Missed Diagnosis of Classic Obstetric Complication

    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.

    Question(s) For Expert Witness

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

    Expert Witness Response E-000874

    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. Patients with mild preeclampsia are often induced after thirty-seven weeks gestation. Before this, the immature fetus is treated with expectant management with corticosteroids to accelerate lung maturity in preparation for early delivery.

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