Sent Home With a “Pregnancy of Unknown Location” and It Was Ectopic: Can You Claim?

A "pregnancy of unknown location" is a classification, not a diagnosis. Queensland's clinical guideline on early pregnancy loss says specialist review and close follow-up are essential until it resolves, with repeat hCG blood tests 48 to 72 hours apart and scans as needed. In Hartfield v Calvary Healthcare ACT Ltd (No 4) [2025] ACTSC 488, a hospital was found negligent for discharging a woman at high risk of an ectopic pregnancy without offering her the chance to stay or explaining what rising pain meant. The same case shows the limit: the court was not satisfied her remaining fallopian tube could have been saved, so nothing was awarded for her loss of fertility. In Victoria, section 60 of the Wrongs Act 1958 (Vic) means the peer-opinion defence does not cover advice and warnings. Adults generally have three years from when the claim is discoverable.

These are the questions an expert works through. The table does not tell you whether you have a claim, and it is not medical information.

If you have symptoms now, this page can wait. Call 000 or go to the nearest emergency department.

If you are reading this afterwards, you may have been told your pregnancy could not be seen yet, or that you were probably miscarrying, and learned a day or a week later that it was ectopic. Some people lose a fallopian tube in emergency surgery. Asking whether that should have been picked up is a reasonable question, and the law gives it a structure. This page covers early pregnancy specifically. Misdiagnosis and delayed diagnosis claims sets out the general rules for any missed diagnosis.

What is a pregnancy of unknown location, and is being sent home with one negligent?

A pregnancy of unknown location is the label used when a pregnancy test is positive but an ultrasound cannot yet show where the pregnancy is. The Queensland Clinical Guideline Early pregnancy loss says it "is a classification not a final diagnosis", and that "a final diagnosis of ectopic pregnancy places women at the most risk of clinical complications and harm". Most of these pregnancies turn out to be in the uterus or to resolve on their own. Some are ectopic, meaning the pregnancy is growing outside the uterus, usually in a fallopian tube.

Being sent home with that label is not negligent on its own. In Hartfield, an expert obstetrician's evidence was that most women with a pregnancy of unknown location are managed as outpatients while tests continue ([165]), and the court accepted that discharge would have been open to the hospital if the patient had agreed to it after full advice ([458]). What matters is how the discharge was done: whether the risk was assessed, whether follow-up was arranged, and whether you were told enough to act if things changed.

Section 48 of the Wrongs Act 1958 (Vic) sets the test for breach. A person is not negligent in failing to take precautions against a risk unless the risk was foreseeable, it was not insignificant, and a reasonable person in their position would have taken those precautions. Section 59 protects a professional who acted in a way widely accepted in Australia by a significant number of respected practitioners as competent practice, unless a court finds that opinion unreasonable.

Related guide Misdiagnosis & Delayed Diagnosis 7 min · 30 Jun 2026

What follow-up should happen after a pregnancy of unknown location?

Clinical guidelines are not law, but they are strong evidence of what competent practice looks like. The Queensland guideline, published in October 2022 and amended in August 2025, sets out a pathway an expert may measure the care against:

• Specialist review and close follow-up. The guideline says "specialist review and close follow-up is essential until resolution".
• Repeat hCG blood tests. It says to "perform serial β-hCG (48–72 hours apart)". A single result cannot be read in isolation. The guideline says a rise of less than 66% or a fall of less than 50%, with no pregnancy seen in the uterus on a repeat scan, should make the clinician suspect an ectopic pregnancy.
• Repeat ultrasound. It says to perform a transvaginal scan as clinically indicated, and that serial hCG with serial scans "are often the only way to distinguish between an early non-viable pregnancy and an ectopic pregnancy in gestations less than 6–7 weeks".

RANZCOG's first national guideline on early pregnancy loss, Miscarriage, Recurrent Miscarriage and Ectopic Pregnancy (C-Gyn 38, March 2025), adds that "an empty uterus or fluid in the uterine cavity could indicate an ectopic pregnancy or a persistent pregnancy of unknown location", and that a repeat ultrasound should be considered where the first one is not diagnostic and the woman is stable.

Which guideline applied, and which version was current on the day, is something an expert will check. The Queensland guideline is written for Queensland services. It is cited here because it sets out the pathway in detail, not because it binds a Victorian hospital.

What did the court decide in Hartfield v Calvary?

Hartfield v Calvary Healthcare ACT Ltd (No 4) [2025] ACTSC 488 is a decision of the ACT Supreme Court given on 31 October 2025. It is not a Victorian case and does not bind a Victorian court, but the ACT provisions it applied on breach and causation are in similar terms to sections 48 and 51 of the Victorian Wrongs Act.

The patient had lost one fallopian tube to an earlier ectopic pregnancy. She was five weeks pregnant, in pain and bleeding, and was admitted overnight. She was discharged the next day with a pregnancy of unknown location: neither a miscarriage nor an ectopic pregnancy had been ruled out. Her pain increased at home. She returned early the next morning, an ectopic pregnancy was diagnosed, and her remaining tube was removed in emergency surgery.

The court rejected her main case, that keyhole surgery should have been done on the first admission. It accepted that the hospital breached its duty in a different way, by "discharging the plaintiff in the circumstances that occurred (that is, without offering the plaintiff an opportunity to remain in hospital for observation and pain management and without full information being provided to the plaintiff about her condition, and the risk posed by increasing pain)" ([8]).

The hospital argued it cannot keep every patient whose condition has not resolved. The court said that was "too widely stated". The question was whether it was reasonable to discharge this patient, with her condition and its particular risks ([434]).

What should you have been told before you were sent home?

This is where Hartfield is most useful. The court found the hospital had a duty "not to discharge the plaintiff without discussing whether she wished to remain for observation and pain management, and without providing her with appropriate information concerning the likelihood of an ectopic pregnancy, the significance of increased pain and bleeding in that connection, and the need to return to hospital immediately in the event of an increase in pain and/or bleeding" ([447]).

She had been told to come back if her pain or bleeding increased, or if she passed out. The court found that was not enough, because she had not been told that an ectopic pregnancy was still a real possibility or why increasing pain mattered ([450]). Earlier, a doctor had told her the pain was most likely from an ovarian cyst ([449]). The court found she did not return sooner because she had not been given adequate advice about how serious her condition was, and it rejected the hospital's argument that she was partly to blame ([474], [483]).

In Victoria, section 60 of the Wrongs Act says the section 59 peer professional opinion defence does not apply to a liability arising from giving, or failing to give, a warning or other information. So a hospital cannot answer a discharge-advice claim simply by showing other doctors would have said the same thing. Section 50 says the duty is to take reasonable care in giving the warning or information.

For comparison, Safer Care Victoria's patient fact sheet Bleeding in early pregnancy (May 2019), written to be given to patients leaving a Victorian emergency department, says "an ectopic pregnancy is an emergency" and lists severe pain in the abdomen or shoulder, heavy bleeding, fever, dizziness or collapse as reasons to return promptly. Whether a discharge met the standard in your case depends on what you were told, what was written down, and what the records show about your risk.

What if you were told you were miscarrying and it was ectopic?

Bleeding and pain in early pregnancy can mean a miscarriage, a pregnancy that is still continuing, or an ectopic pregnancy, and early on they can look the same. That is why the guidelines rely on repeat tests rather than a single result. A diagnosis of miscarriage is not negligent just because the pregnancy later proved to be ectopic.

What an expert asks is whether the miscarriage was confirmed or assumed. Was a pregnancy ever seen in the uterus? Were hCG levels repeated and compared, and did they fall the way a miscarriage would be expected to? Was follow-up arranged until the hCG resolved? A record that says "miscarriage" after one blood test and an empty scan tells an expert something different from a record showing falling hCG levels over several days and a planned review.

What if the ultrasound missed the ectopic pregnancy?

An early ectopic pregnancy is not always visible on ultrasound, and a scan that does not show it is not negligent on its own. The RANZCOG guideline lists the features from which an ectopic pregnancy "can be reliably diagnosed" on ultrasound, such as an adnexal mass containing a gestational sac. The expert question is whether those features were there to be seen on the day, and whether the report was acted on.

Two different failures can sit behind a "missed" scan. One is the reading: something visible was not reported. The other is what happened next: a scan showing an empty uterus with a positive pregnancy test was treated as reassuring, rather than as a pregnancy of unknown location that needed follow-up. An expert will usually want the images themselves, not only the written report.

What if you were given methotrexate or surgery and the pregnancy was viable?

This is the reverse problem. Methotrexate is a drug used to end an ectopic pregnancy without surgery. Given to someone whose pregnancy is actually in the uterus and viable, it can end or harm that pregnancy.

The Queensland guideline lists a "coexistent viable IUP", meaning a viable pregnancy in the uterus, as a contraindication to methotrexate, and says "criteria for excluding a viable pregnancy must be stringent enough to avoid interventions that inadvertently damage a viable pregnancy". In Hartfield the court summarised the UK Royal College of Obstetricians and Gynaecologists guideline as saying methotrexate should not be offered unless the diagnosis is "absolutely clear" and a viable pregnancy in the uterus has been excluded ([172]).

The same questions apply to surgery that removed a tube or ended a pregnancy that later proved to be viable. What did the scans and blood tests show, and did they meet the criteria for the diagnosis at the time? Was the uncertainty explained to you before you agreed to treatment?

Can you claim for losing a fallopian tube or your fertility?

Only if the negligence probably caused that loss. Section 51 of the Wrongs Act requires the negligence to have been a necessary condition of the harm. In Tabet v Gett [2010] HCA 12, the High Court held that losing a less-than-even chance of a better outcome is not damage the law compensates.

Hartfield shows how that works. The court accepted the hospital was negligent, but was not satisfied that the tube could probably have been saved, even if she had stayed in hospital and been operated on that evening. The expert evidence was that once the tube was bleeding, the prospects of removing the pregnancy while keeping the tube were low. So the claims for the tube and for loss of fertility were dismissed ([455], [456], [485]).

The claim succeeded for something else. The court accepted expert psychiatric evidence that she would probably not have developed a trauma-related condition if she had been in hospital, with her pain managed, when the ectopic pregnancy began to rupture. It said this was "not a case where the plaintiff has simply lost a chance of a better outcome" ([467]). Psychiatric injury from medical negligence explains how claims for that kind of harm work in Victoria.

Whether a tube or fertility could have been saved in your case depends on the timeline, so the exact times in the records matter. It is a question for independent experts in gynaecology, and sometimes in fertility.

What if it was a missed ovarian torsion?

Ovarian torsion, where an ovary twists on its blood supply, is a different gynaecological emergency that can also be put down to a cyst or period pain. The legal questions are the same: whether the assessment and the decision to discharge met competent practice at the time, whether you were told what to come back for, and whether a faster diagnosis would probably have saved the ovary. The clinical standard is different, and an expert in that field would need to address it.

How long do you have to claim?

For an adult, section 27D of the Limitation of Actions Act 1958 (Vic) allows three years from the date the claim is discoverable, with a long-stop of twelve years from the act or omission. In a missed diagnosis, the claim often becomes discoverable when you learn the outcome might have been different, rather than on the day you were sent home. A court can extend time in some cases. Time limits for medical negligence claims sets out the rules and how an extension works.

Who do you claim against?

It depends on where the care happened. If you were discharged from a Victorian public hospital emergency department or early pregnancy service, the claim is generally against the health service, not the individual doctor. Suing a Victorian public hospital explains how that works, and whether to complain first. If the scan was done at a private radiology practice, or the follow-up was left with a GP, the claim may be against that provider and its insurer.

What records show what happened?

The claim is built from the timeline, so the first step is the complete file from every visit, not only the discharge summary. That usually includes the triage note, observation and pain charts, the doctors' and nurses' notes, every hCG result with its time, the ultrasound reports and images, any written discharge information you were given, the follow-up plan, and the full record of the admission where the ectopic pregnancy was found. In Hartfield, a pain score recorded by a nurse that the consultant did not know about was central to the finding. How to get your medical records in Victoria sets out how to ask. Writing down what you were told at discharge, while you still remember it, can also help.

If you want the records and the timeline looked at, start a free assessment. If you do not have the records yet, that is no reason to wait. You will be told what to request and from whom.

Common questions

Can you claim if you were sent home with a pregnancy of unknown location and it was ectopic?

Yes, if the discharge fell below competent practice and that probably caused harm. Being sent home with a pregnancy of unknown location is not negligent on its own, because many are safely managed as outpatients. In Hartfield v Calvary Healthcare ACT Ltd (No 4) [2025] ACTSC 488, a hospital was found negligent for discharging a woman at high risk of an ectopic pregnancy without offering her the option to stay or explaining what increasing pain could mean.

Is it negligence if you were told you were miscarrying and it was an ectopic pregnancy?

Not automatically. Early miscarriage and ectopic pregnancy can look the same, which is why clinical guidelines rely on repeat hCG blood tests 48 to 72 hours apart and repeat scans. What an expert examines is whether the miscarriage was confirmed or assumed, and whether follow-up was arranged until the pregnancy hormone resolved.

Can you claim for losing a fallopian tube or fertility after a missed ectopic pregnancy?

Only if earlier diagnosis or treatment would probably have saved the tube or your fertility. In Hartfield, the court found the hospital negligent but was not satisfied the tube could have been saved, so nothing was awarded for loss of fertility. Damages were awarded for the psychiatric injury the negligent discharge caused.

How long do you have to claim for a missed ectopic pregnancy in Victoria?

For an adult, section 27D of the Limitation of Actions Act 1958 (Vic) allows three years from the date the claim is discoverable, with a twelve-year long-stop from the act or omission. A court can extend time in some cases.

Sources

Legislation was checked on legislation.vic.gov.au on 16 October 2026: the Wrongs Act 1958 (Vic) at version 130 (in force from 25 February 2026) and the Limitation of Actions Act 1958 (Vic) at version 113 (in force from 2 October 2026). Paragraph numbers for Hartfield are from the judgment published by the ACT courts.

• Wrongs Act 1958 (Vic) — sections 48, 50, 51, 59 and 60
• Limitation of Actions Act 1958 (Vic) — section 27D
• [Supreme Court of the ACT, Hartfield v Calvary Healthcare ACT Ltd (No 4) [2025] ACTSC 488 (31 October 2025)](https://www.courts.act.gov.au/supreme/judgments/hartfield-v-calvary-healthcare-act-ltd-no-4)
• [High Court of Australia, Tabet v Gett [2010] HCA 12](https://www.hcourt.gov.au/sites/default/files/eresources/2010/HCA/12.pdf)
• Queensland Clinical Guidelines, Early pregnancy loss (MN22.29-V8-R27)
• RANZCOG, Miscarriage, Recurrent Miscarriage and Ectopic Pregnancy (C-Gyn 38), March 2025
• Safer Care Victoria, Bleeding in early pregnancy, patient fact sheet (May 2019)