Doctor's failure to accurately date pregnancy before termination procedure caused patient and family distress

What happened

The doctor relied on the last menstrual period date that Ms A gave him, although this date was not reliable, to date her pregnancy at eight weeks. The doctor did an ultrasound scan but did not measure the length of the foetus.

The doctor decided that Ms A could have a surgical termination procedure (vacuum aspiration) because the Trust's time limit for this procedure is 14 weeks. He assumed that the list of dates for surgical procedures, usually held a few days after the clinic, was going ahead. However, the list had been cancelled because of the holidays. Staff therefore scheduled Ms A's procedure for the following month.

On the day of the scheduled surgical termination, staff did an ultrasound scan and found that Ms A was over 16 weeks pregnant, so was over the time limit of 14 weeks for a surgical termination procedure. Ms A had to wait two days before a medical termination using drugs, (a labour–type delivery), could be done.

Some weeks later Ms A bled heavily. An ultrasound scan showed that some tissue from her pregnancy had remained in her womb. She went into hospital where staff removed this.

What we found

We took advice from an obstetrician/gynaecologist adviser. The doctor did not date Ms A's pregnancy by measuring the length of the foetus, which is what he should have done. In addition, the date the Trust gave Ms A was too long after her clinic appointment for a surgical termination. The Trust did not get it right, and this was service failure.

Because the Trust did not accurately date Ms A's pregnancy and offer her a termination procedure in good time, she had to have a medical, rather than a surgical, termination of pregnancy. The failings in Ms A's care caused deep distress to her and her parents. This was an injustice to them.

In addition, there is a greater risk of tissue from a pregnancy remaining in the womb after a medical termination, rather than a surgical termination. The Trust therefore put Ms A at higher risk of experiencing this. This was also an injustice to Ms A.

Putting it right

The Trust wrote to Ms A to acknowledge the service failure we found and the impact it had had on her and her parents. It paid Ms A and her family £2,500 to recognise the injustice caused to them.

We noted that following its own review of its actions in Ms A's case, the Trust has reorganised its termination of pregnancy service to avoid a recurrence of the failings we identified. We are satisfied that this is appropriate.