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Care provided to pregnant woman with cardiac problems (05HDC13401)
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(05HDC13401, 29 June
Public hospital ~ District health board ~ General
practitioner ~ Midwife ~ Obstetrician ~ Cardiologist ~ Maternity
services ~ Death of mother and baby ~ Informed consent ~
Communication between subspecialties ~ Communication of treatment
options ~ Documentation and formulation of management/treatment
plans ~ Rights 4(4), 4(5)
A woman who had congenital aortic stenosis and had had an aortic
valve replacement in 1997 had her first baby without complications
in 1999. In 2004, she became pregnant with her second child. Her
first cardiac assessment during the pregnancy was not until 15
weeks' gestation, and at 21 weeks she was found to have significant
redevelopment of aortic stenosis. At her further cardiac
assessment, at 25 weeks, she was found to have signs of cardiac
failure and was admitted to the antenatal ward at a hospital in a
On admission, early delivery was considered. The woman's
condition stabilised after admission, and the plan was to deliver
the baby and possibly perform valve replacement surgery, depending
on her condition. During her admission, she was seen frequently by
the cardiology team, maternal fetal medicine team, and
cardiothoracic team, but no formal management plan was documented,
and no plan apart from "expectant management" was considered.
The woman's condition deteriorated suddenly and, despite an
emergency Caesarean section and heart surgery, tragically, both she
and her baby died.
It was held that the public hospital did not have an effective
system to ensure a co-ordinated approach to the woman's care. There
were three options available to the woman when the significance of
her cardiac condition became known. She was not adequately informed
about two options - termination of pregnancy or earlier surgery.
The third, most risky option of expectant management appears to be
the only option that was meaningfully discussed, and that was the
path that was ultimately taken.
It was held that the woman's care was jeopardised by the failure
of the clinical teams to plan and coordinate her treatment.
Corporate responsibility for this failure lay with the DHB.
Accordingly, it was found to have breached Rights 4(4) and