A Tragic Verdict: Understanding Preeclampsia, Stillbirth, and Medical Malpractice

The birth of a child should be a moment of pure joy, but for too many families, it turns into a tragedy. One of the most devastating outcomes is stillbirth, a loss often complicated and compounded when medical negligence is involved. The recent $25 million medical malpractice verdict in a preeclampsia stillbirth case shines a harsh light on this issue. It underscores the critical importance of timely diagnosis and aggressive management of a pregnancy complication known as preeclampsia.

A jury delivered this massive verdict in the wrongful death of an unborn child. The case against two OB/GYNs was based on their alleged negligent failure to diagnose and manage the mother’s severe preeclampsia. According to the complaint, the doctors discharged the mother without proper monitoring. She returned days later with severe complications that resulted in the loss of her baby. The verdict had $4 million for economic value and $15 million for the intangible value of the fetus’s life. It serves as a grave warning about the human cost of medical oversights and miscommunications.

For expecting parents, understanding preeclampsia is not just a matter of health awareness—it’s a critical component of advocating for their own care.

What is Preeclampsia?

Preeclampsia is a serious, sudden-onset hypertensive disorder unique to pregnancy. It occurs with new-onset high blood pressure (hypertension) and signs of end-organ dysfunction. This is most commonly detected after 20 weeks of gestation.

The core issue involves the placenta: in preeclampsia, the blood vessels in the placenta fail to develop normally, leading to poor blood flow to the organ (placental ischemia). This compromised blood flow causes the placenta to release various substances into the mother’s bloodstream, triggering widespread dysfunction of the blood vessel lining (endothelial dysfunction) throughout the mother’s body. This systemic reaction results in the defining symptoms and complications:

• Hypertension: Blood pressure readings of 140/90 mm Hg or higher on two occasions at least four hours apart.
• Proteinuria: High levels of protein in the urine, indicating kidney damage.
• Other Organ Damage: This can include elevated liver enzymes, low platelet count, fluid in the lungs (pulmonary edema), severe headaches, and vision changes.

If preeclampsia progresses and causes seizures, the condition is then classified as eclampsia, a life-threatening medical emergency. A severe form affecting the blood and liver is known as HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets).

What Type of Monitoring is Needed for Preeclampsia and What Does it Show to Avoid a Stillbirth?

Managing preeclampsia involves close, aggressive monitoring and the medical providers must do it once they suspect or diagnose the condition. The goal of monitoring is to assess the severity of the mother’s condition, check for deterioration, and evaluate the baby’s health.

Maternal Monitoring: To Track Progression and Organ Function

• Blood Pressure Checks: Frequent (sometimes daily) checks are necessary to identify any abnormal increases. A blood pressure of 160/110 mm Hg or higher is classified as severe hypertension and requires urgent treatment.
• Urine Samples (Proteinuria): Regular samples (often a 24-hour collection) measure protein levels, which indicate the extent of kidney impairment.
• Blood Tests: These tests are crucial for assessing end-organ function, specifically checking:
  • Platelet Count: To detect a drop, which can indicate HELLP syndrome or clotting issues.
  • Liver Enzymes (e.g., AST and ALT): To check for liver damage.
  • Kidney Function (e.g., Creatinine): To assess how well the kidneys are clearing waste.

Fetal Monitoring: To Assess the Baby’s Well-being

The high blood pressure in the mother can decrease the blood and oxygen flow to the placenta and the baby. This may restrict the baby’s growth. Monitoring includes:

• Fetal Ultrasound: Used to measure the baby’s growth (to detect Intrauterine Growth Restriction (IUGR)) and to check the amount of amniotic fluid. Low amniotic fluid (oligohydramnios) can be a sign of placental problems.
• Nonstress Test (NST): A simple procedure that electronically monitors the baby’s heart rate in response to movement, which can detect stress or distress.
• Biophysical Profile (BPP): This uses ultrasound to measure the baby’s breathing, muscle tone, movement, and the volume of amniotic fluid, providing a more comprehensive view of fetal health.

When Does a Mother Have to Be Admitted and Monitored or Treated?

While mild preeclampsia may sometimes be managed at home with frequent follow-up appointments, a mother with preeclampsia is typically admitted to the hospital for closer observation and/or treatment under several key scenarios:

• Severe Hypertension: If the mother’s blood pressure is consistently 160 mm Hg systolic or 110 mm Hg diastolic or higher. This is a hypertensive emergency that requires immediate in-patient care and parenteral (IV) medication.
• Severe Preeclampsia/Adverse Maternal Conditions: The doctors must hospitalize the patient if she presents with any severe features or adverse maternal conditions. These include:
  • Severe, persistent headaches, visual disturbances, or altered mental state.
  • Persistent epigastric or right upper quadrant pain.
  • Signs of worsening organ failure (e.g., worsening kidney or liver function on blood tests, pulmonary edema).
  • Diagnosis of HELLP syndrome or eclampsia.
• Early Onset Preeclampsia: If preeclampsia is diagnosed before 34 weeks of gestation, a hospital stay is often necessary for continuous monitoring and to administer steroids to help the baby’s lungs mature if early delivery becomes necessary.

In this case, the negligence involved discharging the patient without proper monitoring, highlighting a potential catastrophic failure to recognize the severity of the mother’s condition or to follow admission and surveillance protocols.

What Kind of Treatment is Needed to Avoid a Preeclampsia Stillbirth?

The only curative treatment for preeclampsia is the delivery of the baby and the placenta. However, until delivery is safe or necessary, treatment focuses on managing the mother’s symptoms and preventing life-threatening complications.

Key Treatment Modalities:

1. Antihypertensive Medications: Doctors use medicine to manage high blood pressure and reduce the risk of serious maternal complications like stroke. Common medications include labetalol, nifedipine, or methyldopa. The goal is to bring the blood pressure down to a safer target (e.g., a diastolic blood pressure of around 85 mm Hg).
2. Magnesium Sulfate: This is the first-line medication used to prevent or treat eclamptic seizures (fits) in women with severe preeclampsia. Magnesium sulfate is an anticonvulsant that reduces the risk of eclampsia by more than half.
3. Corticosteroids: If the doctor anticipates a preterm delivery (before 34 weeks of gestation), they give corticosteroids like betamethasone to the mother to speed up the maturation of the baby’s lungs.
4. Delivery: The timing of delivery is a critical decision based on the severity of the preeclampsia and the gestational age of the baby.
   • For preeclampsia that is not severe, the doctor should deliver at or around 37 weeks of pregnancy.
   • For severe preeclampsia, doctors must deliver before 37 weeks to protect the health of the mother and baby.

What is Stillbirth and How Can Preeclampsia Cause It?

A stillbirth is the death of a fetus at or after 20 weeks of pregnancy. This devastating event affects thousands of families annually and can have numerous underlying causes, with placental complications being a major factor.

Preeclampsia is a significant risk factor and contributor to stillbirth, linked to approximately 9.2% of all stillbirths. The connection is rooted in the underlying pathology of the condition: placental insufficiency.

Here is how preeclampsia can lead to stillbirth:

• Compromised Blood Flow: The failure of the mother’s arteries to remodel properly causes preeclampsia, resulting in poor blood flow to the placenta. This damages the placenta, which is the baby’s lifeline for oxygen and nutrients, and essentially starves the baby.
• Fetal Growth Restriction: The impaired blood and oxygen supply often leads to Intrauterine Growth Restriction (IUGR), meaning the baby cannot grow at a healthy rate. A baby with compromised growth is at a much higher risk of distress and death in utero.
• Placental Abruption: Preeclampsia also significantly increases the risk of placental abruption, where the placenta prematurely separates from the uterine wall. This causes severe bleeding and immediately cuts off the baby’s oxygen supply, leading to stillbirth.

The stillbirth of the baby here, resulting from the doctors’ missed diagnosis and failure to manage severe preeclampsia, perfectly illustrates the fatal course of this disease when doctors do not uphold medical standards.

The Legal Imperative: Adherence to Medical Guidelines

The verdict underscores a critical point: while preeclampsia is a complication of pregnancy, its severe consequences, including stillbirth, are often preventable with appropriate and timely medical intervention.

Medical malpractice occurs when a medical provider fails to follow the accepted “standard of care.” Further, that failure causes injury or death. In preeclampsia cases, this often involves:

• Misdiagnosis or Failure to Diagnose: Missing the signs of hypertension and/or proteinuria during routine prenatal visits.
• Failure to Monitor: Discharging a high-risk patient without a clear follow-up plan or failing to admit a patient with severe features for continuous monitoring. In this case, one doctor discharged the patient without proper monitoring, and a second failed to follow up with necessary records.
• Failure to Timely Treat/Deliver: Delaying the administration of necessary medications like magnesium sulfate or delaying the decision to deliver the baby when maternal or fetal conditions indicate imminent danger.

The $25 million award serves as a powerful reminder to medical professionals. Violating medical guidelines can lead to irreversible tragedy. The award holds them responsible for the failure to meet the standard of care in a stillbirth case. For families, it highlights the importance of asking questions, knowing the signs of preeclampsia, and making sure their medical providers are following the protocols for monitoring and managing this dangerous, but often controllable, condition.

You can read Blog Posts on other Verdicts.

If your pregnancy ended in a stillbirth, see below to contact the Kopec Law Firm.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.