Missed diagnosis of Pre-Eclampsia

If the patient starts out her pregnancy with 130/70 and the 70 changes to 80, it must be looked at, not necessarily treated, but looked at. If the 80 goes up to 85, then you have to be concerned about the possibility of early pre-eclampsia, a high blood pressure condition in pregnancy which can cause damage to the mother and the baby. When there is high blood pressure in the mother, blood flow to the placenta, which nourishes the baby, is impaired and there is a higher risk of the placenta separating from the lining of the uterus (abruptio placenta).

Patients suspected of having possible pre-eclampsia are also given urine tests. Protein will appear in the urine abnormally; we call it “spill out”. Actually, the protein leaks through the filtering system of the mother’s kidneys into the urine. The mother’s kidneys filter her blood to remove her impurities and those she absorbs into her blood from the baby through the placenta. With high blood pressure, the filtering mechanism is damaged.

In pre-eclampsia, the protein which is in the blood and which should stay in the blood and not go in the urine will go into the mother’s urine where it can be picked up with these simple, inexpensive tests. It’s standard to check the urine for protein at every obstetrical visit. If any protein is found and if the level of protein in the urine rises, and/or if the blood pressure is rising, the doctor must be concerned about pre-eclampsia.

Reflexes (knee-jerk, ankle, elbow) are tested at each office visit. In pre-eclampsia, these responses become more active (brisker) and are another indicator of potential problems.

If the blood pressure ‘starts rising, the woman must be placed at absolute bedrest (other than going to the bathroom) and a low salt diet prescribed to treat and prevent progression of preeclampsia. Often this works. If that doesn’t work, then you give the mother tranquilizing medications such as the barbiturate Phenobarbital or a sedative. If that doesn’t work, you begin some of the mild antihypertensive agents which reduce blood pressure.

If this office and home treatment for preeclampsia is ineffective, the woman must be hospitalized quickly. This is a clinical judgment; however, it can also be poor judgment, which is negligence. If the diastolic pressure starts to rise to 90 or 95, then she must be hospitalized, regardless of the week of pregnancy. She must be kept in a hospital environment, under treatment, so the blood
pressure stays down in a range safe enough to protect the mother and baby. Then the mother can carry the baby as close to term as possible; as close to the forty weeks the baby would normally go. If the blood pressure continues to rise, however, at that point the obstetrician must intervene to deliver the baby. This can be done either by induction with the hormone-like medication Pitocin which stimulates the uterus to contract down to the mother can deliver the baby vaginally or, if
that’s not successful, and the blood pressure continues to rise, then by a Caesarean section operation. The mother is given either general or spinal anesthesia which paralyzes and numbs the
abdominal muscles. The abdomen is cut and opened between the umbilicus (the belly button) and the pubic bone. The bladder is separated from the lower third of the uterus. The uterus is opened, the baby was taken out and the placenta (afterbirth) removed. Then everything is sewn back up again. The only definitive treatment for pre-eclampsia is to deliver the baby without delay.