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Being told my uterus was empty

Posted By They forgot me

"Being told my uterus was empty"

About: Broome Health Campus / Emergency Department

(as the patient),

This was my 4th pregnancy in approximately 2 years. I was 7 weeks 6 days pregnant. Recently, I noticed I had started bleeding, not heavily. I called ED at the Broome Hospital for advice. I asked if there was anyone on duty that would be able to give me a proper ultrasound, as my past experience with losses and Broome hospital ED were not good (see my previous 'Story' ~1.5 years ago). I was advised they could not asses me over the phone, but someone would be able to give me a bedside scan and that if I was concerned enough to make the call in the first place, I should go to the hospital. 

I arrive at the hospital within 15 minutes to be told there are no beds available at present. 

Finally we are taken through, the doctor gave me an ultrasound, and I recall they said they're sorry, but my uterus was empty. The doctor advised that this result will need to be confirmed by formal ultrasound, and they would refer me to radiology and they will be in contact at some point tomorrow or the next day to book me an appointment. 

I was contacted by radiology and had an ultrasound. My Uterus is not empty, they detected a foetal heartbeat, and the foetus is measuring as it should be for my dates. All looks healthy and normal. 

I am shocked, I am confused and I am thrilled with the result. 

But how is it that a doctor in ED scanned me and told me my Uterus was empty, when I fact that information couldn't be further from the truth? 

I will add that I had an ultrasound at 6 weeks to confirm the pregnancy and its location, So we knew when we presented at emergency that it was not an ectopic pregnancy.

Perhaps seemingly inexperienced doctors should not conduct such scans, and I feel ED should be up-front about what service they can and cannot provide. Also knowing the status of the department prior to presenting to the hospital would have been helpful for me (for example, being told they had no beds currently available). Given I've had 3 miscarriages in the last 2 years, I could have made my own decision to present to ED or not based on receiving the above information up front. 

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Responses

Response from Jared Watts, Head of Department, Obstetrics and Gynaecology, Broome Hospital nearly 2 years ago
We have made a change
Jared Watts
Head of Department, Obstetrics and Gynaecology,
Broome Hospital

Submitted on 18/08/2023 at 2:55 PM
Published on Care Opinion Australia on 21/08/2023 at 10:23 AM

Dear They forgot me,

I am very sorry to hear of your recent experience with your bedside ultrasound in the emergency department and the pregnancy not being able to be seen. I am relieved and happy to hear though that the pregnancy is growing well and there is a good foetal heart rate.

Early pregnancy ultrasounds can be difficult to perform. It can be complicated by aspects such as the uterus pointing backwards, the bowel being in front of the uterus or the bladder not being full. Often we need to use internal scans or prepare patients with fluids to be able to undertake the scan fully. This can be difficult in emergency departments, which can also be busy and unpredictable as to the number of patients arriving at any time.

We have therefore set up the Early Pregnancy Assessment Service (EPAS) in Broome Hospital, one of the only such rural clinics in WA. Any doctor can refer to this service, including GPs from the town. This allows patients to have a set time to be seen and have their scan undertaken by an obstetric doctor. Therefore, patients do not have to wait with a booked clinic time and can have a detailed scan. It can however be difficult and nervous for some patients to wait for the appointment. Similar to Perth metro sites like King Edward Memorial Hospital (KEMH), at times it may take a few days for patients to get into the clinic and we understand waiting and not knowing can be stressful.

With providing phone advice, it can be difficult to assess people over the phone. Therefore, we always try to be cautious, especially in early pregnancy, and offer people the opportunity to come in to be assessed. All ED doctors have the skills to assess a mother’s wellbeing, but scan of the developing baby can sometimes require specialist skills or equipment as for the reasons we discussed above.

We understand that we should be more cautious in what we tell patients with these bedside scans. On discussion with our senior medical officer, we will undertake further education with all our doctors as to what we should inform patients with early pregnancy scans in ED. This will include that we may be required to wait for confirmation with a formal scan before giving a final diagnosis. We will also ensure everyone is aware of the EPAS clinic referral pathway.

Once again, I apologise for the stress you must have experienced, and thank you for writing to us which will allow us the opportunity to improve our communication. My name is Jared Watts, and I am the Director of Obstetrics and Gynaecology for WACHS. Should you have any further feedback or advice for us to assist in improving the patient experience, please feel free to contact me on jared.watts@health.wa.gov.au

We wish you all the best for your pregnancy.

Kind Regard

Jared Watts

***

A/Prof. Jared Watts | WACHS Director of Obs/Gyn | Kimberley HOD of Obs/Gyn

WA Country Health Service - Kimberley

Broome Regional Hospital

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