|January 2003 · Vol. 15, No. 1
Cutting the legal risks of hypertension in pregnancy
What conditions, assumptions, and oversights increase an Ob/Gyn’s vulnerability to legal claims involving hypertensive gravidas? An expert zeroes in and offers steps to reduce liability.
Dr. Sibai is professor and chairman, department of OBG, University of Cincinnati College of Medicine,
All gravidas are at risk for hypertension and preeclampsia in the antepartum, intrapartum, and postpartum periods.
In a patient who was previously normotensive, the diagnosis of hypertension should be based on blood-pressure criteria rather than threshold-increase criteria, since a gradual increase in blood pressure from the first to third trimesters is seen in 67% to 75% of normotensive pregnancies.
The ultimate goals of therapy for hypertensive disorders must always be safety of the mother first and then delivery of a live, mature infant who requires no intensive and prolonged neonatal care.
Antihypertensive medications should not be used to control blood pressure on an outpatient basis in women with preeclampsia.
Common themes in medicolegal claims are the assumption by health-care providers that a patient’s proteinuria resulted from sample contamination or urinary tract infection, and a failure to appreciate the clinical significance of patient complaints during telephone calls.
Complications related to HELLP syndrome are a major cause of litigation claiming failure to diagnose preeclampsia or failure to diagnose syndromes that can mimic preeclampsia.
Hypertensive disorders are the most common medical complications of pregnancy, with a reported incidence in the United States of 6% to 8%.1,2 These disorders are associated with an increased risk of maternal and perinatal mortality and morbidity (TABLE 1).3 Not surprisingly, they are a major cause of litigation against physicians and hospitals, most of it alleging misdiagnosis and/or mistreatment. In this article, I outline precautions that can reduce or prevent the risk of medicolegal claims involving hypertension in pregnancy. Among the issues covered are terminology, diagnosis, management, and complications of the disorders, based on the literature, a review of legal claims, and personal experience.