Preeclampsia and Obstetrical Negligence
The weeks and months leading up to the birth of a baby are full of joy and anticipation. Parents-to-be must be informed by their obstetrician of potential conditions and complications that can occur throughout the course of a pregnancy. One such condition is preeclampsia. As with many other medical conditions, the sooner preeclampsia is diagnosed and treated, the greater the chances of a healthy mother and baby at delivery.
Preeclampsia is known as a hypertensive disorder of pregnancy. Preeclampsia occurs after 20 weeks of pregnancy and the risk of developing it increases as a mother approaches term. According to ACOG (The American College of Obstetricians and Gynecologists), preeclampsia complicates 2-8 % of pregnancies around the world each year.
ACOG has published diagnostic criteria for preeclampsia which include parameters for blood pressure (140/90 mm Hg on two or more occasions at least for hours apart after 20 weeks of pregnancy in a woman with previously normal blood pressure; or systolic blood pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg or more) and protein in the urine (300 mg or more in a 24-hour urine collection; or a protein/creatinine ratio of 0.3 or more; or a urine dipstick reading of 2+). Sometimes a woman with high blood pressure meeting the diagnostic criteria will be diagnosed with preeclampsia even if they do not have proteinuria (protein in the urine) but have other abnormalities with the kidneys, blood, liver, lungs, or a new-onset headache that is unresponsive to medication. Thus, it is of utmost importance that you be monitored closely by your obstetrician during your pregnancy for the development of preeclampsia so it can be successfully treated.
While the exact cause of preeclampsia is debated among medical experts, certain risk factors in a mother increase the risk of developing preeclampsia. Those risk factors include first pregnancy, preeclampsia in a previous pregnancy, hypertension, preexisting diabetes, gestational diabetes (diabetes that develops during pregnancy), lupus, obesity, and advanced maternal age. However, most cases of preeclampsia develop in healthy women pregnant for the first time with no risk factors. Therefore, it is important that your obstetrician monitor your pregnancy closely for the signs and symptoms of preeclampsia even in the absence of risk factors.
Some common signs and symptoms of preeclampsia include high blood pressure, proteinuria, edema (swelling), abnormal weight gain, headaches, upper abdominal pain, vision changes, fatigue, nausea, and vomiting. Some women experience only mild symptoms or no symptoms at all. At each prenatal visit, your obstetrician should be performing a physical examination for signs and symptoms of preeclampsia. You must be weighed at each visit and have a blood pressure check. A urine sample should be checked for protein. It is vital to see your doctor regularly during your pregnancy so that any signs and symptoms of preeclampsia can be caught and diagnosed early. If you or your baby suffered injuries because your obstetrician failed to properly monitor you for preeclampsia during your prenatal care, there may be grounds to file an obstetrical negligence lawsuit.
If preeclampsia is not timely diagnosed and treated, it can cause injury and/or death to the mother. Women with preeclampsia can develop damage to their kidneys, liver, and other vital organs. A placental abruption (a premature separation of the placenta from the uterus) can occur with preeclampsia. A placental abruption causes serious bleeding endangering both the life of the mother and baby. If left untreated preeclampsia can progress to eclampsia. Eclampsia is an obstetrical emergency with the onset of seizures in the mother. A woman who develops eclampsia requires immediate hospitalization, delivery of the baby, and medications to stop the seizures (magnesium sulfate). Uncontrolled eclampsia can lead to brain damage and death. Another severe complication of preeclampsia is HELLP syndrome which is diagnosed by hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelets. HELLP syndrome can lead to liver damage in the mother.
Untreated preeclampsia is also detrimental to the baby. Preeclampsia affects the placental causing decreased delivery of oxygen and nutrients to the baby. A decrease in oxygen and nutrients impairs the growth of the baby which can lead to brain damage. Premature births are also more common in pregnancies complicated by preeclampsia. Premature babies can have many issues including breathing problems and bleeding in the brain. Premature babies are at an increased risk for cerebral palsy.
Treatment for preeclampsia must take into consideration the severity of the condition, the health of the mother and baby, and how far along the pregnancy has progressed. Delivering the baby usually resolves the symptoms of preeclampsia. If the pregnancy is 37 weeks or later, obstetricians will usually recommend the delivery of the baby. If the pregnancy is less than 37 weeks, the obstetrician may consider monitoring the pregnancy to give the baby more time to develop based on the severity of the preeclampsia. If the decision is made to continue the pregnancy, very close monitoring must be done which may include admission to the hospital. If you or your baby suffered injuries because your obstetrician failed to properly treat you for preeclampsia during your prenatal care, there may be grounds to file an obstetrical negligence lawsuit.