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Midwife’s failure to identify and respond to developing pre-eclampsia (14HDC00452)
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(14HDC00452, 18 March
Community-based midwife ~ Blood pressure ~ Pre-eclampsia ~
Labour ~ Communication ~ Right 4(1)
A woman, aged 26 years, was pregnant with her first child. The
pregnancy progressed normally until 39+6 weeks' gestation, when the
woman presented for a routine antenatal check with her LMC midwife.
During this appointment, the woman was noted to have a high blood
pressure. She was also noted to have been experiencing visual
disturbances two weeks previously and again on one occasion in the
days preceding the appointment. The woman was advised of the signs
and symptoms of pre-eclampsia and she was told to contact the
midwife if she experienced these symptoms or noticed a decrease in
fetal movements. The midwife did not recommend to the woman that
she consult with a specialist, or take additional steps to assess
the woman's pre-eclampsia, such as arranging for blood tests and
The following morning, the woman sent a text message to the
midwife stating that she had experienced headaches and further
visual disturbances that morning. At around midday, the midwife
telephoned the woman and left a message, asking the woman to let
her know if she experienced any more "symptoms". She did not
arrange to assess the woman urgently in response to the symptoms
she had reported.
That evening, the woman started experiencing contractions. She
subsequently met the midwife at hospital.
On arrival at the delivery suite the midwife carried out an
assessment and noted that the woman's blood pressure was very high.
She did not carry out any further assessment in response to the
raised blood pressure at that time, such as blood or urine testing.
All other observations of the woman and baby were normal. The
midwife then left the room.
When the midwife returned to the room, the woman reported
feeling faint. The woman's blood pressure had risen further, and
was very high. The on-call obstetric registrar was called. The
registrar then took over the woman's care. The woman was managed
for pre-eclampsia, and gave birth to her baby early the following
morning. The woman continued to be managed for the symptoms of
pre-eclampsia in the postnatal period.
It was held that the midwife failed to identify and respond
appropriately to the developing pre-eclampsia. Accordingly, she
failed to provide services to the woman with reasonable care and
skill and breached Right 4(1).
Criticism was also made about the midwife's failure to advise
the woman appropriately about the use of text message communication
in relation to urgent matters, her lack of communication with the
woman regarding her condition during labour, and her comments to
the woman regarding another professional.
The midwife was referred to the Director of Proceedings. The
Director decided to institute a proceeding, which is pending.