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Misdiagnosed Miscarriage: A Tragic Medical Blunder Pregnant Women Can Prevent

3 month ultrasoundSofia Taylor just went through an enormously difficult (and very rare) experience.  At her 3 month ultrasound,The U.K. pregnant woman was told there was no heartbeat and her pregnancy was not viable.  She was encouraged to proceed with medical procedures to remove the fetus from her uterus. But she opted not to, reportedly because her instincts told her that she had not miscarried. (It’s not clear whether she was having any miscarriage symptoms).

A week later Sofia Taylor returned for a second scan and was told that there was a heartbeat and the pregnancy was viable after all. She is now carrying what seems to be a normal and healthy fetus. The mother of 3 (going on 4) was obviously extremely distressed at this major mistake, but relieved in the end to find out that her baby was okay after all.

This near miss touches on so many pregnancy anxieties.  When I first read the story, I thought, why get everyone riled up about a freak accident? I decided to do a little investigating into the problem of misdiagnosed miscarriage. After all, the story that alerted me to the phenomenon was in a rather tabloid-ish paper. But it turns out that misdiagnosed miscarriage is more common than I thought.

Don’t get me wrong. It’s still very, very uncommon.  The chances of a pregnancy being diagnosed as not viable when it is are EXTREMELY slim.  But this is not the only story I read about this experience. In fact, there’s an entire web site dedicated to women who have experienced this unfortunate medical blunder.  The site offers stories, support, and information on women’s rights after a miscarriage diagnosis.

The upshot is this: If you are told that your fetus is not viable after an ultrasound examination, you have some choices.

A doctor will usually ask whether you would like to wait to see whether a miscarriage will occur naturally.  This happens in a fairly high percentage of cases, but it sometimes takes awhile. This is part of why a D&A or D&C is offered, because many women do not want to deal with the extended period of waiting to see whether a miscarriage will occur naturally. The idea is that by getting the procedure, the woman can “be done with it” and begin the mourning process rather being in a holding pattern for a week or more. There is also the possibility that there may be some residual tissue left if the miscarriage is allowed to proceed naturally. Removing the tissue via D &A or D&C is a way doctors can be sure that the uterus has been completely cleared. The farther along the pregnancy is, the more likely a natural miscarriage is to be “incomplete”, and the more likely a D & C will be considered medically necessary.

Here are some ways you can ensure your miscarriage has not been misdiagnosed:

1. Consider waiting for a natural miscarriage if the diagnosis occurs before 10 weeks gestation.

2. Ask for a second ultrasound on a different machine

3. Ask for a second opinion from a different technician or doctor

4. Ask to come back on another day just to make sure before proceeding.

5. If you do decide to move forward with a D&A, D&C or medication to promote the progress of the miscarriage, ask for another ultrasound before the procedure is initiated

This is such a tough subject, because in an overwhelming majority of situations, when a miscarriage is diagnosed, it’s because the fetus really is not viable. It’s true that misdiagnosis is possible. But it’s so rare that it’s hard to even talk about it without feeling like it’s giving unrealistic hope to a huge number of women who ultimately will have to face the painful reality of pregnancy loss.  It also brings up all kinds of issues about the doctor-patient relationship and trust.

Many of the stories I read about misdiagnosed miscarriage point to the woman’s instinct as a key factor in resisting pressure to do a D & C or D & A.  Instinct can be a powerful tool, but it is often difficult to parse out what’s instinct and what’s emotion, especially in such a hyper-charged situation. There are so many situations where women who have had miscarriages say they always knew something wasn’t right with the baby. But then there are those who are taken completely by surprise. And those who went around with a cloud of anxiety about something going wrong and delivered perfectly healthy babies after uncomplicated pregnancies. I’m not sure we can put the pressure on women to be able to read their instincts and know which way to proceed after a miscarriage diagnosis. Or at any rate, the message instinct sends needs to be fortified by information and good communication. It seems to me that the precautions above should be standard procedure in a miscarriage diagnosis to prevent the very rare—but very tragic— misdiagnosis. In many cases, some or all of the above precautions might be taken by a sensitive healthcare provider. But should the situation arise, it’s good to know that you have the right, and the ability, to take steps to make sure the diagnosis is accurate.

photo: Collinson/flickr

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