sorry Op.
But you didn't tell us the medicine the supposed pharmacist gave you sir.I won't be surprised if it is just folic acid and multivitamins supplements . At least if you know the drug, you will have a chance to eliminate all likely cases of adverse drug reactions if it was what happened.
Nigerian health professionals are always ridiculing one another before patients who care less about the rivalry in the health sector.

slap1:
Yes. In Yoruba, translated into English by Prof. Wole Soyinka.

That is wrong ( Igbo Irun male)it was written by someone else

omicron:
According to WHO, Quinnine is known to be safe in first trimester preganancy.

It does not cause miscarriage. Rather, it is the malaria that causes miscarriage.

Coartem is not conclusively safe in early pregnancy as there are not enough data to prove its safety yet. Some new studies however, show it could be safe in pregnancy.

I do not see any malpractice here OP.

Sorry for your loss.

thank u my brother. Instead of blaming/counselling or advicing d op people r busy blaming the doctor.in a delicate country like Nigeria I fink d best thing any body can do to help himself in any health issue is to visit a hospital immediately u notice ya body system ain't feeling good.not going to pharmacist or a chemist .from d hospital one will be guided on what and what to do.what I notice as a country boy is that most people like to patronise patent chemist shops or pharmaceutical shop to complain so as jus to get some cheap services .it is now when may b complications r setting In they will quickly run to d hospital.

omicron:
lol

Op said MP was 1+ which in otherwise healthy adult is not significant. But sometimes, startin treatment based on 1+ is justified if clinical symptoms are supportive of malaria. In pregant people, you dont want to take any chance.

What is not clear is what caused her miscarriage. But from what is known, we cannot blame the quinine.

Op thinks its the quinine, but he is wrong. He should have sought for knowledge. Everythin is here online. The public is simply not doing their due diligence when it comes to medicine. Instead, they prefer the blame game in things they have not tried to understand.

I think it is lack of communication. Treating sick pregnant people is dicey and challenging. Most times you are in a dillema. It helps to tell them what is safe and what is not safe, but necessary.

I too was beginning to wonder what was wrong with Quinine in Pregnancy which is actually d safe drug to use...I'm sure if it was his doctor in yankee dat prescribed same medication with same outcome he wont complain...what he doesn't know is dat any febrile episode in Pregnancy can terminate it & its better prevented hence d reason for giving pregnant Mothers IPT with Fansidar and instructing to sleep under insecticide treated nets...when Malaria don set for her body its either she's treated & the baby survives or she loses d baby...how much more someone coming from a place without Malaria to a place that is Malaria endemic... Nigerians & dr badbelle against dr doctors is just getting nauseating by d day..

scholarteam:
sorry Op.
But you didn't tell us the medicine the supposed pharmacist gave you sir.I won't be surprised if it is just folic acid and multivitamins supplements . At least if you know the drug, you will have a chance to eliminate all likely cases of adverse drug reactions if it was what happened.
Nigerian health professionals are always ridiculing one another before patients who care less about the rivalry in the health sector.

Your last statement is very true.

marc99:


Boy, be formal next time. Don't just assume everyone on NL is within your age group. I'm sure you won't address your uncle a "dude".

You didn't get my point well enough.

Oga sir sorry oh i meant no insult.

That your nurse must be a traditional birth attendant or at best "nursu Eliza" what's she talking about flushing the womb?oh! my goodness.

quinine if given at a recommended dose for treatment of malaria has not shown to increase the risk of miscarriage.Even though, it was formerly placed in pregnancy category x(don't use in pregnancy) by manufacturers, studies have not shown any associated increased in miscarriage when used in first trimester when compared with control group. It's currently placed in pregnancy category C (use with caution)by FDA.
Doctors are not trained to be robots, they are trained to weigh risk-benefit ratio and make appropriate decision in the best interest of the patient.

It might also interest you to note that, no anti malarial drug is certified 100%safe in pregnancy.most of them with reasonable efficacy at present, are placed in pregnancy category C(ie ,use with caution)

your nurse is also hopelessly wrong when she said that pregnancy below 6wks cannot be detected by Ultrasound. Ultrasound can pick pregnancy as early as 2wks after conception ie 4wks after last menstrual period(LMP)
I agree that the doctor should have done a PT since there was a history of vagi.nal bleeding but people should mind how they easily label others quack.

Op you should apologise to the doctor for mentioning the name of his hospital here.
I didn't see any malpractice here.
You were asked to go for a scan you didn't claiming ur wife was weak.
It is possible your wife's pregnancy was not viable in the first place ( blighted ovum)
Mind you those pregnancy tests could be false positive. Also know that malaria is a major cause of miscarriage.
The scan you did later saw nothing( not even retained products) and somebody is giving your wife what to flush her womb Even blaming the doctor for not doing so
Please when next your wife is pregnant take her to another hospital of your choice and stop patronising quacks in the name of family members.

anitank:

But these are the things the doctor would have tried explaining to them rather than dismiss their claim about being pregnant because they hadn't gone for a scan. That's just unfair and doesn't portray him to be a good doctor.

If a urine or blood test showed the op's wife was pregnant, then she most definitely was. Besides most people don't go for a scan till after their first trimester

You are right that the doctor should have counselled her about the safety profile of the drugs prescribed. I already alluded to that in my 2nd post on the topic.

However, a positive pregnancy test is most likely suggestive of pregnancy, but not "most definitely" so. There are other conditions that can give u false positive pregnancy tests with even similar symptoms of pregancy. An example is what is called molar "pregnancy".

It is best do ultrasound in the first trimester and another later in pregancy.

slimmy05:
Shame on you. You couldn't give your first child a first class treatment. After all the struggle abroad like you claim. You killed him yourself for not taking her to a better hospital . Your sisters wife work in one of the biggest an d best hospital and you decided to take your wife to a dead hospital. Shame on you, you killed your baby yourself and if I was your in-law I would sue you.

All you did well was to spread her legs and got her pregnant and you run around patronizing quacks and brainless pharmacist who only want to sell their drugs.

you are sooo hash.

omicron:
According to WHO, Quinnine is known to be safe in first trimester preganancy.

It does not cause miscarriage. Rather, it is the malaria that causes miscarriage.

Coartem is not conclusively safe in early pregnancy as there are not enough data to prove its safety yet. Some new studies however, show it could be safe in pregnancy.

I do not see any malpractice here OP.

Sorry for your loss.

You Don't see any malpractice?? Typical 9ja doctor. A patient presents with a test result confirming pregnancy, you treat her for malaria, she ends up with a miscarriage, bleeding per vagina. You order an ultrasound hoping to detect a pregnancy that is probably less than a few week. At the end you conclude that there is no pregnancy, and send the woman home, not withstanding the test result and bleeding per vagina. What if she has retained products?.? Once again, are you sure there is no malpractice?

0monnakoda:
I think the fact that doctor is prepared to discredit the pregnancy test is worrying.Even now it should be possible to confirm if she was ever pregnant. If indeed she did have a "miscarriage" you are right that the reason is UNKNOWN. We cannot say quinine is not to blame .At best we can say it is unlikely based on xyz. We DO NOT KNOW. Everything is NOT online as far as adverse reactions are concerned.New ones are reported daily. Drugs are withdrawn or discontinued for that reason. The true doctor never assumes that ALL knowledge has been .There is always something to learn. G6PD is one theoretical explanation,accidental overdose is another there are others no doubt.
G6PD individuals have partial immunity to malaria and quinine can cause miscarriages.Therefore if malaria was misdiagnosed and quinine administered unnecessarily there is a case for malpractice,IF

On the other hand ,in pregnancy symptomatic malaria has a 50% risk of miscarriage and 33% where there are no symptoms.

Like i said, it is a lack of communication between the doctor and patient.

New facts are discovered by the second, but the patients can do some self education. The information available online from WHO, CDC, Mayo Clinic, and many reliable websites is enough for such basic self education. We doctors should also take out time to educate patients at every time when possible.

Quinine is not known to cause miscarriage, and it is so considered safe. It is a myth which is even common within health professionals. Unless there are new studies to the contrary.

However, anything is possible. Maybe, that's part of the message you tried to pass across.

freecocoa:
OP sorry for your loss.

They ought to have made sure your wife's body is not resistant to quinine before injecting her with it.

Some of these doctors are just busy giving the medical personnels a bad name.

Body resistant to quinine?

IDEKEALUMONA:
That your nurse must be a traditional birth attendant or at best "nursu Eliza" what's she talking about flushing the womb?oh! my goodness.

quinine if given at a recommended dose for treatment of malaria has not shown to increase the risk of miscarriage.Even though, it was formerly placed in pregnancy category x(don't use in pregnancy) by manufacturers, studies have not shown any associated increased in miscarriage when used in first trimester when compared with control group. It's currently placed in pregnancy category C (use with caution)by FDA.
Doctors are not trained to be robots, they are trained to weigh risk-benefit ratio and make appropriate decision in the best interest of the patient.

It might also interest you to note that, no anti malarial drug is certified 100%safe in pregnancy.most of them with reasonable efficacy at present, are placed in pregnancy category C(ie ,use with caution)

your nurse is also hopelessly wrong when she said that pregnancy below 6wks cannot be detected by Ultrasound. Ultrasound can pick pregnancy as early as 2wks after conception ie 4wks after last menstrual period(LMP)
I agree that the doctor should have done a PT since there was a history of vagi.nal bleeding but people should mind how they easily label others quack.

Yeah yeah...... Blame the nurse, thats real easy

dicefrost:





You Don't see any malpractice?? Typical 9ja doctor. A patient presents with a test result confirming pregnancy, you treat her for malaria, she ends up with a miscarriage, bleeding per vagina. You order an ultrasound hoping to detect a pregnancy that is probably less than a few week. At the end you conclude that there is no pregnancy, and send the woman home, not withstanding the test result and bleeding per vagina. What if she has retained products?.? Once again, are you sure there is no malpractice?

We do not know the LMP or EGA so we cannot say if it is correct he ordered the ultrasound when he did.

Blood tests do not comfirm pregnancy. Ultrasound did not show any retained products

The percieved malpractice by the OP is that the doctor caused the miscarriage. And that is not true.

nice one.ppl dey think well sha.

drlawizle:


I too was beginning to wonder what was wrong with Quinine in Pregnancy which is actually d safe drug to use...I'm sure if it was his doctor in yankee dat prescribed same medication with same outcome he wont complain...what he doesn't know is dat any febrile episode in Pregnancy can terminate it & its better prevented hence d reason for giving pregnant Mothers IPT with Fansidar and instructing to sleep under insecticide treated nets...when Malaria don set for her body its either she's treated & the baby survives or she loses d baby...how much more someone coming from a place without Malaria to a place that is Malaria endemic... Nigerians & dr badbelle against dr doctors is just getting nauseating by d day..

omicron:
Like i said, it is a lack of communication between the doctor and patient.

New facts are discovered by the second, but the patients can do some self education. The information available online from WHO, CDC, Mayo Clinic, and many reliable websites is enough for such basic self education. We doctors should also take out time to educate patients at every time when possible.

Quinine is not known to cause miscarriage, and it is so considered safe. It is a myth which is even common within health professionals. Unless there are new studies to the contrary.

However, anything is possible. Maybe, that's part of the message you tried to pass across.

I m afraid I must disagree with you on several grounds.
I wonder whether you practice in a jurisdiction where you are required to have insurance and what the insurers would have to say about what you have written
1. "LACK OF COMMUNICATION" that is a peculiar choice of words. The doctor has a duty to communicate unambiguously about the purpose,benefits and risks of any intended treatment.Not only that the doctor must be satisfied that the patient understands the information and is able to balance the consequences of choosing treatment or not. Failure to do this is NEGLIGENCE

2. PATIENT CAN DO SOME SELF EDUCATION . Medicolegally this point deserves no response and has been dealt with by (1) above. The responsibility lies with the doctor not just to explain but to be satisfied patient understands

3 . QUININE IS NOT KNOWN TO CAUSE MISCARRIAGE. This is very funny. Historically it was used as an abortifacient!! On this point you did not take your own advice and use the internet. I already addressed this above maybe you did not read it. Just Google Quinine + miscarriage , for even more details add G6PD to your search.
Now check the information in the SPC for quinine ; The manufacturer says and I quote "Quinine sulphate should not be used during pregnancy unless the benefits outweigh the risks"
http://www.medicines.org.uk/emc/medicine/27759
What is the LEGAL implication of this
a) the doctor should know the risks
b) the doctor should explain the risks to the patient and once again be satisfied the patient understands/is capable of understanding

Having said all the above the drug is relatively safe but what is on display is a gung-ho dismissive attitude found in Nigerian doctors that gets them into trouble abroad. It is UNTRUE to say the drug is unknown to cause miscarriage. If you had said that to this patient as her doctor you will already be liable for tens of thousands of dollars. Intellectual humility is a very crucial attribute

The woman should BE SCREENED FOR G6PD

I don't usually comment on a thread like this. The op made up his mind the doctor must be held responsible for the wife misfortune. First, the wife may not be pregnant afterall. The pregnancy was not properly diagnosed. Secondly, delayed menses, even when it happens for the ist time doesn't mean always mean pregnancy. Thirdly, quinine is safer than the coartem your wife took from the pharmacist during the ist trimester. Malaria itself, if not well treated or if not treated early can cause abortion. It is not everytime that a misfortune happens to a patient that the doctor is to blame. This doesn't mean I don't sympathise with you on the unfortunate loss. Several things can cause early abortion....chromosomal abnormalities, hormonal imbalance, maternal sickness, drug induced etc. it could be any of this but even if you will sue the doctor, not because of quinine....it is actually recommended by both WHO and federal ministry of health protocol for malaria treatment in all trimester of pregnancy.

The stroy line is too sketchy to help you identify the cause of your wife miscarriage. But I'll just state some medical facts.
1) Most first trimester miscarriage are due to the fetus themselves. This is due to a congenital abnormalities that's incompatible with life. So it's natures way of clearing things up. (Selection of the fittest u may call it)
2) Quinine as being shown to be safe in pregnancy, its being placed in category C by WHO. Doctor in foreign countries also make use of it and am sure it was prescribed by a foreign doctor, you won't have assumed that he was the cause for the miscarriage.
3) The ability to carry a pregnancy successfully goes beyond what happen after conception. But rather @least 3 month b4 conception. Most Nigerian just want to get pregnant. But are not willing to do the right thing to have a successfully pregnancy. Its advised that a woman start taking folic acid 3month prior to attempt at conceiving.
4) There are know conditions in a woman that can also lead to early miscarriage.
5) No matter the amount of experience gained by a nurse.... She cannot be equated to a doctor. So the fact that ur sister in law is saying a lot of things, doesn't mean the doctor is a quack(u haven't proven him to be a quack in ur story)
6) The pregnancy test strip has bn known to produce false positive result and the confirmation of pregnancy is best done with a scan.
7) I am sorry for your loss.

helpee:
I don't usually comment on a thread like this. The op made up his mind the doctor must be held responsible for the wife misfortune. First, the wife may not be pregnant afterall. The pregnancy was not properly diagnosed. Secondly, delayed menses, even when it happens for the ist time doesn't mean always mean pregnancy. Thirdly, quinine is safer than the coartem your wife took from the pharmacist during the ist trimester. Malaria itself, if not well treated or if not treated early can cause abortion. It is not everytime that a misfortune happens to a patient that the doctor is to blame. This doesn't mean I don't sympathise with you on the unfortunate loss. Several things can cause early abortion....chromosomal abnormalities, hormonal imbalance, maternal sickness, drug induced etc. it could be any of this but even if you will sue the doctor, not because of quinine....it is actually recommended by both WHO and federal ministry of health protocol for malaria treatment in all trimester of pregnancy.

Quinine is safe but it is not risk free. Did the doctor explain the risks? Once again in black people a significant number have G6PD .Did the doctor inquire about this? or a history of sickling?

0monnak0da:

I m afraid I must disagree with you on several grounds.
I wonder whether you practice in a jurisdiction where you are required to have insurance and what the insurers would have to say about what you have written
1. "LACK OF COMMUNICATION" that is a peculiar choice of words. The doctor has a duty to communicate unambiguously about the purpose,benefits and risks of any intended treatment.Not only that the doctor must be satisfied that the patient understands the information and is able to balance the consequences of choosing treatment or not. Failure to do this is NEGLIGENCE

2. PATIENT CAN DO SOME SELF EDUCATION . Medicolegally this point deserves no response and has been dealt with by (1) above. The responsibility lies with the doctor not just to explain but to be satisfied patient understands

3 . QUININE IS NOT KNOWN TO CAUSE MISCARRIAGE. This is very funny. Historically it was used as an abortifacient!! On this point you did not take your own advice and use the internet. I already addressed this above maybe you did not read it. Just Google Quinine + miscarriage , for even more details add G6PD to your search.
Now check the information in the SPC for quinine ; The manufacturer says and I quote "Quinine sulphate should not be used during pregnancy unless the benefits outweigh the risks"
http://www.medicines.org.uk/emc/medicine/27759
What is the LEGAL implication of this
a) the doctor should know the risks
b) the doctor should explain the risks to the patient and once again be satisfied the patient understands/is capable of understanding

Having said all the above the drug is relatively safe but what is on display is a gung-ho dismissive attitude found in Nigerian doctors that gets them into trouble abroad. It is UNTRUE to say the drug is unknown to cause miscarriage. If you had said that to this patient as her doctor you will already be liable for tens of thousands of dollars. Intellectual humility is a very crucial attribute

The woman should BE SCREENED FOR G6PD

Quinine is not a category A drug. But it is safe for treatment of malaria in pregnancy. You should have known it means the benefit therein outweigh the risks.

It was thought to be aiding abortion historically, but that is only history. What is known now is that it is the malaria that caused the abortions.

I have not said that docs aint reaponsible for counselling patients, but patient self education is also helpful.

Lack of communication means the doctor did not counsel the patient adequately, and the patient did not ask informed questions too.

Thanks for your responses. Byebye

FlirtyKaren:


Hello dear OffshoreKing,

Can i share your story on a blog?

May i know your blog? sure you are free to share it.

0monnak0da:
Quinine is safe but it is not risk free. Did the doctor explain the risks? Once again in black people a significant number have G6PD .Did the doctor inquire about this? or a history of sickling?

the risk as in quinine causing abortion? Of course no drug is free including paracetamol. Paracetamol in high dosage can destroy the liver. Why are you so particular about G6PD deficiency? is it the relationship between quinine and G6pD or the relationship between pregnancy and quinine that matters? A sickler at that age will know her status and will most definitely inform you. Moreso, why is Sickling so important to you in this unconfirmed abortion. This pregnancy was not even confirmed. Tell me the alternative the doctor would have used to treat the malaria then I will know you understand what we are sayinh

holyokoto:
[s]The next day came, my wife was weak to go to scan, we went and took another injection, [/s]

Your wife was too weak to go for a scan but can go for treatment. By the way we don't know the over sea you are before coming to Nigeria including the silence on your village

.


Where i came back from doesn't matter. Yes my wife was so weak, because we have to go far distance for the scan, beside scan cannot dictate early pregnancy, scan can only get from 6 weeks upwards, is after the incident i now found out. So it was wrong for him advice us to go for scan.

[quote author=Aqib09 post=31824228][/quote]


No you are totally wrong here, no good doctor will give quinine to a pregnant woman, yes Malaria it work perfectly but once there is pregnancy, you don't have to use quinine, i spoke with few doctors after the incident.

delishpot:
Sorry OP. Hope your wife gets better soon. the doctor saying scan should show result of early pregnancy, what kind if scaning equipment does he have? Yes new exprnsive machines can show pregnancy of a few weeks as soon as the heart starts beating and its done vaginaly too. I doubt its that type they did for your wife.
Na wa. If it makes you feel better sha, we lost 4 pregnancies before we got out 2 kids And one was caused by a "doctor" too. The first successful pregnancy was almost destroyed by a nurse who gave the wrong prescription to my wife. Luckliy for me, I insisted she called her doctor to be sure cos on the leaflet they said not to be taken by pregnant women. The doctor said hell Nooo, hope you did not take it? and asked to bring it back to the hospital. She was given another persons meds( Nowadays we ask the doctor the name of the medication before leaving his office just incase nurse gives us the wrong stuff ). Its well. Wishing you guys twins in future.

NB, misscariages could happen spontenously too. Sometimes the body may sense some problem with tge fetus and expell it. At least that was what our doctors told us then. Next time sha, you and wifey should prepare her body before TTC. she should sleep under net and eat healthy, that way the early days of her pregnancy will happen a bit more peaceful. All women who are TTC should do so too.

Thanks bro, i sincerely appreciate.

Op might be wrong cos he isn't trained but I feel the dr is also wrong.whether quinine or coartem cos abortion or not,scan shows pregnancy or not,d dr shld ve investigated d cos of d vagina bleeding.something must ve caused that na!he shld ve investigated y the lab test +prenancy and scan didn't see anything.
@ op,abeg,take ur wife to a general hosp and explain this situation to a 'new' dr.
@house,don't let us forget that it is not said here if the wife did blood test to rule out rhesus factor effect since she probably had a miscarriage.the deed has been done.prevention of further occurence nko?

docbindl:
The stroy line is too sketchy to help you identify the cause of your wife miscarriage. But I'll just state some medical facts.
1) Most first trimester miscarriage are due to the fetus themselves. This is due to a congenital abnormalities that's incompatible with life. So it's natures way of clearing things up. (Selection of the fittest u may call it)
2) Quinine as being shown to be safe in pregnancy, its being placed in category C by WHO. Doctor in foreign countries also make use of it and am sure it was prescribed by a foreign doctor, you won't have assumed that he was the cause for the miscarriage.
3) The ability to carry a pregnancy successfully goes beyond what happen after conception. But rather @least 3 month b4 conception. Most Nigerian just want to get pregnant. But are not willing to do the right thing to have a successfully pregnancy. Its advised that a woman start taking folic acid 3month prior to attempt at conceiving.
4) There are know conditions in a woman that can also lead to early miscarriage.
5) No matter the amount of experience gained by a nurse.... She cannot be equated to a doctor. So the fact that ur sister in law is saying a lot of things, doesn't mean the doctor is a quack(u haven't proven him to be a quack in ur story)
6) The pregnancy test strip has bn known to produce false positive result and the confirmation of pregnancy is best done with a scan.
7) I am sorry for your loss.

God bless you. You took the words out of my mouth.
When given instructions, patients always find excuses not to do them and when consequences of not doing them comes knocking. "kill the doctor".

Sorry for your loss.

But the doctor should have followed up and investigated what happened to the fetus, made deductions, and adviced the couples so that they'll prepare properly for the next pregnancy.
This is an attitude I find lacking in most doctors in Nigeria.

0monnak0da:
Quinine is safe but it is not risk free. Did the doctor explain the risks? Once again in black people a significant number have G6PD .Did the doctor inquire about this? or a history of sickling?

Lets assume the woman has G6PD deficiency, or she's been blessed with excess Hb S, she's however noted to be very ill with confirmed malaria parasite in a malaria endemic region( and perhaps she's coming from the glorious U.S of A) and equally found to be very much pregnant in the 1st trimester, should that have changed the decision to use quinine in the mgt of this woman?

I think the benefits of the use of quinine in this woman far outweighs the risks. Without suitable alternatives, quinine can be used in G6PD def despite the small risk of hemolysis. Malaria does KILL, and pregnant women are not exempted but rather have a higher risk of having severe malaria.
The issue of the Dr explaining these risks however is another matter entirely.

@ The Op, sorry about your loss. Losing a much wanted pregnancy is tough, and the pain is almost or even equally as deep as losing a child. However, life is not as rosy as we all wished it were and we all can only make the best out of the situations we find ourselves. It's all part of what we call experience and it makes us wiser. Console your wife, and she you in this time of grief. If it would be of any consolation, you are not alone going through this. If you need to talk about it, pls do so. You would be surprised at the great no of women that have gone through this at one point or the other. Support groups would be of immense help. Take care Sir. It is well.

scholarteam:
sorry Op.
But you didn't tell us the medicine the supposed pharmacist gave you sir.I won't be surprised if it is just folic acid and multivitamins supplements . At least if you know the drug, you will have a chance to eliminate all likely cases of adverse drug reactions if it was what happened.
Nigerian health professionals are always ridiculing one another before patients who care less about the rivalry in the health sector.

he first drug she took 2 times one tablet each is ( Coarcem B/F 80/480 Milligram, ) she took it in the night and morning the next day before we went to the doctor.

All Nigerian doctors according to Nairalanders are fake( INCLUDING ME), so next time any nairalander is ill please look for a hospital with Oyibo doctors. I hear there are plenty Indian, Egyptian and even Chinese doctors all over Nigeria. Please do not come to government hospitals like General hospital, irresponsible , useless Nigerian doctors work there. Better still there are many good pharmacists and experienced Nurses and laboratories around. It is better to be safe than sorry oh!