Coroner's finding: ruptured splenic artery aneurism
The SA Coroner’s court has inquired into the death of a young woman aged 25 years, who was 23 weeks pregnant at the time of her death, from a ruptured splenic artery aneurism. In a finding handed down on 25 May, the coroner made a number of recommendations. The recommendations included that educational and professional development strategies be directed to the medical profession, including medical practitioners and nursing and midwifery staff, concerning the condition of ruptured splenic artery aneurysm. The recommendations are repeated verbatim below:
15.2 The Court makes the following recommendations directed to the Chief Executive of SA Health, the Chief Executive Officer of the Women’s and Children’s Hospital, the Chief Executive Officer of the Country Health SA Local Health Network, the President of the Australian Medical Association (SA), the Chair of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (SA), and the Chair of the Royal Australian College of General Practitioners (SA),:
1) That educational and professional development strategies be directed to the medical profession, including medical practitioners and nursing and midwifery staff, concerning the condition of ruptured splenic artery aneurysm. Such measures should include reference to (a) the proposition which appears to be generally accepted that a diagnosis of ruptured splenic artery aneurysm should be considered in any pregnant patient who complains of sudden onset of severe left upper-abdominal pain regardless of whether pain or shock is prominent at the time of evaluation, (b) the symptomatology of the condition, (c) the fact that patients who are experiencing a ruptured splenic artery aneurysm will not necessarily present in the first instance in shock, (d) the fact that practitioners should be alive to the possibility that false reassurance might be derived for a period of haemodynamic and other stability following the initial episode, (e) the fact that limited diagnostic reassurance can be derived from a patient’s positive response to analgesia, (f) the issue as to whether or not the absence of abdominal guarding and rigidity is of diagnostic significance, (g) the diagnostic measures that are available and appropriate to diagnose a ruptured splenic artery aneurysm, and (h) the need for urgency in the conducting of diagnostic measures in cases where a differential diagnosis of ruptured splenic artery aneurysm is involved;
2) Presentations of a pregnant woman who complains of a sudden onset of severe left upper abdominal pain, especially with evidence of loss of consciousness at the time, should immediately be referred to, as far as is possible, a consultant obstetrician and gynaecologist or other medical practitioner at consultant level, including an Emergency Department consultant or surgical consultant;
3) That such patients be the subject of continual and detailed observation, and that such observation should be supervised by a medical practitioner at consultant level;
4) The recommendation of the Victorian Coroner’s Court in respect of the death of Michelle Johnson is endorsed, namely:
'Intra-abdominal haemorrhage (e.g. ruptured splenic artery aneurysm, ruptured liver) should be considered as part of the differential diagnosis when a pregnant woman presents with severe abdominal pain especially if she requires narcotic analgesia.'
5) That consultations between consultant medical practitioners and radiologists regarding the appropriateness or otherwise of conducting CT scans of pregnant women in circumstances where ruptured splenic artery aneurysm is a part of a differential diagnosis be encouraged to take place routinely;
6) In cases where ruptured splenic artery aneurysm is part of a differential diagnosis, but where other preferred or more likely diagnoses need to be explored, that all diagnostic measures in respect of those other diagnoses be conducted urgently and at the first available opportunity;
7) That the services currently provided at the Women’s and Children’s Hospital be co-located with the Royal Adelaide Hospital.
The finding in full can be found on the Coroner's Court website under the section Coroners Findings > All Findings > 25/05/2016 PALTRIDGE, Mellanie Joanne.
You can also access an article publiced in teh AMA(SA)'s magazine, medicSA, about the finding, at the PDF below.