Serissa McKay, from Winnipeg, who is expecting her first baby on 16 July 2017, had gone for an appointment with the doctor on 21 June. She was given medical abortion pills used to induce labour, although she was not ready for delivery and never had the intention to end her pregnancy.

The 21-year-old mother-to-be was given two packets of hexagon-shaped tablets – four in each – by the receptionist, and was told to put four of them into her vagina at that time; and another four eight hours later.

She had assumed it was part of her routine pre-birth vaginal examination and inserted the pills as instructed. However, while in the washroom, she received a call from the receptionist, asking to confirm if she was McKay, and if she had already inserted the pills.

When McKay told her she had already done so – she was asked to go to the doctor immediately to have them removed. She said the receptionist made her feel bad for not recognising the pills, or realising they were not for her to take. And still, she had to go through the torment, both physically and emotionally.

"It was actually pretty painful," expressed McKay, of the removal process.

Though it was a shock for her, the doctor appeared nonchalant and carried on, according to McKay, as if it was a routine appointment – asking her if she had any questions or concerns.

Concerned about the consequences on her unborn child, she asked the doctor, "What will happen? I took pills that I wasn't supposed to, so what should I watch for?"

McKay said her baby survived the mishap but she is concerned about its well-being and about the same doctor delivering her child. Photo credit: Ruth Bonneville/Winnipeg Free Press
McKay said her baby survived the mishap but she is concerned about its well-being and about the same doctor delivering her child. Photo credit: Ruth Bonneville/Winnipeg Free Press

She was told to watch for cramping and signs of labour – and the doctor admitted the drug had been intended for a woman who had suffered a miscarriage.

McKay said, "It didn't really hit me until I actually got home."

Drug commonly used to induce labour and medical abortions

According to family-planning specialist and McMaster University Prof. Dusstin Costescu, McKay's description of the pills and the receptionist’s instructions to insert them match misoprostol, which only comes in two doses – 100 micrograms and 200mg – so at minimum McKay inserted 400 micrograms into her vagina, at most, 800mg. He added that that is well above what doctors would use to induce labour.

"With labour induction at term, it can be used in as small as 25 to 50mg," he said, "So you use an eighth or even a 16th of the dose you use in first trimester."

Misoprostol is approved for treating stomach ulcers, although it’s commonly used in medical abortions and to induce labour as it softens the cervix and brings on contractions. However, it is not common practice in Canada for doctors to use the drug to induce labour unless it is a stillbirth.

"It is very effective at ending a pregnancy, regardless of gestational age," he said, but added, “It is clearly contraindicated in a setting of a wanted pregnancy.”

Costescu said the baby is likely going to be fine since McKay hasn't had any reactions in the week since the accidental insertion and the doctor removed the pills so quickly. When inserted vaginally, misoprostol usually takes 40 to 60 minutes to take action, he said, with "peak onset about one to two hours after".

Nevertheless, McKay and her partner, Daniel Monkman, are not reassured and Daniel jumps every time she groans or aches or moves in a funny way, she said.

McKay has filed a complaint to the College of Physicians and Surgeons of Manitoba, which regulates the profession. But she felt the doctor and the clinic are not addressing her complaints. When she expressed her intention to switch doctors, she was told she had to consult her doctor first. They told her that even with the switch, she might have the same doctor delivering her baby, depending on the time of birth and the doctors on call at that time.

But Mckay is not comfortable with her doctor. "I don't want that at all," she said. "You’re supposed to trust your doctor.”

"It's something to be taken seriously," Costescu said.

McKay has yet to receive an apology from her doctor or an acknowledgement of the gravity of the mistake, which could have hurt her baby, she said.

Patient advocate urged healthcare providers to discuss prescriptions thoroughly with patients

The Winnipeg Regional Health Authority (WRHA) said because McKay attended a private clinic, the agency has no oversight role.

"For anyone who puts forward a complaint about an interaction with a fee-for-service physician, the WRHA's practice would be to refer the patient to the College of Physicians and Surgeons (CPSM) as the appropriate body to connect with their concerns," said a spokesperson.

"The WRHA does not intake complaints for private physicians or on behalf of CPSM."

The Canadian Patient Safety Institute's Kossey said, along with an apology, that the young mother-to-be deserves the chance to hear how her healthcare providers will learn from their mistake.

"[She needs] an assurance that clinic or that care provider is doing everything possible to learn from that event and prevent it from happening to somebody else," said Kossey.

Kossey urged health practitioners to “have open candour and communication, letting the patient and their family know what's happening and why they're taking those steps.”

Similar case in Mumbai – mother lost one of her twins

In a recent case, Dr Tarannum Wasif Khan, a dentist who was 25 weeks’ pregnant, lost one of her twins when she was reportedly given an abortion pill by a nurse at Jaslok Hospital in Mumbai. The other baby was born prematurely. In the unfortunate erroneous prescription, the pill was meant for another patient who was scheduled for medical termination of her pregnancy.

In response to the mother’s complaint on the hospital, CEO Dr Tarang Gianchandani of Jaslok Hospital said, “An internal inquiry did not find any lapse on the part of its medical staff in the case. She said that while there was a patient admitted to the hospital for medical termination of pregnancy, she was not on the same floor as Dr Khan and thus there was no possibility of a mix-up in administering medicines.”

“To avoid such mistakes with identical medicines, we have prepared guidelines so that no one is confused. In this case, I have a full sympathy with the patient. In fact, we saved the other twin and she was discharged from the hospital hale and hearty,” remarked Dr. Gianchandani. MIMS

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