Delayed Pre-Eclampsia Diagnosis Results in Loss of Baby

Nicholas Leahy

Introduction to the case

Nick Leahy, Associate in our Clinical Negligence department, has recently settled a birth injury claim against Chelsea and Westminster Hospital NHS Foundation Trust. Our client, Mrs AB, experienced a traumatic series of events during her first pregnancy, which resulted in the tragic death of her newborn baby at just 3 days of age.

Early warning signs

On 18 February 2021, at 23 weeks gestation, our client contacted her GP when she was at work to report facial and peripheral oedema, both warning signs of pre-eclampsia. Her GP advised her to present the following day for a urine test and provided safety netting advice. Our client had an appointment with her midwife approaching and so decided to speak to her midwife first. Following the call with her GP, our client called the Maternity Assessment Suite at Chelsea and Westminster Hospital, reported the same symptoms, and was told to attend immediately.

Our client attended the MAS later that day. She was triaged on arrival and her symptoms were noted to be oedema of the ankles, hands and face. Her MEWS score was 0 and a normal pattern of fetal movements was noted. The midwife provided our client with advice about carpal tunnel syndrome, and told her to elevate her ankles at night. The midwife was concerned about our client’s facial swelling and so asked for an obstetric review.

Timeline of Events

2 March 2021

• Client noticed reduced and weaker baby movements.
• She called the Maternity Assessment Suite (MAS) and spoke to a midwife by phone.
• The midwife advised her to lie down and focus on movements and promised to call back later that day — but no call occurred.
• This call was not documented in the client’s medical records.

Later that Day – 2 March 2021

• Client attended the hospital for assessment but was left waiting for several hours due to a busy ward.
• She was seated uncomfortably in a chair and had not been reviewed.
• At 18:30, a midwife documented that the client wished to go home and was clinically well enough to do so.
• She was advised to return the following day for review.

3 March 2021

• Client returned to the Maternity Assessment Unit (MAU) after work for review by an obstetrician.
• The obstetrician ordered blood tests, and a midwife placed a sticker on the results folder marked “chase results.”
• Client had the blood tests and was told she could go home and would be contacted with the results.

Late Evening – 3 March 2021

• At 22:41, blood test results became available and showed:
  • Raised urate
  • Low albumin
• The midwife reviewing the results noted that PCR and MSU tests were not showing as ordered.
• A message was left for the day team (intended for 4 March) to contact the client and ask her to return for further tests.
• However, the client was not contacted at all.

7 March 2021

• Client suffered a seizure at home while in the garden with her husband.
• Her husband witnessed the seizure and called an ambulance immediately.
• The ambulance crew administered a 4mg loading dose of magnesium sulphate en route to hospital.

Arrival at Northwick Park Hospital – 7 March 2021

• 13:46: Client arrived at hospital; still actively seizing after a second seizure.
• 13:51: Consultant obstetrician performed a bedside scan and detected fetal bradycardia.
• 13:53: A category 1 emergency caesarean section was authorised due to fetal distress.

Baby born in a critical condition

At 14:04, our client delivered a male baby in a critical condition. He had to be resuscitated in theatre and a pediatric crash call was put out. At 14:07 it was noted that the baby was being intubated, however  this was unsuccessful. The second set of chest compressions took place at 14:09 and by 14:10 the baby’s HR was 140bpm.

It was deemed that our client would need admission to the ITU and a plan was made for this at 14:15. A maintenance dose of magnesium sulphate was prepped and brought into theatre, and this was commenced at 14:20. By 14:25 the caesarean section was complete and estimated blood loss was noted to be 250mls.

Post-delivery complications

Our client’s baby was transferred to the neonatal unit and our client was taken to the ITU. Our client’s husband was informed that their baby would be transferred across to Queen Charlotte’s and Chelsea Hospital, for ongoing care in their neonatal intensive care unit. It became apparent that our client’s baby’s health was deteriorating, marked by significant growth restriction.

Our client remained sedated on ITU for 2 days before being stepped down to the medical ward. By this time her baby had been transferred to Queen Charlotte’s. Upon arrival, the baby presented with anemia, thrombocytopenia, and lactic acidosis. An echocardiogram revealed normal structure and function, with a clinically insignificant patent ductus arteriosus (PDA). By 9 March 2021, the baby experienced anuria with acute renal failure, though signs of recovery emerged following frusemide boluses.

Tragically, on 9 March 2021, our client’s baby suffered a massive pulmonary hemorrhage, requiring aggressive ventilation with elevated pressures. The distressing pattern continued on 10  March 2021, marked by recurrent pulmonary hemorrhages, accompanied by episodes of desaturation and bradycardia.

Recognising the terminal nature of the baby’s condition on 10 March 2021, our client’s husband was asked to attend Queen Charlotte’s and Chelsea Hospital as their baby was unlikely to survive. The team at Northwick Park were asked to transfer our client as soon as possible, so that she could spend time with her baby. Sadly, our client’s baby passed away later that evening, with the recorded time of death noted as 21:32.

Claim against the hospital Trust

In January 2022, our client instructed Nicholas Leahy, an Associate in the Clinical Negligence team at Osbornes Law, to pursue a claim against the hospital Trust. Our client’s medical records were obtained, and supportive expert evidence was then obtained from a midwifery expert and from a leading Consultant Obstetrician.

The expert obstetrician was of the opinion that there were missed opportunities to diagnose pre-eclampsia in pregnancy, which represented substandard care.

A Letter of Claim was sent to the Trust in October 2022 and a Letter of Response was received in August 2023. The Defendant made significant admissions of liability in their Letter of Response and invited our client to disclose a Schedule of Loss in anticipation of settlement of the case. We instructed an obstetrician to prepare a Condition and Prognosis report, as well as a Consultant Psychiatrist, as our client had also suffered a psychiatric injury as a result of these events.

The expert psychiatrist, Dr Rebecca Moore, was of the opinion that our client was suffering from moderately severe PTSD, which remained ongoing but was resolving slightly with time. However, she was of the opinion that our client’s prognosis was good provided she engaged with the treatment which had been recommended (at least 20 sessions of trauma focused therapy and/or compassion focused therapy immediately, and 15 more sessions during any future pregnancy).

Settlement of £58,000

Following receipt of this evidence, a Schedule of Loss was prepared and finalised, before disclosed to the Defendant on a Without Prejudice basis. Offers of settlement were exchanged between the parties and our client eventually accepted the Defendant’s Part 36 offer of £58,000 in December 2023.