Woman denied immediate treatment to end life-threatening ectopic pregnancy until board decision

Updated at 5:00 pm with health ministry reaction  

A woman suffering from an ectopic pregnancy was denied immediate treatment because its abortive nature required authorisation by a board, Doctors for Choice said.

According to the NGO, the woman was denied methotrexate treatment because a doctor was not allowed to administer it without special authorisation.

Ectopic pregnancy also called extrauterine pregnancy, is when a fertilised egg grows outside a woman's uterus, somewhere else in their belly. It can cause life-threatening bleeding and needs medical care right away. An ectopic pregnancy is not viable.

However, Malta's blanket ban on abortion does not allow a doctor in such circumstances to immediately administer treatment that ends the pregnancy.

In a subsequent reaction, a health ministry spokesperson said that in key instances, any authorisation only takes a few hours, denying the existence of a board. 

The NGO said this was a consequence of Malta’s “pro-life abortion ban.” The authorisation was greenlit days later, however, the NGO argued that ectopic pregnancies needed to be treated urgently, and any delay in treatment could result in an increased risk of rupture which may cost the woman her life. 

“Even if she survives an ectopic rupture, there likely would be long term consequences on her health and fertility,” Doctors for Choice said. 

The story was published on Break the Taboo Malta.

“My fertility and, indeed, my life were needlessly put at risk because of unnecessary procedural delays all stemming from this umbrella ban on abortion,” the woman in question, wrote in the blog post. 

The woman described the fear, she felt when the doctors told her the news that she was suffering from an ectopic pregnancy. "Within a few days we had a scan done and it confirmed my fear... it was ectopic. The pregnancy was not viable, the embryo could never survive; its existence threatened my fertility and my life," she said. 

She praised the gynaecologists, however, criticised the fact that because the treatment was abortive, her case had to be put in front of a board.

"There were significant barriers in place to hinder the doctors from administering the treatment. My case had to be brought to a board and discussed at length and then signed off by specific people in the hospital before it could be dispensed. 

"It took two and a half days for the medicine to be approved. In the meantime, the embryo was growing and so with every hour that passed my fallopian tube was more at risk of scarring and perforating (bursting), and the treatment itself was becoming less likely to work," she said. 

The woman said the first dose of the treatment did not work, partly blaming the delay in the procedure. She had to be re-admitted for another dose, which eventually worked. 

“I’m thankfully on the road to recovery now but still incredulous at the status quo,” she said.

Health ministry reaction 

The health ministry has said that there is a significant percentage of ectopic pregnancies that can be treated medically as long as a number of criteria are adhered to.

“Once the case fits the criteria a request form for methotrexate is signed by the Consultant or his/her delegate and countersigned by the Chairman or his delegate of the Department of Obstetrics and Gynaecology,” it said. 

It went on to say that the procedure usually takes a few hours, and no board oversees the process.