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Antenatal care of woman with pre-eclampsia and HELLP syndrome (13HDC00952)
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(13HDC00952, 23 June
Midwife ~ Student midwife ~ Antenatal care ~ Pre-eclampsia ~
HELLP syndrome ~ Urinalysis ~ Weighing ~ Rights 4(1), 4(2),
A woman became pregnant with her first child and engaged a
midwife as her lead maternity carer (LMC). The midwife did not
weigh the woman or test her urine at any of the antenatal
appointments and kept minimal records. The woman felt that her
appointments with the midwife were rushed, and she felt unable to
When the woman was 38 weeks' pregnant, she had an appointment
with the midwife, during which a student midwife was present. The
student took the woman's blood pressure and informed the midwife
that it was elevated. The midwife did not document rechecking the
high blood pressure reading or any further action.
The woman recalls that the midwife informed her that the student
would be present at the birth. The woman was concerned at this, so
emailed the midwife explaining that she and her husband would
prefer not to have the student there. The midwife responded to the
email explaining that the student would be a great support, and
stated: "Think it is not a wise decision."
A week later, the woman had a further antenatal appointment. The
student midwife took the woman's blood pressure and recorded it as
normal, but this was not checked by the midwife.
The woman called the midwife the next day as she had pain in her
mid chest. The woman had eaten fried chicken an hour previously,
and the midwife suggested the woman rest, as the pain could have
been caused by the fatty food. The midwife said that if the pain
did not subside, the woman might have food poisoning or a gall
bladder problem and should seek medical help if her condition
worsened. The woman self-presented to the local hospital emergency
department that night with epigastric pain and high blood pressure.
She was diagnosed with severe pre-eclampsia and HELLP syndrome.
The woman underwent an emergency Caesarean section, and her baby
subsequently progressed well. However, the woman was transferred to
the intensive care unit. Her recovery was complicated by a large
subcapsular haematoma (bleeding in the liver), and she remained in
hospital for a month.
It was held that the midwife's antenatal care of the woman was
suboptimal. The midwife did not establish the woman's medical
history, failed to monitor her appropriately by urinalysis and
appeared not to elicit from the woman that she had oedema and that
there had been a reduction in fetal movement. Further, the midwife
failed to respond to the woman's high blood pressure appropriately
at the 38 week appointment by rechecking the reading and by
undertaking urinalysis at that point. At the 39 week appointment,
the midwife did not assess the woman's blood pressure herself
despite the high reading the previous week. Accordingly, the
midwife failed to provide services with reasonable care and skill
and breached Right 4(1).
The midwife's email response to the woman in relation to the
student's presence at the birth was inappropriate and
disrespectful, and therefore the midwife breached Right 1(1). The
midwife's inadequate documentation amounted to a failure to comply
with professional standards and, accordingly, the midwife breached
It was recommended that the midwife provide an apology to the
woman, a reflection on the case, and undertake further training.
The Midwifery Council of New Zealand was asked to consider whether
a further competence review was warranted.