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    Heterotopic or ectopic pregnancy?



    Ms. Collins is an attorney specializing in medical malpractice in Long Beach, California. She welcomes feedback on this column via e-mail to [email protected].

    Heterotopic or ectopic pregnancy? 

    A Louisiana woman was treated at a hospital for a suspected ectopic pregnancy in 2010. She was transferred to another hospital for a more definitive diagnosis and a consult with an obstetrician for the use of methotrexate. The on-call obstetrician was in surgery when the patient arrived and a nurse informed the patient that the physician had ordered the administration of methotrexate, which was given and terminated the pregnancy. Several weeks later the patient complained of abdominal pain. After evaluation it was determined that she had had a uterine pregnancy, not an ectopic.

    Also read: Extrauterine pregnancy detection and management

    The patient sued the obstetrician and the second hospital, arguing that the physician ordered methotrexate to terminate a normal uterine pregnancy without seeing the patient first, and that he should have repeated the testing performed at the first hospital. She claimed that testing would have identified an intrauterine pregnancy and avoided the termination.

    The nurse claimed the physician ordered the methotrexate when the patient arrived, but the physician argued he did not give the order for the drug. They also claimed that the patient had a rare heterotopic pregnancy.

    The verdict

    A defense verdict was returned.


    In this case, the defendants pointed the finger of blame for the methotrexate order at each other. This “dueling defendants” scenario usually does not play well with juries, as they assume there must have been substandard care. Here the jury found for the defense, however, even with dueling defendants. The plaintiff made a motion asking the judge to enter judgment in favor of the plaintiff notwithstanding the jury’s verdict, and the judge granted the motion, deciding there must have been credible evidence of negligence. An appeal of this decision is expected.



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