Delayed Pre-Eclampsia Diagnosis Resulting in Tragic Baby Loss

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.

Hospital Response and Delays

However, due to the ward being busy our client had to wait a number of hours without being seen. She was told the wait could be longer and so expressed a wish to go home, as she had been left sitting uncomfortably in a chair. The midwife documented at 18:30 that our client wished to go home and that as she was clinically not unwell, she could do so, and attend for review the following day.

Our client returned home to rest, and the following day after work she re-presented to the MAU for review by an obstetrician. Our client was seen by an obstetrician who ordered blood tests. The midwife placed a sticker on the results folder which read “chase results”. Our client had the blood tests, and was then told she could go home, and that she would be called with the results.

The blood test results were available at 22:41 that evening and showed a raised urate and low albumin. The midwife reviewing the results noted a PCR and MSU test were not showing on the order. The midwife then noted “Message lett [sic] for the day team on 20/02/21 to call AB and see if she is ok and ask her to come in to do a PCR and MSU”. However, our client was not contacted at all.

Critical Events Leading to the Tragedy

The next events occurred on 2 March 2021, when our client noticed that her baby’s movements had changed. She reports that her baby was not moving as often as he was before and that the intensity of the movements was less powerful. She instructed us that she called the MAS and reported this, and that she spoke to one of the midwives on the phone. This conversation was not documented within her medical records. We are instructed that the midwife our client spoke to told her to lay quietly and focus on her baby’s movements, and that she would call her back later that day, however no call back occurred.

On 7 March 2021, our client was at home in the garden with her husband, when she had a seizure. Her husband witnessed this seizure directly, and immediately called the ambulance. The ambulance crew attended and conveyed her to Northwick Park Hospital. She was given a 4mg loading dose of magnesium sulphate in the ambulance.

Upon her arrival at the hospital at 13:46 it was noted that our client was still fitting, having suffered a second seizure.  At 13:51, a consultant obstetrician performed a bedside scan, detecting bradycardia. By 13:53, recognizing the urgency, a category 1 caesarean section was authorised.

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 and Loss

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.

Legal Action and Expert Opinions

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 and Resolution

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.