Midwife misses potentially fatal condition
A midwife who told a heavily pregnant woman she ''probably had a chest infection'' when she was displaying early symptoms of a potentially fatal pregnancy complication has been found to be in breach of health standards.
In a report released today, Health and Disability Commissioner Anthony Hill ruled the midwife failed to respond appropriately to the woman's symptoms when she was later diagnosed with pre-eclampsia.
The report does not identify the midwife, nor where in New Zealand she was practising.
The condition occurs in about one in 10 New Zealand pregnancies a year, and kills an estimated 70,000 pregnant or post-natal mothers, and 500,000 foetuses, around the world - making it one of the top three causes of maternal death.
The midwife, who had name suppression, gained the 22-year-old woman as a client when she was about halfway through her first pregnancy.
After her third antenatal appointment, the pregnant woman left the region in the midst of a ''natural disaster'', and returned two weeks later.
When the woman was 37 weeks pregnant, she missed an appointment with her midwife as she was unwell with diarrhoea and abdominal cramps.
That evening, she texted the midwife for advice on her symptoms, who replied that a medical visit was ''more appropriate'' than a midwifery visit, resulting in her cancelling their appointment the next day.
The woman's condition deteriorated when she was unable to schedule an appointment with her doctor the next day.
Two days later she began experiencing sharp, stabbing pains in her chest, shortness of breath, headaches and upper abdominal pain.
As her condition worsened, she called her midwife again for advice and was told she probably had a chest infection and advised to rest, drink electrolyte fluids, and see her doctor if she was worried.
After again attempting to book a doctor's appointment in vain, the woman asked the midwife to contact her doctor so she could schedule an emergency appointment.
However, the midwife misunderstood, thinking the request was in regards to payment for the appointment and replied to the woman by text to say she had been unable to contact the doctor.
That night, the woman's chest symptoms worsened and she was taken to the after-hours medical clinic by her partner. She was then rushed to hospital by ambulance for further assessment.
She was diagnosed with pre-eclampsia and an urgent decision was made to deliver her baby by Caesarean section.
Hill found the midwife breached the Code of Health and Disability Services Consumers' Rights by not responding appropriately to the woman's symptoms, failing to ensure that the woman had a review during that period and failing to schedule an urgent review in light of her symptoms.
Hill acknowledged the circumstances faced by the midwife were ''very challenging'' in the wake of the natural disaster, and as she was also under pressure providing cover for colleagues.
''[The midwife] was in an unenviable position.''
The midwife had since apologised to the woman for not following up on her symptoms, has changed her practice regarding texting and is seeking further education regarding pre-eclampsia.
PRE-ECLAMPSIA - THE FACTS
- a medical condition in which blood pressure spikes during pregnancy while excess protein is released into the urine
- occurs in 5-8 per cent of all pregnancies (some studies say up to 10 per cent)
- symptoms include elevated blood pressure, protein in the urine, swelling (particularly in the mother's hands, feet and legs)
- if left untreated, can develop into eclampsia - life-threatening seizures
- pre-eclampsia is fatal in about 2 per cent of cases
- causes are not clearly understood but may be the mother's immune system reacting to the presence of her baby and the placenta
- no known cure for the condition, the only known definitive treatment is to deliver the fetus and placenta by labor induction or Caesarean section.
- post-partum pre-eclampsia can occur up to six weeks after delivery even if symptoms were not present during the pregnancy
- © Fairfax NZ News
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