When an Ectopic Pregnancy Turns Tragic

The Musafa’s were referred to my Early Pregnancy Clinic by a colleague. ‘They have had two consecutive early miscarriages and wish to seek your expert opinion before another pregnancy’ concluded the referral note from Dr Muchiri.

They were a pleasant couple in their mid-30s. As is the norm in such cases, neither had any significant past medical history. ‘Most people with two previous early miscarriages will subsequently have a successful pregnancy without any intervention’ I said reassuringly. It was explained that extensive testing is usually not recommended after two miscarriages.

The cause is usually genetic (chromosomal abnormalities) in the fetus (early pregnancy), and thankfully non-recurrent. Most couples will have normal results after exhaustive and often expensive testing, warranting no specific intervention.

The Musafa’s would hear none of this. ‘We wish to have every available test if just for reassurance’ they said. As it turned out, all their tests were normal. ‘We will take it easy for a year or so before embarking on another pregnancy’ they said in parting.

I must have forgotten about the Musafa’s till they came along to see me 2 years later. They were now ready for another pregnancy. I gave them standard pre-conception advise and added, ‘Please arrange to see me if you have not conceived within 6 months.’

As anticipated, Mrs Musafa conceived almost immediately. They came along for an ultrasound scan at about 7 weeks. They were understandably very anxious during the scan. I was a bit taken aback when I couldn’t identify a pregnancy inside the uterus, and neither could I clearly identify one outside the uterus (known as ectopic pregnancy). As I explained the findings, I could see their faces turning grey and their eyes misting with tears.

‘Your scan findings suggest you might have an ectopic pregnancy’, I concluded.

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I arranged for a pregnancy hormone level to give further guidance. This turned out to be too high, meaning that Mrs Musafa most likely had an ectopic pregnancy. ‘This is a dangerous situation that needs treatment immediately’ I said, painstakingly explaining the reasons for this. ‘Why us?’ Mrs Musafa intoned tearfully. Her husband was not taking it better either. For that reason, they asked to be left alone to make a decision. Hours later, they contacted me saying they were going away to contact other doctors in Kenya and seek a second opinion. ‘Please take this seriously, it’s potentially life-threatening. You cannot afford to delay treatment’ I cautioned.

Three days later, events took a worse course. Mrs Musafa was brought to our Emergency Department in a collapsed state. We rushed her in for emergency surgery. The ectopic pregnancy had ruptured and caused heavy bleeding inside her abdomen. ‘You just got to us in the nick of time’, I explained as she recovered in the high dependency unit.

‘That’s us done with pregnancies’ her husband interjected, ‘two miscarriages, now an ectopic, who knows what next?’ he continued in a sad monotone. I was struggling to find reassuring words as I bid them goodnight.

Read more on Dr. Murage’s blog