Preeclampsia (also written as pre-eclampsia) is defined as a condition of high blood pressure during pregnancy and in the first six weeks after delivery. High blood pressure is accompanied by increased protein in the urine. Preeclampsia (or toxemia), is dangerous to both mother and unborn child and requires immediate treatment to prevent it from worsening into eclampsia.
Preeclampsia is serious. It is highly dangerous to both the mother and fetus and can lead quickly to neurologic complications such as seizures and death. Preeclampsia is the leading cause of maternal death. It also leads to premature birth is the leading cause of death in children under five and has tragically caused many birth injuries that last the child's entire life. It is also common, affecting to some extent 8% of pregnancies.
There is no effective treatment for preeclampsia other than the delivery of the child. But there are viable medical malpractice claims for preeclampsia for failure to properly manage the condition.
If you believe that you or a loved one has suffered from preeclampsia that should have been caught and treated in a timely manner by a physician, please speak with a lawyer for advice. You can call us at 800-553-8082 or click here to discuss your case confidentially online.An Overview of Preeclampsia
Preeclampsia can occur anytime after Week 20 of a woman's pregnancy (although if it is diagnosed before Week 32, it is called early onset and the morbidity risk increases) is characterized by high blood pressure and high protein in the urine. Preeclampsia can be mild or severe; one in 200 progress into eclampsia.
Preeclampsia occurs in approximately three to seven percent of all pregnancies. Mild pre-eclampsia is diagnosed if the mother's blood pressure is over 140/90 but under 160/110. Protein in the urine may or may not be accompanied by swelling in the hands, feet, and ankles.
Severe preeclampsia is diagnosed when the mother's blood pressure is over 160/110, there are significant amounts of protein in the urine, and the woman also experiences abdominal pain, decreased growth of the fetus, severe headache, or visual problems. Increasing blood pressure eventually leads to seizures, retinal detachment, cerebral hemorrhage, ruptured liver, abruptio placentae (where the placenta detaches from the uterine wall), and death.
Signs visible or detectable symptoms of preeclampsia are swelling, especially in the hands and face, sudden weight gain, blurred vision, nausea, a headache, lower back pain, shoulder pain, and upper abdominal pain. High blood pressure should be discovered during routine care examinations during the woman's pregnancy. Special urine test strips detect the presence of protein. These tests are usually done at each doctor visit during pregnancy. (Keep in mind some women never suffer any symptoms of preeclampsia, which is why it is so important that blood pressure tests and urine protein tests are done on a regular basis.)Causes and Risk Factors for Preeclampsia
There are several known risk factors for preeclampsia that good doctors need to bear in mind. Those who are at risk include women who are over 40 (and, oddly, under 20), women who have had previous pregnancies with preeclampsia or eclampsia, black women, overweight women, and women who live in the southeastern United States. (Bizarrely, smoking is associated with a decreased risk of preeclampsia although this is probably because it can mask symptoms.)
The causes of preeclampsia or eclampsia are poorly understood. This disorder usually occurs late in a pregnancy and is associated with kidney and metabolic abnormalities. This condition poses the risk of serious complications to pregnant women and their children. It can quickly result in neurologic complications such as seizures and death.
Eclampsia is a condition of seizures and coma as a result of the progression of preeclampsia. Without treatment, preeclampsia will lead to eclampsia which causes brain damage, coma, and even death. Hemorrhage or status epilepticus and can occur before, during or after childbirth. The mechanism of brain injury is related to seizures and/or hemorrhage.
So it goes without saying that doctors and midwives should take preeclampsia very seriously. It is standard practice in prenatal care for medical professionals to monitor an expectant mother for these signs and symptoms, particularly when she has risk factors for this condition. Even in mild cases, care must be taken that it does not progress, and usually, the woman requires bed rest at the very least. A woman with anything but the mildest of cases should be immediately admitted to hospital for observation. Some patients require magnesium sulfate injections to lower the possibility of seizures. If the baby is large enough, and the woman's condition is stable, then labor can be stimulated through the use of drugs or a cesarean section will be performed.
Ultimately, the only way to solve preeclampsia is for the mother to give birth. But you have to balance this against the risks to the child if the birth would be premature. In that case, preeclampsia may be best treated by treating the symptoms with rest and whatever else while you wait until the infant can survive and thrive outside of the womb.
A doctor or midwife who either fails to notice a woman has developed preeclampsia or fails to act in a timely manner to treat the condition may be responsible for any injury or death that results. The key word is "may." Every case is different. But there is no question that the doctor may be responsible for the harm done to the child or the mother if this condition was not correctly diagnosed and treated.
In the not so far distant future, it may be malpractice to fail to give a preeclampsia test. There are now serum biomarkers that can predict pre-term labor that are particularly effective in predicting preeclampsia.Classic Preeclampsia Malpractice Cases
Many preeclampsia malpractice cases involve:
- Failure to hospitalize or otherwise take all of the necessary steps to control the disease
- Failure to diagnose the treat sepsis
- Failure to see the symptoms of preeclampsia
- Terminating pregnancy too soon or not soon enough
- Failure to give a urine protein test
Here are some example fact patterns that have led to plaintiffs' verdicts in preeclampsia malpractice claims:Example #1
Plaintiff goes to ER 28 weeks pregnant with ambiguous symptoms: cramping, headache, nausea, vomiting, and ear ringing. Her medical records show a history of high blood pressure. After a long wait in the ER, she was seen by an ER doctor who checked her blood pressure, noted it was high, but heard the fetal heartbeat. He diagnosed otitis media and discharged her.
She returned, clearly in distress, that same night and was again sent home with a new diagnosis: a urinary tract infection.
She came back again with blood pressure through the roof: 174/121. There were no fetal heart tones. She delivered a stillborn baby boy.
Plaintiffs filed a lawsuit claiming what you would expect: the preeclampsia should have been caught and treated sooner.
The case settled against one of the doctors, and the jury awarded $650,000 in damages against the other doctor.Example #2
A woman in the 7th month of her pregnancy noticed a rise in blood pressure, weight gain, and edema, all symptoms that could be many things but could also be preeclampsia. They told her to come back in a week. She then presented to emergency room with headaches. She delivered preterm.The child was thankfully healthy. But the mother died a day later of a brain hemorrhage that everyone agreed at trial was caused by preeclampsia.
Plaintiffs' wrongful death lawsuit alleged that the OB/GYN failed to diagnose and treat preeclampsia. The jury awarded $2.75 million.Appellate Opinion Preeclampsia Malpractice Cases
- Ng-Wagner-Hotchkiss (2018): A $44 million verdict (reduced to the Maryland noneconomic damage cap) affirmed by the court after the parents alleged the doctor failed to properly treat their surrogate mother's preeclampsia. (Note: this is an unreported opinion.)
- Krishnan v. Ramirez (2000): Evidence supported finding that the doctor's failure to admit the mother to the hospital to monitor preeclampsia was the cause of the death of the fetus.
Finding the Right Medical Malpractice Lawyer for You and Your Child
If your child, or the mother, has suffered an injury, call us. We are here to help you with your case and to guide you through this nightmare. Call 800-553-8082 or get a free no-obligation medical misdiagnosis consultation.
Yes. Your OB/GYN has an obligation to diagnose preeclampsia so that they can take proper steps to manage the condition and avoid harm to the baby. If your doctor negligently fails to timely diagnose your preeclampsia and your baby is harmed as a result of that diagnostic failure, you may have a medical malpractice case against that doctor.
Yes. OB/GYNs have an obligation to diagnose preeclampsia and then take appropriate action to treat and manage the condition so that the baby is not harmed. Appropriate management of preeclampsia varies depending on the severity and stage of pregnancy. However, it often involves hospitalization or early delivery. If your doctor fails to properly manage your preeclampsia and your baby is harmed as a result, you can sue for medical malpractice.
Yes. Preeclampsia can be a very serious condition that can threaten the health of the baby if not properly diagnosed and effectively management. If not properly treated, preeclampsia can cause the baby to suffer brain damage or even death. The problem is that preeclampsia is a very common pregnancy complication. As a result, doctors and nurses have a tendency to take preeclampsia less seriously than they should.
These verdicts and settlements may be helpful to you in understand the average range of these cases when the plaintiff is successful. Keep in mind that these malpractice case results are not necessarily representative of your case. Why? Because every medical malpractice case is different and past results are no guarantee of a favorable outcome in a future case, even when the facts may seem identical. Juries are different. Sometimes the details of the events can be very different in two cases that are seemingly the same from reading these short summaries.
People are also sometimes looking for the average preeclampsia settlement or verdict in these birth injury cases. That figure is not out there. But if someone did compute that number, it would be mostly useless because these cases are just so different. The biggest factors are going to be how reliable the negligence case is against the doctor or hospital and how severe the injuries to the child.
We have not seen many preeclampsia verdicts in Maryland because these cases usually settle before trial with confidentiality clauses.
- Trabue v. Atlanta Women's Specialists (Georgia 2017) $45 million: Plaintiff was 38-years, significantly overweight and with an extensive history of preeclampsia and blood pressure issues. 3 days after a c-section delivery she suffered a cardiopulmonary arrest causing a hypoxic brain injury that left her completely mentally disabled and requiring care and assistance for the rest of her life. She sued the doctors for negligently failing to recognize and manage the risks presented by her preeclampsia and post-delivery blood pressure. Defendants insisted that their pre-delivery labs and testing did not indicate preeclampsia. The jury in Atlanta's Fulton County found in favor of the plaintiff and awarded a staggering $45 million in damages.
- Plaintiff Mother v. Defendant OB/GYN (New York 2017) $975,000: Mid-30s plaintiff experienced serious preeclampsia before and during delivery. After delivery the headaches and hypertension from the preeclampsia continued but she was discharged from the hospital anyways. 2 days after her discharge she called the doctors complaining that her headaches were worse but they told her to take pain medication. The next morning she suffered a large hemorrhagic stroke. Plaintiff sued for malpractice claiming that in light of her significant preeclampsia she should not have been discharged. Plaintiff also alleged that when she called about her headaches the doctor should have told her to go to the hospital. Defendants disputed proximate cause and claimed that even if she had been told to go to the hospital, it would not have prevented her stroke. The case settled just prior to trial for just under policy limits at $975,000.
- OG Pro Ami v. Kaiser Foundation Hosp. (California 2016) $4.5 million: Plaintiff had diabetes and allegedly exhibited signs and symptoms of preeclampsia including headache and blurred vision. Despite these indications of preeclampsia, doctors did not perform an immediate c-section delivery. Instead they waited another 2 weeks. Plaintiff claimed that this delay was negligent and resulted in baby suffering hypoxic brain injury. Baby was born with spastic cerebral palsy and had significant mental and physical disabilities. The case settled before trial with $2 million of the settlement put into an annuity and $1,296,266 to be placed into a special needs trust.
- Santiago Guzman v. USA (New York 2015) $4.6 million: The plaintiff, 20-year old single mother, alleged that defendant failed to recognize signs of preeclampsia, including edema in the legs and rapid weight gain. Despite these symptoms, defendant sent her home instead of admitting her to the hospital where her blood pressure could have been monitored. By the time the baby was eventually deliverd the next week, the mother had severe preeclampsia and her blood pressure reached 210/120 at one point. The baby was born healthy but the mother claimed to suffer permanent physical injuries and could not walk without a mobility aid.
If you are a lawyer handling preeclampsia birth injury cases, you need to get to know the medical literature. These are some of the key medical journal articles:
- Elizabeth Phipps et al. “Preeclampsia: Updates in Pathogenesis Definitions, and Guidelines.” Clinical Journal of American Society of Nephrology. 2016.
Preeclampsia is very common and is a large contributor to persistently high maternal mortality rates. This article is an overview of the condition that lists risk factors, pathogenesis, and some of the reasons why there is such a high rate of preeclampsia today.
- Liona Poon et al. “Screening and Prevention of Preeclampsia.” Fetal Medicine. 2019.
This article highlights issues with the traditional screening methods for preeclampsia. The authors suggests that medical and obstetric history, in addition to current signs and symptoms, need to be considered to assess a mother’s risk.
- Daniel Rolnik et al. “Aspirin Versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia.” New England Journal of Medicine. 2017.
This study asks whether taking low-dose aspirin during pregnancy is beneficial for the prevention of preterm preeclampsia. The women studied showed a lower incidence of preterm preeclampsia if they took low-dose aspirin as opposed to a placebo pill. This supports recommendations from official bodies that doctors prescribe low-dose aspirin to mothers who have warning signs of preeclampsia. However, aspirin, especially in high doses, is not recommended in normal pregnancies.
- Jean-Ju Sheen et al. “Maternal Age and Preeclampsia Outcomes during Delivery Hospitalizations.” American Journal of Perinatology. 2020.
This study, which analyzed hospital data from 1998 to 2014, was based on the fact that women are giving birth later in life now than ever before. Preeclampsia increased in all age groups over the time period. Severe sickness from preeclampsia was highest for the older age group (40-54) but also for the 18-24 age group. Teen mothers ages 15-17 were at the highest risk for eclampsia—high blood-pressure strokes. In other words, just because a mother is young does not mean she is safe from preeclampsia.
- Anisha Bouter and Johannes Duvekot. “Evaluation of the clinical impact of the revised ISSHP and ACOG definitions on preeclampsia.” Pregnancy Hypertension. 2019.
Organizations like the Society for the Study of Hypertension in Pregnancy (ISSHP) and the American College of Obstetricians and Gynecologists (ACOG) have recommendations on how to diagnose and treat preeclampsia. Both recently revised their recommendations for the condition’s diagnosis. Essentially, this revision provided for new evidence on non-proteinuric preeclampsia. Researchers are still unsure what to expect from non-proteinuric preeclampsia mothers. Defense attorneys will try to use this definitional uncertainty to their advantage when defending a medical malpractice claim.