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The importance of NICE guidance in a clinical negligence claim regarding the diagnosis and management of pre-eclampsia - Sam Holden & Gemma Dunn, Clyde & Co

08/10/18. The Court recently considered the importance of NICE guidance in a clinical negligence claim regarding the diagnosis and management of pre-eclampsia. Clyde & Co were instructed by NHS Resolution on behalf of the Trust. The decision reinforced the position that NICE guidance (and other specialism-specific guidance) should be followed unless there is a clinically justified reason to depart from it.

Background

The claimant presented to East Kent University Hospitals Foundation Trust on 1 November 2012, late in her first pregnancy having been referred by her GP with headaches, hypertension and trace protein in urine on dipstick testing. Sequential blood pressure readings were obtained in hospital, together with laboratory protein/creatinine levels (PCR), and the claimant was booked for induction of labour on 5 November 2012.

She in fact re-attended on the morning of 4 November 2012 with early signs of labour. Her blood pressure was normal, with no protein on dipstick testing. Contractions settled and the Claimant was sent home. She re-attended that same night as she had not felt the baby move; her son was sadly delivered still-born the following day.

The Claimant alleged that the Trust should have diagnosed pre-eclampsia on 1 or 4 November 2012, on the basis of her raised uric acid levels and having regards to other alleged risk factors such as her raised BMI. It was alleged they should have admitted her and delivered the baby.

Breach was denied on the basis that the Claimant did not satisfy the diagnostic criteria of pre-eclampsia. This requires hypertension in the presence of significant proteinuria. The Claimant had, at most, mild hypertension but, crucially, the PCR testing had been normal and the definition of "significant proteinuria" was not met. It was, however, admitted that the baby would have been born alive had he been delivered by the morning of 4 November 2012...

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