Failure to Diagnose Preeclampsia

Preeclampsia is a serious medical condition that develops in some pregnancies, typically sometime after the 20 week mark. If not properly diagnosed and treated, preeclampsia can lead to serious complications, or even death, for both mother and baby.

Preeclampsia is present in about one out of 25 pregnancies, and is responsible for about 15% of all premature births. It’s common enough, and serious enough, that obstetricians should screen and diagnose it in pregnant patients who present for care. When they fail to do so, that failure may constitute medical malpractice, especially if the patient has risk factors for the condition.

Risk factors for preeclampsia include:

• Chronic high blood pressure
• Advanced maternal age
• Preeclampsia in a previous pregnancy
• Diabetes (Type 1 or Type 2) prior to pregnancy
• Kidney disease
• Autoimmune disease such as lupus
• Use of in vitro fertilization
• Pregnancy with multiple babies.

How is Preeclampsia Diagnosed?

When a pregnant person has high blood pressure after 20 weeks of pregnancy combined with at least one of the following symptoms, preeclampsia is diagnosed:

• Protein in urine (proteinuria) or other signs of kidney damage
• Elevated liver enzymes, which can indicate liver impairment
• Fluid in the lungs (pulmonary edema)
• Low blood platelet count
• Recent-onset vision disturbances
• Recent-onset headaches that do not improve significantly with pain medication

“High blood pressure” in pregnancy is defined as systolic blood pressure (the top number) of 140 or higher or diastolic blood pressure (the bottom number) of 90 or higher. High blood pressure itself may not have any symptoms; for that reason, it’s often referred to generally as “the silent killer.” Preeclampsia may also be present without any symptoms that the patient notices. However, if a pregnant person does experience headaches, vision disturbances, or other symptoms associated with preeclampsia, she should mention these to her doctor.

Women with preeclampsia may experience sudden weight gain, swelling of the face and hands, nausea and vomiting, or difficulty breathing. While some symptoms, such as nausea, swelling, and weight gain, are often associated with a normal pregnancy, it’s still important to mention them so that the obstetrician will screen for preeclampsia.

If a pregnant person has high blood pressure, their medical provider should order further tests to detect preeclampsia. These may include blood tests for liver and kidney function and platelet counts; tests to detect protein in urine; ultrasound to monitor fetal growth; and nonstress tests that check the fetus’ movement and heart rate.

Complications of Preeclampsia

As mentioned above, preeclampsia can lead to a number of medical problems for both mother and baby. These include:

• Fetal growth restriction due to diminished blood flow to the placenta. This means that less oxygen and fewer nutrients get to the fetus.
• HELLP syndrome, which stands for hemolysis, elevated liver enzymes, and low platelet count. Hemolysis is the destruction of red blood cells. HELLP syndrome threatens the life of both the mother and the fetus; even if the mother and baby survive the pregnancy, the mother could have ongoing health problems long after the delivery.
• Placental abruption, in which the placenta separates from the uterus’ inner wall prior to delivery. In severe cases, placental abruption leads to heavy, life-threatening bleeding.
• Preterm delivery, which is defined as delivery prior to 37 weeks of pregnancy. Babies delivered prematurely may have a host of health problems, including difficulty feeding or breathing, impaired vision or hearing, cerebral palsy, and developmental delays.
• Eclampsia, which is a progression of preeclampsia to seizures or coma. Unfortunately, it is not easy to predict when preeclampsia will progress to eclampsia; eclampsia develops in some patients even before preeclampsia is diagnosed.
• Damage to mother’s kidneys, liver, heart, lungs, or eyes
• Increased risk of future disease of the heart and blood vessels (cardiovascular disease), especially in repeat cases of preeclampsia.

Because of the potentially serious outcomes of preeclampsia, proper management is essential. However, in severe cases, the only choice may be to deliver the baby early, often via emergency C-section.

How is Preeclampsia Treated?

There are not many treatments available for preeclampsia; if the baby is sufficiently developed, delivery is the best option for both mother and child. If it is too dangerous to deliver the baby, medical providers may try to control the preeclampsia until the baby can be more safely delivered. Doctors may order medications to lower the mother’s blood pressure and to prevent seizures. Medical providers may also administer corticosteroids to help the baby’s lungs develop before delivery.

While delivery usually resolves preeclampsia, in rare cases preeclampsia can continue or develop after birth (postpartum preeclampsia). New mothers with symptoms of preeclampsia should seek medical help promptly.

What if my Doctor Failed to Diagnose Preeclampsia?

If your doctor failed to diagnose your preeclampsia, and you or your baby suffered injury as a result, you should contact an experienced medical malpractice attorney to discuss your options. If you do have a valid claim for malpractice, you have only a limited amount of time to file it before the statute of limitations expires. To learn more, contact The Fraser Law Firm P.C. to schedule a consultation.