Pregnancy is naturally a time of mixed emotions, blending excitement with worry. However, when specific warning signs are dismissed by medical professionals, that worry can turn into a life-altering tragedy. Pre-eclampsia is often referred to as the great impostor. It can present itself as simple swelling or common indigestion, masking a condition that is volatile and potentially deadly.
At Michael Boylan LLP, we understand that pre-eclampsia does not always present with the classic textbook symptoms immediately. However, the condition follows a physiological path that properly trained medical staff should recognise. When the Health Service Executive (HSE) Clinical Guidelines are ignored, or when a mother’s concerns are brushed aside as the complaints of an anxious patient, the window to prevent catastrophe closes rapidly.
We act for mothers who have suffered devastating injuries, such as stroke, liver rupture, or kidney failure, and for families who have tragically lost a baby because the medical team failed to join the dots. If you feel your symptoms were ignored, we are here to investigate the care you received.
What Is Pre-eclampsia?
Pre-eclampsia is a serious disorder characterised by the onset of high blood pressure (hypertension) and the presence of protein in the urine (proteinuria). This typically occurs after the 20th week of pregnancy.
While the exact cause relates to the placenta not developing properly, the effect is a constriction of blood vessels throughout the mother’s body. This raises blood pressure and reduces blood flow to vital organs, including the liver, kidneys, and brain, as well as reducing blood supply to the unborn baby.
Warning Signs of Pre-eclampsia
One of the most distressing aspects of the cases we investigate is how often a mother’s intuition was correct, yet her symptoms were minimised by her GP or attending midwife. Many of our clients report having raised the following issues, only to be told they were experiencing normal pregnancy side effects:
- Severe headaches: Often described as a tight band around the head that does not go away with paracetamol.
- Visual disturbances: Flashing lights, blurring, or seeing stars.
- Sudden swelling: Oedema that comes on rapidly, particularly in the face, hands, or feet.
- Epigastric pain: Severe pain just below the ribs, often mistaken for indigestion.
- Vomiting: Being sick late in pregnancy without a clear cause.
When these red flags are present, the standard of care dictates that medical staff must rule out pre-eclampsia before diagnosing a lesser ailment. Assuming these symptoms are benign without clinical verification can be a breach of duty.
How Pre-eclampsia Negligence Can Occur
In our experience investigating mismanagement claims across Irish maternity units, negligence rarely happens in a single moment. It is often a sequence of missed opportunities where doctors or midwives failed to adhere to the National Clinical Guidelines.
Failure to Act on Risk Factors
Proper care begins at the booking appointment. Your medical team has a duty to identify if you are at high risk for developing pre-eclampsia. Negligence can occur right at the start of the pregnancy if the team fails to flag specific risk factors, such as:
- A previous history of pre-eclampsia or hypertension.
- A Body Mass Index (BMI) of 35 or more.
- Advanced maternal age (over 40 years).
- A family history of the condition.
- Underlying kidney disease or autoimmune disorders.
The Aspirin Protocol: An important, yet frequently missed preventative step, involves the prescription of low-dose aspirin. Clinical studies and HSE guidelines support prescribing aspirin daily from early pregnancy (usually 12 weeks) for women with high-risk factors. This simple intervention can significantly reduce the risk of pre-eclampsia developing. Failure to prescribe this can be a central element of a negligence claim if the condition subsequently develops and causes harm.
Failure to Monitor
We often see cases where the signs were present in the notes from antenatal checks but were not acted upon with sufficient urgency.
- Ignoring Trace Protein: Urinalysis is standard at every appointment. If a midwife finds protein in the urine (often noted as trace or +1), this requires further investigation, especially if combined with rising blood pressure. Ignoring this or failing to recheck it is a failure of care.
- Discharge Errors: Sending a mother home with borderline high blood pressure without referring her to a Day Assessment Unit is a common negligent act. The Day Assessment Unit allows for a longer period of monitoring (blood pressure profiles and blood tests) to see if the condition is stabilising or worsening. Sending a patient home without this review is a gamble with the patient's safety.
Failure to Deliver
Managing pre-eclampsia is a balancing act between the maturity of the foetus and the health of the mother. However, maternal safety must always be the priority. Negligence often arises when consultants delay delivery to buy time for the baby to grow, even when the mother is showing signs of severe instability. If the medical team waits too long, hoping to reach a later gestation week while the mother’s organs are beginning to fail, they have breached the standard of care.
HELLP Syndrome
In the most severe cases of mismanagement, pre-eclampsia can evolve into HELLP Syndrome. This is a medical emergency that poses a significant threat to the life of both mother and child.
What Is HELLP?
The name is an acronym standing for the three key features of the condition:
- Haemolysis (the breakdown of red blood cells).
- ELevated Liver enzymes (indicating liver damage).
- Low Platelet count (affecting the blood's ability to clot).
The Diagnostic Error
HELLP Syndrome is notoriously difficult to diagnose if the clinician is not vigilant, leading to catastrophic delays in treatment. The classic presentation involves severe pain in the upper abdomen (epigastric pain) or pain radiating to the back.
We have handled heartbreaking cases where this pain was misdiagnosed as gastric flu, cholecystitis (gallbladder issues), or severe heartburn. Mothers are sometimes prescribed antacids and sent home, while their liver function is rapidly deteriorating.
The Consequences of Missed Diagnosis
Because HELLP affects the blood clotting mechanism and the liver, a delay in diagnosis of even a few hours can be fatal. If not treated immediately by stabilising the mother and delivering the baby (often via emergency Caesarean section under general anaesthetic), the consequences are severe:
- Liver Rupture: The capsule surrounding the liver can burst, causing massive internal bleeding.
- DIC (Disseminated Intravascular Coagulation): A condition where the blood loses its ability to clot, leading to uncontrollable haemorrhage.
- Placental Abruption: The placenta separates from the womb too early, depriving the baby of oxygen.
- Cerebral Haemorrhage: Stroke caused by uncontrolled high blood pressure.
At Michael Boylan LLP, we work with leading independent obstetric and haematology experts to analyse the medical records. We look for the moment the diagnosis was missed,the blood test that wasn't ordered, the pain that was mislabelled, or the delay in transfer to theatre. If you believe your condition was mismanaged, we are here to help you find answers.
Postpartum Pre-eclampsia
There is a dangerous misconception that once the baby is delivered, the risk of pre-eclampsia disappears instantly. While delivery is the ultimate cure, the mother’s body takes time to recover. In the days following birth, blood pressure can remain dangerously high or spike suddenly, placing the mother at risk of stroke or seizures even after she has held her baby.
A significant gap in care often occurs during the discharge process. Many mothers are discharged from the maternity hospital too early, often while their blood pressure is still unstable. Once home, the safety net of 24-hour hospital monitoring is removed, and the mother is reliant on community care which can sometimes be fragmented.
We frequently investigate cases where the warning signs were missed in the postnatal period:
- Severe Headaches: A mother complaining of an intense headache 2 or 3 days after going home is often told to take painkillers and rest, when in reality, she needs urgent readmission.
- Visual Disturbances: Issues like blurring or flashing lights are dismissed as tiredness from caring for a newborn.
- Monitoring Failures: A failure by Public Health Nurses or GPs to physically check blood pressure during postnatal visits, assuming the danger has passed.
Assessing the Standard of Medical Care
In medical negligence law, we do not expect perfection, but we do demand competence. To bring a successful claim for pre-eclampsia mismanagement, we must prove that the care you received fell below the acceptable standard and that this failure caused your injury.
The Legal Test
We assess every case against the Dunne Principles, which is the legal standard set by the Irish Supreme Court. Simply put, we must prove that no competent obstetrician or midwife would ordinarily have managed your pregnancy the way yours was managed. If other medical professionals would have acted differently,for example, by delivering the baby earlier,then negligence may be established.
HSE National Guidelines
The HSE operates under National Clinical Guideline No. 4, which mandates the use of the Irish Maternity Early Warning System (IMEWS). This system is designed to catch physical deterioration early using a specific "traffic light" protocol.
When we review your medical records, we focus heavily on these IMEWS charts. If your blood pressure or other vitals triggered a Yellow or Red alert, mandatory steps should have followed,specifically, an urgent review by a senior doctor. If the hospital staff recorded the warning signs but failed to escalate your care as required by the guidelines, this breach of duty is often central to proving your case.
Frequently Asked Questions
Can I claim if I wasn't given aspirin during my pregnancy?
Yes, if you were considered high-risk. The failure to prescribe low-dose aspirin is a significant issue in modern obstetric negligence. If you had clear risk factors,such as a history of pre-eclampsia, a high BMI, or advanced maternal age,and your doctor failed to prescribe aspirin, and you subsequently developed severe pre-eclampsia that caused injury, this can form the basis of a claim.
My wife died due to eclampsia. Can the family claim?
Yes, the family can bring a fatal injury claim. This is a heartbreaking outcome, and Irish law provides a specific mechanism for families to seek justice. We can help you pursue a claim for the mental distress caused to the family (the solatium) and for the financial loss of dependency if the mother was a provider for the household. We also represent families at the Coroner’s Inquest to ensure the full truth of what happened is placed on the public record.
Is there a time limit for bringing a case?
Generally, the time limit is two years from the date of the injury or the date you became aware of the negligence. However, this is strictly for the mother’s injury. If the baby suffered an injury due to the mismanagement (such as cerebral palsy caused by oxygen deprivation), the time limits are much longer. A child has until two years after they turn 18 to bring a claim, though practically, these cases should be taken as soon as possible.
Will I have to go to court to tell my story?
It is unlikely that you will have to go to court. The vast majority of medical negligence cases in Ireland are settled outside of the courtroom. Our goal is to build such a robust case, supported by independent expert reports, that the State Claims Agency (who represent the HSE) accepts liability before a trial is necessary. If a trial is required, we will support you every step of the way.
What if my medical records are missing or incomplete?
We can still investigate the claim. It is the hospital's legal duty to maintain accurate records. If records are missing, we can often infer what happened based on other evidence, such as blood test results or testimony regarding your symptoms. We have a dedicated team that specialises in forensic analysis of medical notes to find the gaps in care.
Get in Touch
At Michael Boylan LLP, we know that no compensation can undo a traumatic birth or bring back a loved one. However, holding the hospital accountable ensures that your suffering is acknowledged and provides the financial security you or your child may need for the future.
If you have been affected by the issues raised here, please contact our team. We will listen to your story with empathy and advise you on the best path forward.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
