The number of maternal deaths worldwide has dropped dramatically in the past few decades (WHO, 2014). In the U.S., however, maternal death rates have more than doubled since the 1980s, showing that women are still at risk for pregnancy complications that can end in mortality (Robeznieks, 2015).
Preeclampsia – a disorder that involves rapid increases in blood pressure during pregnancy and the postpartum period (i.e., the six weeks after delivery) – is a condition that still affects five percent of all pregnancies and can be potentially life threatening for both the mother and the baby (August & Sibai, 2015). Without proper detection and treatment, preeclampsia can result in devastating consequences.
Preeclampsia involves two major problems: hypertension and proteinuria (i.e., protein present in urine). Diagnosis in pregnant women typically requires a blood pressure higher than 140/90 mmHg and a urine sample with greater than 0.3 grams of protein (August & Sibai, 2015). Other signs that signal the onset of preeclampsia include swelling, severe headaches, abdominal pain, changes in vision, nausea, sudden weight gain, and difficulty breathing (August & Sibai, 2015; Preeclampsia Foundation, 2010).
If the disorder is progressing rapidly, a woman may not realize she is suffering from symptoms of preeclampsia. Frequent blood pressure and urine tests can help with detection, especially when other symptoms are not reported. Preeclampsia, if not treated, may result in stroke, seizure, multiple organ failure, or even the death of the mother and/or the child (Preeclampsia Foundation, 2010).
Severe preeclampsia can lead to other disorders including eclampsia and HELLP syndrome (Preeclampsia Foundation, 2010). Mothers with eclampsia have grand mal seizures in addition to all the other preeclampsia symptoms; if a woman develops eclampsia, inducing labor is required no matter the age of the fetus (Mayo Clinic Staff, 2014). HELLP syndrome is another severe condition that results from preeclampsia. HELLP stands for hemolysis (i.e., the breakdown of red blood cells), elevated liver enzymes, and low platelet count. This disorder may result in harm to many organ systems, but it may be hard to detect because it can quickly develop before the mother acquires high blood pressure or proteinuria. Preeclampsia and its related disorders – eclampsia and HELLP syndrome – are among the top four causes of maternal death in the United States (August & Sibai, 2015).
Preeclampsia is linked with 10 to 15 percent of maternal mortality cases worldwide (August & Sibai, 2015). There are many risk factors that play a role in developing preeclampsia including if it is the woman’s first pregnancy, if the woman or her family has a history of the disorder, and if it is a multiple pregnancy (e.g., twins, triplets, etc.). Another important factor is the age of the woman; women older than 40 or younger than 18 are at a higher risk (Preeclampsia Foundation, 2010). Moreover, women who are obese or have a BMI of 30 or more are more likely to develop preeclampsia (Preeclampsia Foundation, 2010).
Reliable screening tests have not yet been developed to detect the onset of preeclampsia; however, it is essential that pregnant women be regularly monitored. Frequent prenatal visits may increase the likelihood of detection. Obstetricians should look at multiple factors in a woman’s pregnancy in addition to blood pressure and urine tests. This is especially important after the 20th week of pregnancy, as this point marks the typical onset of preeclampsia. (Preeclampsia Foundation, 2010).
Once a mother is diagnosed with preeclampsia, it is common to develop a management plan. The obstetrician has three main objectives for treatment: 1) termination of the pregnancy, if necessary, with little trauma to both the mother and fetus, 2) the birth of a healthy infant, and 3) restoring the mother’s health (Cunningham et al., 2010). Also, the patient should be under continued hospital surveillance once preeclampsia is diagnosed. Blood pressure should be checked at least four times a day, and medication to reduce blood pressure may be administered (BabyCentre, 2014). In severe cases, the mother should stay in the hospital until delivery with frequent blood pressure and urine tests. In addition to medication, the mother may be put on a magnesium sulfate drip to lower her risk of developing eclampsia or reoccurrences (BabyCentre, 2014). In minor cases, it may be necessary to induce labor, and in severe cases, a cesarean delivery may be recommended. In general, the main goal should be to prevent serious damage and deliver a healthy baby.
The medical malpractice attorneys of Meyers Evans Lupetin & Unatin have seen the unfortunate consequences that can result when obstetricians and hospitals fail to recognize preeclampsia. We understand the steps doctors and hospitals must take to diagnose and treat preeclampsia, and we are too familiar with the tragic consequences to the expectant mother and baby if appropriate precautions are ignored. If you believe you or somebody in your family received substandard obstetrical care and treatment related to preeclampsia and were seriously injured, we invite you to call us and let us listen to you to determine whether somebody should be held accountable.