Complex disorder usually found in routine screening

A woman who presents during pregnancy with swelling of the lower limbs and higher than normal blood pressure has a condition called pre-eclampsia until proven otherwise. It’s one of the main reasons women are monitored closely during pregnancy, due to the risk the condition poses to both the mother and baby.

Pre-eclampsia is a multi- system disorder involving the placenta, liver, kidneys and the neurological and cardiovascular systems. It is usually picked up by routine screening of blood pressure and by urinalysis: the presence of protein in the woman’s urine suggests the kidneys are under stress.

The exact cause of pre-eclampsia remains unclear. However, it is likely the result of an interplay between a genetic predisposition to the condition; reduced blood supply to the placenta followed by cellular changes leading to high blood pressure; protein in the urine; and the risk of reduced growth of the baby in the uterus.

Pre-eclampsia is more common in first pregnancies, with an overall incidence of 4 to 5 per cent among women attending antenatal clinics. A family history of the condition increases the risk of pre- eclampsia fourfold to eightfold.

It is also more common in women diagnosed with hypertension prior to becoming pregnant.

Untreated, pre-eclampsia can cause stroke, seizures and acute renal failure with a consequent risk of death.

In Dhara Kivlehan’s case, the finding of abnormal liver function tests raised the possibility of her having a severe form of pre-eclampsia called HELLP syndrome.

It describes a group of clinical signs: H stands for haemolysis ( the breakdown of red blood cells); EL represents elevated liver enzymes; and LP stands for low platelet count. HELLP occurs in more than 10 per cent of cases of severe pre-eclampsia or full-blown eclampsia.

As many as one in four women with HELLP develop serious complications, including a breakdown of the body’s clotting system called disseminated intravascular coagulation (DIC); fluid build-up in the lungs; kidney failure; liver haemorrhage; and failure and separation of the placenta from the wall of the uterus.

Treatment includes early delivery of the baby and a whole range of supportive therapies including lowering blood pressure, an infusion of platelets and respiratory support.

The comment by Ms Justice Mary Irvine that the late admission of liability by the defendants was “very regrettable” is apposite.

It flies in the face of the internationally recognised “open disclosure” movement in medicine in which it is recognised that when an adverse outcome occurs, an apology and, if appropriate, an admission of liability must be made at the earliest opportunity.