Misdiagnosed Surgery?

[acer19800]

My wife began having pains below the stomach area Thursday night. She was due to get her period and I think that might be it. However, 4 days before that she started throwing up which made us believe she might be pregnant.

On Friday she went to work and nearly calapsed so I was called and took her to the hospital:

Navaminthra Hospital

47/94 Moo 13, Sihaburanukit Minburi, Bangkok 10510 Thailand

Tel: 02- 918 5080

They tested her, blood test, pee test, ultrasound, xray and told her she was pregnant but her baby was in the wrong area. We were very upset and things moved fast at this point, they wanted to take the baby out right away. We have both never experienced anything like this and things were moving real fast, next thing I know a paper was handed for me to sign. Speaking very little Thai, I never was able to meet or talk to the doctor (which at this time, I regret).

Nothing was explained to me, only my wife crying her eyes out telling me they have to take the baby out because it is in the wrong place. I am under the impression they are going to give her an abortion, some tube in her vagina. Again I have no experience, and even asked how long this will take and if she would be able to go home right afterwards. She said, it takes 2 hours and she will have to stay overnight.

She went up and they did the surgery, 3 hours later she is in her hospital room and starting to recover. Many hours go by the doctor never came in but my wife was ok. More hours go by and my wife asked if I wanted to see where they cut. I asked, CUT ? and she shows me the bandage where she basically had a C-section.

This was shocking and I realized she must be in a tremendous amount of pain. The next day the doctor comes in at 3pm and I finally meet him. Translating and broken english he explains a baby was not removed but blood and a cyst. ????? <deleted> ! Am I overreacting here?? She was pregnant, and was told by the doctor and all the nurses the baby must come out, but a baby did not come out. The ultrasound showed a cyst but was mistaken for a baby??? She had her period one month ago so the baby can't be older than 1, 2 or 3 weeks old, can that be seen in an ultrasound at all ?? The doctors told us she may still be pregnant and a test in a week will determine that. I don't believe the doctor, something is wrong here. So, still baffled by what was said by the doctor just then i call the head nurse to come in with her chart. She explains she had a "cystarectamy" ? I can't find that term on the internet, did she have a hystorectamy? The doctor said only blood and the cyst came out, my question is where is the baby?

Yesterday I brought her home and she is recovering ok, but today she started having blood come out of her vagina which I assume is her period. So I don't think she is pregnant now. What happened, did this surgery cause a miscarrage, when they opened her up they realized she was pregnant but not the cause of the pain?? Did they have to cut her at all ? We are lost here, with only an appointment to go back in a week.

I feel horrible as my lack of communication and understanding may have let this mistake happen.

Is this a legal issue? Any suggestions appreciated.

[donna]

i would suggest that you do a couple of things:

find out exactly what procedure was carried out on your wife. it sounds as if she had a ruptured cyst on an ovary to me. in the west, this would be removed by doing a laparoscopy, which is where a small camera and instruments are maneuvered inside the body in order to track down the 'nasty' and get rid of it. this is not hugely invasive, and causes less trauma to the body than the procedure that was used on your wife. it is highly likely that they did not have time to get her to a hospital with this equipment, and had to to the surgery straight away.

if it is a burst cyst, then i am not sure if she would be pregnant or not. a simple urine test may be able to tell you this.

she may have also had an ectopic pregnancy, which is where the fetus is not inside the womb. this is dangerous for the mother, and needs to be dealt with sooner rather than later. thus, another reason for emergency surgery.

a fetus of 3 or 4 weeks MAY be able to be seen in an ultrasound, but it will only be a couple of mm in size, making it difficult. the easiest way to see if she is still pregnant is to do a urine/blood test.

to me, it sounds as if you still dont have all the facts you need in order to take any action. perhaps you can schedule an earlier appointment with the doctor to find out what really happened? now that the emergency has been dealt with, you could get a clear explanation?

good luck though. i hope that your wife recovers soon from her ordeal.

[joskydive]

Try looking up 'cysterectomy'. As Donna explained, it's a cyst on the ovary.

Sorry the hear about your problem and hope your wife is feeling well soon.

[acer19800]

if it is a burst cyst, then i am not sure if she would be pregnant or not. a simple urine test may be able to tell you this.

I would have to say she was pregnant, she had a urine test and the doctor told her she was. What is confusing me is how a baby can be mistaken for a cyst. The doctor said only blood and the cyst was removed, where is the baby now?

[donna]

if the doctor said that only blood and a cyst were removed, then your wife could still be pregnant.

alternatively, she may be in the middle of a miscarriage, taking in to consideration that you said that she was bleeding now.

[acer19800]

Yes, I think it is a miscarriage - just now she showed me something that came out that would not be normal for a women's period.

She is very upset, was this caused by the surgery? (asking myself). Was there even a cyst? The only thing for sure is, she was pregnant. My feeling at this point is, they went in to remove a fetus they thought was in the wrong place (based on an ultrasound), then once in there either removed blood, cyst or nothing. Of course a Thai doctor is not going to admit to an incorrect diagnosis or tell what really happened in surgery if he was wrong.

The last topic in this thread suggests medication over surgery: can't post URLs but put .com in the middle:

forums.wrongdiagnosis /showthread.php?t=26583

I am glad my wife is ok, that is the most important thing.

[donna]

this MAY have been caused by the surgery, or it may not. you may never really find out. but one thing for sure is that you must find out what the operation really was for. maybe in the stress of the whole situation you mis-heard what was really going on?

if your wife is passing 'bits' then it does look like she may be having an early miscarriage. this is not unusual, though. many women miscarriage in the early stages of pregnancy, and it just seems like a heavy period. they/we never realise its a miscarriage in many cases.

if your wife did indeed suffer a burst cyst, its a very painful and potentially dangerous situation, so surgery may not have been avoidable.

best you get back to the doctor and get the full story in a calm environment.

i wish you both the best of luck.

[Dakhar]

Acer,

Her symptoms could be caused by many things. But at the very least they did not hand her some pain pills and told her to go home.

It is good to hear she is recovering.... my thoughts are with you. I know it has to be frustrateing, a night mare to be more discriptive.

Now you got a taste of what the deaf go through.

[Mobi]

Acer, maybe the best thing is to take her to a specialist at another hospital and get a second opinion. Maybe the specialist there can contact the first hospital and try to ascertain exactly what happened - or alternatively, you are entitled to request a copy of your wife's records to take to the new hospital.

I am glad to hear your wife is recovering, and I wish you both well.

[Sheryl]

Actually from what you describe it is quite possible that they did not do anything worng or unreasonable and that the main problem was just communication.

What it sounds like is that she came in with signs of an acute internal problem with signs of internal bleeding. Immediately in a woman of child-bearing age, even without a history of possibly being pregnant but especially with it, one of the most serious possibilities is an ectopic pregnancy: a pregnancy in which the egg implanted outside the uterus, usually in a Fallopian tube. Ectopic pregnancies have no possibility of resulting in a live birth and are a serious risk to the woman's health; an ectopic pregnancy that has ruptured is a life-threatening emergency from which the woman can easily die unless surgery is performed at once.

Such surgery is not done through the vagina; it requires an incision into the abdomen and removal of the entire fallopian tube that is affected. (Still leaves one tube so future pregnancy still possible). Of course the embryo (which may or may bot at that point still be alive, but in any case has no chance of developing to full term) will also be removed along with it but this is not considered an abortion since the procedure is not perfromed for the purpose of terminating a pregnancy per se but rather to save a woman's life in a situation where the pregnancy has no chance.

It sounds like they did both pregnancy tests and an ultrasound; presumably the pregnancy test was positive, no embryo was visible on ultrasound in the uterus and there were signs on the ultrasound of internal bleeding in the vicinity of the ovary/fallopian tube; possibly there was also a low blood count or other clinical signs of dangerous loss of blood. Together with the clinical signs and history, a probably ruptured ectopic pregnancy was tentatively diagnosed and was a reasonable diagnosis and one that warranted abdominal surgery at once with no time to waste.

When they went in surgically, they found no ectopic but rather a ruptured (presumably ovarian) cyst, which they removed. It is perfectly possible to mistake a ruptured ectopic for a ruptured cyst and in any case, they would still have needed to operate to remove the cyst even if they had known in advance that's what it was, as from the sounds of it the cyst had ruotured and there was internal bleeding.

She did not have a hysterectomy nor a c-section, and the surgery did not invovle her uterus, which is still intact. As far as I can tell friom what you describe, her treatment was appropriate, albeit obviously very traumatic for you due to difficulty communicating. It would not have been safe to have waited to call in better interpretors etc. A ruptured ectopic is a serious emergency, and ruptured ovarian cysts can also cause internal bleeding (as this one apparently did).

As to where the baby is, there are 2 possibilities basically depending on what the pregnancy test showed:

possibility #1 pregnancy test was positive = the baby was in the uterus throughout, just not visible by ultrasound because of the very early gestation. In which case she may be having a spontaneous miscarriage now. The stress of not just the surgery but the ruptured cyst, pain and internal bleeding that necessitated surgery might have contributed to the miscarriage or it might just be happening on its own, as sometimes occurs; there is no way to know. but regardless it does nto sound like there was any choice about operating without risking her life.

possibility #2 pregnancy test was negative(this can happen in a ruptured ectoic pregnancy if as a result of the rupture the embryo has already died, so it would not have rukled out the possibility of ectopic pregnancy especially given the history of a slightly delayed period etc), she never was pregnant and what she is having now is her period.

What is important now is to confirm if she has miscarried or not, and if she has miscarried, whether or not it is complete or any tissue is retained (which could cause bleeding or infection later).

Make an appointment with a good, English speaking Ob-Gyn. If it is important to you to know whether or not she ever was pregnant (assuming that she is not any longer) -- and I can understand that it probably is -- then before going get her hospital records from the hospital that did the surgery; this will include the results of the pregnancy tests (urine and blood most probably). You will have to pick them up in person at the hospital and sign for them, and to save time, should have a Thai speaker call ahead that you are coming and provide the hospital number. there should not be any trouble with this and if there is,, hold firm; hospitals are required by law to provide patients with their records on demand.

The OB-Gyn will review the records, repeat pregnancy tests if the ones done in the hospital had been positive and also do an internal exam, and then be able to tell you if she has had or is in the priocess of having a miscarriage.

I see you are online know so I'll post this but then post again with names of some Western trained, English-speaking Ob-Gyns that other TV members have recommended.

[Sheryl]

As promised:

Dr. Siripat Preechasanongkit (female) Samitivej Srinikarin Hospital www.samitivej.co.th – Srinakarin Rd and Rama IX. Not Western trained but reported to have excellent English and be very compassionate/sensitive.

Dr. Sankiat (male) Samitivej Sukhumvit same website as above, Sukhumvit Soi 49

Dr. Noppadol (Bumrungrad) www.bumrungrad.com Sukhmvit bet Sois 1 and 3.

Many members gave positive feedback without specifying doctor’s name for experiences with pregnancy/delivery in both Bumrungrad and Samitivej. Both hospitals have a large number of English speaking Ob-Gyns on staff and qualifications of each doctor can be examined on their websites.

Bound to be some good ones at Bangkok Hospital and Bangkok Nursing Home Hospital too but these are what I found mentions of.

[riadoc]

Acer,

First, allow me to extend my condolences for the tough time you and your wife are experiencing now. I am sure it is sad and frustrating and scary. That being said, you have been given excellent counsel by the list, and the names of some good facilities. I would add Ramathibodi University Medical Center, Siriraj University hospital and as well as Chula all which have excellent care, and will assumably be less expensive if cash is at issue. I would be treated in any of those hospitals and I have a PhD in healthcare Administration and am a former OR Tech. I have been treated in Bumrungrad and Bangkok International.

I would not make the broad assumption that a Thai doctor would not admit to a mistake. Thai doctors are covered for professional liability by the hospital that employs them. They are also ethical and take seriously the sacred trust placed by those for whom they provide compassionate care. In addition, many are trained longer and more extensively than their western counterparts, as they often add an additional 3 years abroad to their training. While the command of English may not have been to your expectations, I would not be so quick to dismiss their care, skill and compassion at this frustrating time.

As for legal action, it is different in Thailand. There are requirements to submit disputes and allegations of impropriety for binding arbitration, in Thai, and rarely coverage for pain and suffering, only true economic damages.

Stick by each other's side for now, provide support and compassion for your wife who may indeed be in the process of losing a fetus, which also includes hopes, dreams, fears and a bundle of mixed emotions. Her abdominal muscles hurt, several layers of tissue were cut, they have to physically heal. Focus on what's important: healing, the love you share with each other, the appreciation for how much worse it could have been, but wasn't, and use this to weave a fabric of a tighter bond. If a wrongdoing occurred, it will still be wrong, actionable and all that other stuff in a few weeks, a month, or whenever. Stay calm, focused and balanced.

I hope she feels physically better and for the two of you, I wish you peace.

Maria Todd, MHA PhD