Court documents tell us that on May 9, 2012 Kimberly Stinnett’s, a resident of Alabama, found out she was pregnant. Two days later, on Friday, May 11, Ms. Stinnett had abdominal cramping and fever and the OB/GYN covering calls, Dr. Kennedy, instructed her to go to the emergency room . Upon admission Ms. Stinnett reported that her last menstrual period was April 1, 2012, so she was approximately five weeks and 5 days pregnant. Her medical history was significant for 2 prior miscarriages and a prior ectopic pregnancy in 2010, which resulted in the rupture and removal of her left fallopian tube (salpingectomy).
An ultrasound in the emergency room revealed fluid in the endometrial cavity that “could be a gestational sac” but the court records do not describe this as definitive nor do they list the size. There was no yolk sac, fetal pole, or cardiac activity. Ms. Stinnett’s beta-hCG was 18,473. At this beta-hCG there should have been a yolk sac. If there was an intrauterine pregnancy they available evidence indicated it was not normal.
Dr. Kennedy was concerned about ectopic pregnancy or an inevitable abortion (an abnormal pregnancy destined to miscarry). Her patient had one of the biggest risk factors for ectopic pregnancy, a previous ectopic pregnancy. Failure to promptly diagnose and treat an ectopic pregnancy can cause severe blood loss and even death. If not expertly treated it could also result in the loss of her one remaining fallopian tube which would require in vitro fertilization for any subsequent pregnancies.
Dr. Kennedy did a laparoscopy to look for an ectopic pregnancy and did not see one. To not do this would have been malpractice. She also did a dilation and curettage (D & C) to confirm the intra-uterine placement of what the evidence suggested was a non viable pregnancy. If the pregnancy was in the uterus then no further treatment for an ectopic was needed.
The pathology results from the D & C showed products of conception, so a pregnancy in the uterus (one destined to fail). Dr. Kennedy still recommended methotrexate operating under the assumption that there might be an ectopic. It is possible for there to be a pregnancy in the tube and the uterus, this is called a heterotopic. She was concerned enough that she recommended methotrexate, a cancer drug and a recommended therapy for ectopic pregnancy. This was given on May 13, so at 6 weeks gestation.
On May 14 another ultrasound was performed (likely looking for the ectopic) and a yolk sac was seen. Medically this means that Dr. Kennedy missed some of the abnormal intrauterine pregnancy with the D & C. Ms. Stinnett subsequently miscarried on June 8, 2012. She sued in civil court for wrongful death of her “previable unborn child” claiming she should never have received the methotrexate. A lower court judge dismissed her claim, but all eight justices of the Alabama Supreme Court agreed they should overturn that ruling. Justice Tom Parker wrote a special concurring opinion that “unborn children are protected by Alabama’s wrongful-death statute from the moment life begins at conception.” Parker has a well documented mission to outlaw Roe V. Wade.
This is wrong on so many levels.
With a beta hCG of 18,473 a yolk sac should have be seen on the initial ultrasound on May 11th. In fact, 99% of the time a yolk sac should be seen with a beta hCG of 17,716. The gestational sac wasn’t normal looking so with that pregnancy hormone level and the absence of a yolk sac it is pretty hard to conclude this pregnancy was viable. Remember the fetal pole cardiac activity bills? We often see cardiac activity at 6 weeks, so an irregular gestational sac at 5 weeks and 5 days by with no yolk sac is itself is very abnormal.
I asked 3 reproductive endocrinologists what the chances of a pregnancy being normal with a beta hCG of 18,473 and no yolk sac and they all looked at me like I was nuts.
A D & C can miss part of a pregnancy. It can even sometimes miss the whole thing, especially early on. The tissue is very small and you are operating blindly.
Methotrexate can cause abortions, it is about 69% effective by day 21 after administration. Ms. Stinnett actually completed her miscarriage outside of this window.
There is zero evidence in the court documents supporting the idea that the pregnancy was normal and no proof that the methotrexate was the cause of the miscarriage. Facts are obviously irrelevant in Alabama.
And then there is the issue of calling a 6 week pregnancy a previable child. It looks like this. The big circle is the gestational sac, the little circle is the yolk sac, the line between the markers is the fetal pole.
However, the pregnancy based on the information in the court documents didn’t look like this as it appeared very abnormal.
A reasonable OB/GYN would conclude given this scenario that there could not be a viable intrauterine pregnancy. The issue Dr. Kennedy had to figure out was if there was also an ectopic pregnancy. She erred on the side of caution and treated. She did the best with the information that she had.
I don’t have all the data. I don’t have the ultrasound images to review nor the size of the gestational sac. If the sac were 25 mm or greater and empty (so no yolk sac) there would be a 100% chance of miscarriage. I also don’t know how much pain Ms. Stinnett was in, how much she was worried about losing her remaining tube, and a variety of other factors that go into making the best medical decision. However, I see no proof that Dr. Kennedy caused Ms. Stinnett to miscarry.
Allowing this lawsuit to go forward is frightening. If I practiced in Alabama I would want another opinion before doing a D & C for an inevitable abortion or fetal demise. In rural communities that could lead to significant delays and some women with ectopic pregnancies will suffer (never mind the suffering caused by the delay for the women miscarrying). It will also increase the cost for patients and insurers as more ultrasounds will be done to satisfy a legal fetal fetish and people will have to pay for unnecessary second opinions.
The ruling also sets a chilling precedent regarding viability and fetal personhood. If Ms. Stinnett is successful in her case, and I’m pretty sure there will be some top anti choice lawyers helping her out, then that could set the wheels in motion to overturn Roe v. Wade.
It’s 2017. Facts are completely irrelevant to medicine and pregnant people and their doctors are at the whim of ignorance.
What a time to be alive.
- Updated 10:40 pm January 5 to correctly reflect the fact that there were no products of conception on the D & C