Missed Diagnosis of Classic Obstetric Complication

Case Overview

This case involves a pregnant patient who presented to an Ob/Gyn clinic at thirty-nine weeks with complaints of headaches, swelling, and poor vision. The obstetrician on call performed a stenography that showed all normal findings and external fetal monitoring was also normal. The patient did not have high blood pressure at the time of the visit and she was sent home. Three days later, the patient was admitted for complaints of decreased fetal movement, and a sonogram was performed that once again was deemed normal. The patient was sent home and told to return if the latent phase of labor initiated. The patient returned five days later after a spontaneous rupture of membranes, but monitors now showed no fetal movement and the patient delivered a stillborn baby.

Questions to the Gynecology expert and their responses

Should this person have been admitted for closer observation when she originally presented with headaches, swelling, and poor vision?

I believe this woman had the early signs and symptoms of preeclampsia and she should not have been sent home after the initial visit. This situation most likely could have been avoided. The optimal management of a woman with preeclampsia depends on gestational age and disease severity. Because delivery is the only cure for preeclampsia, clinicians must try to minimize maternal risk while maximizing fetal maturity. The primary objective is the safety of the mother and then the delivery of a healthy newborn. Obstetric consultation should be sought early to coordinate transfer to an obstetric floor, as appropriate.

About the expert

This actively practicing, board-certified expert is an experienced OB/GYN who has received his medical training at among the finest medical institutions in the country. Over his 25 years of clinical experience, he has worked in OB/GYN private practice, HMO's, and in the hospital clinic environment.

E-000874

Specialties:

Gynecology

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