tubal pregnancy or rupture, removal of the majority of the fallopian tube (salpingectomy) is the only option^[5].

Although a robust opinion may be obtained that community Standard of Care has been breached, Causation and therefore Quantum of Damages may be less straightforward.

The pregnancy may have been particularly precious because the client was relatively infertile. This feature increases the probability of seeking legal redress, but decreases Quantum.

Further, the additional decrement in fertility, particularly between linear salpingostomy and salpingectomy, is less than might be expected. Previously no difference in subsequent fertility could be demonstrated^[5], whereas recent figures suggest that out of 20 women desiring a subsequent pregnancy, 13 will be successful following linear salpingostomy, 9 after salpingectomy^[6].

Part of the reason for this relatively small difference is, of course, that many of the women have a second fallopian tube, albeit perhaps damaged to greater or lesser degree.

With current technology, this is not the end of the story, because In Vitro Fertilisation is an option^[4]. This technique involves harvesting the egg from the ovary, fertilising it artificially with the partner's sperm and placing the fertilised egg into the uterus. Success rates for this procedure may be greater than for natural conception following tubal pregnancy optimally treated. Costs to the couple are in the range $10-20,000, but this scarcely warrants the expense and risk of an Action for medical malpractice unless the Defence is motivated to settle.

Copyright © 2008 Electronic Handbook of Legal Medicine