All healthcare professionals who deal with pregnant women must recognise and act on the clinical signs of pre-eclampsia
"Sir, The latest UK report into deaths in pregnancy is shocking. More than nine out of ten women who died from hypertensive disorders of pregnancy (pre-eclampsia, the most common medical complication of pregnancy) between 2006 and 2008 had substandard care. Of these, 64 per cent had “major” substandard care where “different treatment might have altered the outcome”. Substandard care of pre-eclampsia has been a persistent feature of all similar inquiries over the past two decades. These findings highlight basic failures in management and organisation of care in the community and in hospital.
Every death from pre-eclampsia is tragic but is the tip of an iceberg of many more tragedies: deaths of babies, “near misses” and serious ill-health caused by pre-eclampsia. The underlying issues of management are complex — including staff shortages, a focus on “normal” pregnancy to the detriment of safety, and fragmented care because of new shift systems — while the cause of pre-eclampsia is still poorly understood. However, there is no excuse for the basic errors of failure of detection and lack of adequate control of blood pressure.
We believe that all healthcare professionals who may come into contact with pregnant women (whether in a GP surgery, antenatal clinic, emergency department or labour ward) must be able to recognise and act on the clinical signs (hypertension, protein in the urine) and symptoms (upper abdominal pain, headache, visual disturbance in the mother or reduced foetal movements/ small baby) of pre-eclampsia.
Critically, we need to identify what workable systems will improve the situation. We want a careful analysis of maternity care, including the major quality measures that are used to practice. Without this, unnecessary maternal and baby deaths and adverse health outcomes will continue."
Carol Cooper, Gp, Imperial College School of Medicine; Chris Redman, Professor of Obstetric Medicine, University of Oxford; Andrew Shennan, Professor of Obstetrics, King’s College London; Catherine Nelson Piercy, Professor of Obstetric Medicine, Guy’s and St Thomas’ Foundation Trust; Professor James Walker, Department of Obstetrics and Gynaecology, University of Leeds; Philippa Brice, Trustee, Action on Pre-eclampsia; Stephen Robson, Professor of Fetal Medicine, University of Newcastle; Fiona Milne, trustee Action on Pre-eclampsia; Helen Crafter, chair of trustees, Action on Pre-eclampsia, Senior Lecturer in Midwifery, Thames Valley University; Kim Turner, trustee Action on Pre-eclampsia, Trainee Obstetrics and Gynaecology; Gillian Fletcher, service user representative, PRECOG group; Jason Waugh, Consultant Obstetrics and Maternal Medicine, Newcastle upon Tyne
Every Woman is entitled to understand what happened in her pregnancy when pre eclampsia strikes. I hope to be able to support that process.