Ultrasound scanning equipment.

The diagnosis of ectopic pregnancy

HSIB legacy content

HSIB legacy content

This investigation was carried out by the Healthcare Safety Investigation Branch (HSIB). Find out more about HSIB legacy.

National investigation

This patient safety investigation explores the diagnosis of ectopic pregnancy.

An estimated 12,000 women experience an ectopic pregnancy each year in the UK. Ectopic pregnancy occurs when the fertilised egg implants outside the uterus, usually in the Fallopian tube. If it’s left untreated, it can rupture and cause internal bleeding, putting women at risk of severe harm and death. Ectopic pregnancy may also impact on a woman’s fertility.

Most ectopic pregnancies can be diagnosed by a transvaginal ultrasound scan (TVUS). These scans are commonly undertaken in hospital-based early pregnancy units (EPU).

National incident data from the NHS shows that between April 2017 and August 2018 there were 30 missed ectopic pregnancies leading to ‘serious harm’.

Reference event

The reference event in this investigation follows the care of a 26-year-old woman who experienced a delayed diagnosis of an ectopic pregnancy.

She first went to a local minor injuries unit with abdominal pain on a Saturday morning. She was then advised to go to the emergency department with a suspected urinary tract infection. Following a positive pregnancy test, she was suspected by a doctor to have a problem in early pregnancy and was referred to an EPU for a TVUS within 24 hours and discharged home.

She followed up with the EPU over the weekend but, although she remained in a lot of pain, didn’t have a scan until Tuesday. By then she was found to have a ruptured ectopic pregnancy that required emergency surgery for significant blood loss.

Investigation summary

The investigation looks at:

  • Referral from emergency departments to early pregnancy services.
  • The provision of early pregnancy services to diagnose and manage ectopic pregnancy.
  • Information that women receive on discharge from the emergency department.