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What Causes Pregnancy Induced Hypertension?
Question: Hi .. my wife delivered baby at 36 weeks (emergency) because of PIH ... that was the first time we came know that she has PIH.. would like to know from how long it has been not detected? From blood tests done at 36 weeks can I derive whether she got it at 32 / 34 weeks?
Brief Answer:
BP CHART CAN TELL YOU
Detailed Answer:
Hello
Thanks for writing to us with your health concern.
PIH is pregnancy induced hypertension.
As the term implies, it is high blood pressure induced in an otherwise non hypertensive woman due to pregnancy related changes.
IT can occur at any time during pregnancy.
Once the placenta forms around 12 - 14 weeks, it can be observed at any week of pregnancy.
It is possible to develop it suddenly at 36 weeks also.
THe only way to detect it is to regularly measure the blood pressure.
Pedal edema ( swelling on feet ) also points towards it.
The only definitive diagnosis is the raised blood pressure.
There are no blood tests that can tell you WHEN exactly the PIH developed.
The only way is to check her BP chart.
In any standard antenatal care unit, it is standard protocol to measure the BP of a pregnant woman every 1 - 2 weeks in the third trimester.
That can easily tell you when PIH developed.
All the best
Please feel free to discuss further.
BP CHART CAN TELL YOU
Detailed Answer:
Hello
Thanks for writing to us with your health concern.
PIH is pregnancy induced hypertension.
As the term implies, it is high blood pressure induced in an otherwise non hypertensive woman due to pregnancy related changes.
IT can occur at any time during pregnancy.
Once the placenta forms around 12 - 14 weeks, it can be observed at any week of pregnancy.
It is possible to develop it suddenly at 36 weeks also.
THe only way to detect it is to regularly measure the blood pressure.
Pedal edema ( swelling on feet ) also points towards it.
The only definitive diagnosis is the raised blood pressure.
There are no blood tests that can tell you WHEN exactly the PIH developed.
The only way is to check her BP chart.
In any standard antenatal care unit, it is standard protocol to measure the BP of a pregnant woman every 1 - 2 weeks in the third trimester.
That can easily tell you when PIH developed.
All the best
Please feel free to discuss further.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi
Thanks for the answer.
We had regular checkups done. Unfortunately it never came up in the BP chart.
The irony is, the hospital where I go, nurses check BP. Let me draft the whole story.
On 26-July-2014 at 12-30PM (my wife completed 36 weeks) , BP mentioned by nurse in the doctor consulting room was 120/80. Doctor felt the stomach was swollen. She recommended 4 point BP checkup in casualty and PIH blood tests done. At 12-45PM, we have been to casualty and checked by automatic BP machine and the reading was 200/110. The blood tests also conveyed that BP is very high. After identifying that, they did C-Section within 2 - 3hrs. I don't have any problem with Doctor. Not sure what best she could have done given the information to her. I learnt it is not medical negligence case as once they identified she has been very high BP (200/110) they have given outmost care.
Unfortunately the legs / hands / face is swollen and we couldn't identify the problem. It is definitely not single day problem. I assume, the problem was existing at least from 2-3 weeks. Even the baby weight was around 1.67 kgs ( 3.68 pounds) and doctor mentioned based on the weight they would consider the baby to be around 33-34 weeks. My baby is in NIC from the last 30 days. It is very frustrating and tough for us from the last 1 month.
Between 34 to 36 weeks ( 15-Jul-2014 to 26-Jul-2014 ) my wife got admitted to the hospital for 4 days where the nurses checked the BP at least 4 times a day. And I believe they did check it wrong or no one wants to highlight the correct reading assuming that they seen something wrong as no one else highlighted BP problem. My whole problem is with Nurses / BP machines they are using.
Now I would like to prove my theory. At present it is derived hypothesis. I would like hospital to take moral responsibility for giving me wrong data and make us suffer so much. I can't prove this apart from hospital records on 26-Jul-2014 at 12-30PM (120/80) and at 12-45PM ( 200/110) which is definitely wrong and they did wrong earlier also. I'm looking for more pointers to prove it. I thought from PIH blood tests readings we shall be able to derive from how long the problem exists. Is there any other pointers I can look for. Please let me know.
Proving this would help me reducing my hospital XXXXXXX which would be around 5-7 lakhs for my baby because of premature complications. Now it has been 1 month and he is still in hospital. In future, I expect hospital to take some preventive measures such that no else would suffer the way we are suffering now.
Looking forward to your answer.
Regards XXXXXXX
Thanks for the answer.
We had regular checkups done. Unfortunately it never came up in the BP chart.
The irony is, the hospital where I go, nurses check BP. Let me draft the whole story.
On 26-July-2014 at 12-30PM (my wife completed 36 weeks) , BP mentioned by nurse in the doctor consulting room was 120/80. Doctor felt the stomach was swollen. She recommended 4 point BP checkup in casualty and PIH blood tests done. At 12-45PM, we have been to casualty and checked by automatic BP machine and the reading was 200/110. The blood tests also conveyed that BP is very high. After identifying that, they did C-Section within 2 - 3hrs. I don't have any problem with Doctor. Not sure what best she could have done given the information to her. I learnt it is not medical negligence case as once they identified she has been very high BP (200/110) they have given outmost care.
Unfortunately the legs / hands / face is swollen and we couldn't identify the problem. It is definitely not single day problem. I assume, the problem was existing at least from 2-3 weeks. Even the baby weight was around 1.67 kgs ( 3.68 pounds) and doctor mentioned based on the weight they would consider the baby to be around 33-34 weeks. My baby is in NIC from the last 30 days. It is very frustrating and tough for us from the last 1 month.
Between 34 to 36 weeks ( 15-Jul-2014 to 26-Jul-2014 ) my wife got admitted to the hospital for 4 days where the nurses checked the BP at least 4 times a day. And I believe they did check it wrong or no one wants to highlight the correct reading assuming that they seen something wrong as no one else highlighted BP problem. My whole problem is with Nurses / BP machines they are using.
Now I would like to prove my theory. At present it is derived hypothesis. I would like hospital to take moral responsibility for giving me wrong data and make us suffer so much. I can't prove this apart from hospital records on 26-Jul-2014 at 12-30PM (120/80) and at 12-45PM ( 200/110) which is definitely wrong and they did wrong earlier also. I'm looking for more pointers to prove it. I thought from PIH blood tests readings we shall be able to derive from how long the problem exists. Is there any other pointers I can look for. Please let me know.
Proving this would help me reducing my hospital XXXXXXX which would be around 5-7 lakhs for my baby because of premature complications. Now it has been 1 month and he is still in hospital. In future, I expect hospital to take some preventive measures such that no else would suffer the way we are suffering now.
Looking forward to your answer.
Regards XXXXXXX
Brief Answer:
PLEASE UPLOAD RESULTS, MIGHT HELP
Detailed Answer:
Dear XXXXXXX
I respect your honest and XXXXXXX question, and it makes sense to me.
You are right about one thing.
The BP cannot be 200 / 110 overnight.
She would be having raised BP from atleast the past 1 - 2 weeks, if not more.
How long back was she having the swelling on the body and legs and tummy ?
Also, it is naturally understood that the reading taken at 12.30 PM cannot be 120 / 80, it is next to impossible.
Why was your wife admitted between 34 - 36 weeks and why was the BP checked 4 times a day if PIH was not already suspected ?
Furthermore, there are some blood tests which are pointers to this condition - reduced platelet counts, raised uric acid and LDH levels, raised Serum Creatinine levels etc.
In general, if these parameters were altered, it cannot have happened overnight for sure.
It cannot tell you WHEN the change started, but it can prove that it was not overnight.
Please upload the test results done so far, I might be able to go through them and give you some pointers.
IN almost all centres, due to paucity of trained Specialists, the nursing staff measures the BP, they are trained to do it.
Probably they took their job lightly or the machines were faulty, it is a distinct possibility.
WHat hospital did you deliver at ?
Can you upload other reports that mentioned the readings, the records during antenatal visits etc ?
Looking forward to hearing from you.
Take care.
PLEASE UPLOAD RESULTS, MIGHT HELP
Detailed Answer:
Dear XXXXXXX
I respect your honest and XXXXXXX question, and it makes sense to me.
You are right about one thing.
The BP cannot be 200 / 110 overnight.
She would be having raised BP from atleast the past 1 - 2 weeks, if not more.
How long back was she having the swelling on the body and legs and tummy ?
Also, it is naturally understood that the reading taken at 12.30 PM cannot be 120 / 80, it is next to impossible.
Why was your wife admitted between 34 - 36 weeks and why was the BP checked 4 times a day if PIH was not already suspected ?
Furthermore, there are some blood tests which are pointers to this condition - reduced platelet counts, raised uric acid and LDH levels, raised Serum Creatinine levels etc.
In general, if these parameters were altered, it cannot have happened overnight for sure.
It cannot tell you WHEN the change started, but it can prove that it was not overnight.
Please upload the test results done so far, I might be able to go through them and give you some pointers.
IN almost all centres, due to paucity of trained Specialists, the nursing staff measures the BP, they are trained to do it.
Probably they took their job lightly or the machines were faulty, it is a distinct possibility.
WHat hospital did you deliver at ?
Can you upload other reports that mentioned the readings, the records during antenatal visits etc ?
Looking forward to hearing from you.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr XXXXXXX
Sorry for the late reply. I had look gather the reports and scan them.
Actually there was no swelling on the legs / hands / face. That is we couldn't identify personally. Only the swell was there on stomach and we thought baby was growing fast. I do have all respect for the doctor at least on 26-Jul she identified there is problem (stomach swell) and didn't carried away with BP report by nurse which was 126/72.
At 34 wks, she got admitted because 1 day she had 4 loose motions and vomited twice. Just a precaution I did admit. They check it 4 times for admitted patient as a normal practice. Nothing special. Even they were doing NST every 4-6 hrs.
I did attach discharge cards which contains blood reports. If the report is legible please let me know. I will try better scan next time.
From the beginning until delivery the doctor and hospital is same. My personal feeling nurses might not be negligent. At 34wks, patient was not tagged as BP patient. Any nurse should have guts to highlight I see the reading high when all others are saying it is normal. They might consider people will look at me incompetent. At 36 wks, once patient tagged as BP patient everyone was saying the reading around 170/110mg.
I think BP Chart is good input for me. From 11-Jul to 14-Jul the weight has been increased by 2.x kgs which was not observed in rest of the visits. Do you think it as a good enough evidence?
Can you please go through reports and let me know any other supportive points. Looking forward to hear back from you.
Thanks for your all support.
Regards XXXXXXX
Sorry for the late reply. I had look gather the reports and scan them.
Actually there was no swelling on the legs / hands / face. That is we couldn't identify personally. Only the swell was there on stomach and we thought baby was growing fast. I do have all respect for the doctor at least on 26-Jul she identified there is problem (stomach swell) and didn't carried away with BP report by nurse which was 126/72.
At 34 wks, she got admitted because 1 day she had 4 loose motions and vomited twice. Just a precaution I did admit. They check it 4 times for admitted patient as a normal practice. Nothing special. Even they were doing NST every 4-6 hrs.
I did attach discharge cards which contains blood reports. If the report is legible please let me know. I will try better scan next time.
From the beginning until delivery the doctor and hospital is same. My personal feeling nurses might not be negligent. At 34wks, patient was not tagged as BP patient. Any nurse should have guts to highlight I see the reading high when all others are saying it is normal. They might consider people will look at me incompetent. At 36 wks, once patient tagged as BP patient everyone was saying the reading around 170/110mg.
I think BP Chart is good input for me. From 11-Jul to 14-Jul the weight has been increased by 2.x kgs which was not observed in rest of the visits. Do you think it as a good enough evidence?
Can you please go through reports and let me know any other supportive points. Looking forward to hear back from you.
Thanks for your all support.
Regards XXXXXXX
Brief Answer:
POINTS TO CONSIDER.
Detailed Answer:
I have gone through the reports.
What I consider good strong points to consider are -
1. The disparity in BP records at 12.30 and then at 12.45.
2. The drastic weight gain, which clearly indicates swelling which should have been picked up.
3. THe baby weight is only 1.6 at birth, very very less for 36 weeks, this growth restriction should also have been definitively observed and acted upon.
4. Did the same doctor check her everytime ?
5. Urine albumin on admission was 3 +, which again indicates that such severe hypertension cannot occur overnight.
6. Why was she given tablet Gardinal after the surgery ?
Take care.
POINTS TO CONSIDER.
Detailed Answer:
I have gone through the reports.
What I consider good strong points to consider are -
1. The disparity in BP records at 12.30 and then at 12.45.
2. The drastic weight gain, which clearly indicates swelling which should have been picked up.
3. THe baby weight is only 1.6 at birth, very very less for 36 weeks, this growth restriction should also have been definitively observed and acted upon.
4. Did the same doctor check her everytime ?
5. Urine albumin on admission was 3 +, which again indicates that such severe hypertension cannot occur overnight.
6. Why was she given tablet Gardinal after the surgery ?
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr XXXXXXX
Thanks for your time. I know I'm writing big stories. Idea is to give decent picture such that you can guide me.
1. Swelling picked up but only to stomach (not legs / hands). My wife used to literally struggle with her stomach. The problem was we were thinking Baby growth has really picked up in 9 month (after 34 wks). We didn't know it was swell :-( .She used to cry a lot in last 2 weeks (34-36 wks). Actually looking at her struggle I requested doctor once to do C-Section. But Dr. didn't recommend as nothing alarming. She mentioned all discomforts in 9 month are very common to 90% of women and you (my wife) have to show patience. Infact at 35wks, i asked couple of Jr. Drs. will the stomach like this. They mentioned it is natural. It was just beginning at that time.
2. From Urine Albumin - 3+ can we derive any duration (how long) rather than saying it is not overnight (out of curiosity) ?
3. Baby weight during 34 weeks sonography (discharge card of 34 wks) came out as ~2kgs. I feel that after 34 - 36 wks baby started reducing weight. His intensine growth was compromised and got infection. I think just because there is no enough blood supply / oxygen in the last 2 weeks the intensine started lessening which initiated the infection (i guess). Again this is hypothesis at my level. Not sure how to prove this.
4. What is Gardinal, I don't know it will be used for what problem. After surgery at 4PM, BP came down to normal. But after 7PM it picked up to 170/110 mg again. She was in special care for almost 3 days. Even I was allowed after 2 days. It has been 5 wks after surgery now and even now she is under BP medication.
5. The Doctor is same for the last 2 yrs and I have lot of respect towards her.
In Mar-2011, my wife had severe PIH at 6 month (26 weeks) and they had to terminate the baby. After termination, I have visited lot of doctors in XXXXXXX and spent more than 50k for lab tests but no one could give me single problem. One doctor didn't even spend 2 mins even after test results. It is pure commercial hospital. Finally I found one doctor who at least was talking to us. Again in Oct-2013, she had miscarriage after 7 weeks of pregnancy. She couldn't give me root cause. I lost trust on Doctors and started feeling everything is commercial. Sorry to say this.
During that time I moved to XXXXXXX and one of my close friend recommended this Doctor. She also started with lot of tests (around 30k). I thought the cycle started again :-) But there were three problems she identified. TNF Serum was one of them. I was really happy to see a problem identified. She doesn't talk much but she listens and explains. Even during pregnancy, there were panic times. It was very difficult time for both us (mywife and myself). She got admitted 4 times to the hospital including delivery. Doctor identified root causes very fast. Even after post surgery, I came to know that Doctor tried giving her special care even on Sunday she stayed in hospital to be near by. For my wife, she is like Demigod. When she lost confidence she used to say, God is there + Doctor is there + and I'm there to support. Unfortunately Doctor didn't do surgery as she got planned event. But she is back within 1 day cutting short her plan and stayed in hospital only.
Doctor is very good and professional. I never felt she is commercial and I don't have complaint with her. From 34-36 wks, she didn't get opportunity to see my wife's stomach. I guess it has been written that we have go through this.
Sorry to bore you with complete history.
Regards XXXXXXX
Thanks for your time. I know I'm writing big stories. Idea is to give decent picture such that you can guide me.
1. Swelling picked up but only to stomach (not legs / hands). My wife used to literally struggle with her stomach. The problem was we were thinking Baby growth has really picked up in 9 month (after 34 wks). We didn't know it was swell :-( .She used to cry a lot in last 2 weeks (34-36 wks). Actually looking at her struggle I requested doctor once to do C-Section. But Dr. didn't recommend as nothing alarming. She mentioned all discomforts in 9 month are very common to 90% of women and you (my wife) have to show patience. Infact at 35wks, i asked couple of Jr. Drs. will the stomach like this. They mentioned it is natural. It was just beginning at that time.
2. From Urine Albumin - 3+ can we derive any duration (how long) rather than saying it is not overnight (out of curiosity) ?
3. Baby weight during 34 weeks sonography (discharge card of 34 wks) came out as ~2kgs. I feel that after 34 - 36 wks baby started reducing weight. His intensine growth was compromised and got infection. I think just because there is no enough blood supply / oxygen in the last 2 weeks the intensine started lessening which initiated the infection (i guess). Again this is hypothesis at my level. Not sure how to prove this.
4. What is Gardinal, I don't know it will be used for what problem. After surgery at 4PM, BP came down to normal. But after 7PM it picked up to 170/110 mg again. She was in special care for almost 3 days. Even I was allowed after 2 days. It has been 5 wks after surgery now and even now she is under BP medication.
5. The Doctor is same for the last 2 yrs and I have lot of respect towards her.
In Mar-2011, my wife had severe PIH at 6 month (26 weeks) and they had to terminate the baby. After termination, I have visited lot of doctors in XXXXXXX and spent more than 50k for lab tests but no one could give me single problem. One doctor didn't even spend 2 mins even after test results. It is pure commercial hospital. Finally I found one doctor who at least was talking to us. Again in Oct-2013, she had miscarriage after 7 weeks of pregnancy. She couldn't give me root cause. I lost trust on Doctors and started feeling everything is commercial. Sorry to say this.
During that time I moved to XXXXXXX and one of my close friend recommended this Doctor. She also started with lot of tests (around 30k). I thought the cycle started again :-) But there were three problems she identified. TNF Serum was one of them. I was really happy to see a problem identified. She doesn't talk much but she listens and explains. Even during pregnancy, there were panic times. It was very difficult time for both us (mywife and myself). She got admitted 4 times to the hospital including delivery. Doctor identified root causes very fast. Even after post surgery, I came to know that Doctor tried giving her special care even on Sunday she stayed in hospital to be near by. For my wife, she is like Demigod. When she lost confidence she used to say, God is there + Doctor is there + and I'm there to support. Unfortunately Doctor didn't do surgery as she got planned event. But she is back within 1 day cutting short her plan and stayed in hospital only.
Doctor is very good and professional. I never felt she is commercial and I don't have complaint with her. From 34-36 wks, she didn't get opportunity to see my wife's stomach. I guess it has been written that we have go through this.
Sorry to bore you with complete history.
Regards XXXXXXX
Brief Answer:
SOME MORE THOUGHTS.
Detailed Answer:
Urine albumin + 3 indicates atleast a few days' worth of PIH, again, it cannot be used to predict exact onset.
One test that could have helped you is the Fundus examination.
This is the examination of the back of the eye.
Stage of changes in the eye reflect how long back BP was raised, but it should have been done on admission, if it is done now, it again is useless, as the pregnancy changes would have reverted by now.
Baby growth was compromised due to raised BP, no doubt about it, this weight itself is a strong evidence that the baby had chronic insult and reduction in blood supply due to the raised BP.
Gardinal is given to prevent seizures ( convulsions ), it indicates that your wife had extremely elevated BP, and they were afraid of seizures because of that, so it was started.
I am happy that you have faith in the doctors and the nurses, but all said and done, this high BP and the severe growth restriction in the baby should definitely have been picked up.
Weekly check ups are recommended in the third trimester for such a high risk patient.
Was urine albumin done before this ?
SOME MORE THOUGHTS.
Detailed Answer:
Urine albumin + 3 indicates atleast a few days' worth of PIH, again, it cannot be used to predict exact onset.
One test that could have helped you is the Fundus examination.
This is the examination of the back of the eye.
Stage of changes in the eye reflect how long back BP was raised, but it should have been done on admission, if it is done now, it again is useless, as the pregnancy changes would have reverted by now.
Baby growth was compromised due to raised BP, no doubt about it, this weight itself is a strong evidence that the baby had chronic insult and reduction in blood supply due to the raised BP.
Gardinal is given to prevent seizures ( convulsions ), it indicates that your wife had extremely elevated BP, and they were afraid of seizures because of that, so it was started.
I am happy that you have faith in the doctors and the nurses, but all said and done, this high BP and the severe growth restriction in the baby should definitely have been picked up.
Weekly check ups are recommended in the third trimester for such a high risk patient.
Was urine albumin done before this ?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. XXXXXXX
1. Urine Albumin was not done before. It was done only during 36wks (26-Jul) when she identified with BP. BP reading of 160/110 mg and lab test reports are of the same day.
2. We didn't do Fundus. My wife mentioned she has vision blurriness very slightly but she didn't stress on that as she was going through other bigger problems.
3. Gardinal they must given. It was panic for the hospital team for couple of hrs when she got admitted. Even post surgery Dr. kept her under close observation with special care as BP was not coming down. Dr. herself staying in hospital for one night shows it was very critical case. After BP identifications, the reactive actions are really good. To my unfortunate, they couldn't identify earlier such that they could have some proactive measures.
4. We used consult Dr. every week. There are times when we consulted twice in a week in the third trimester. Every alternate week we have done sonography. Unfortunately there was no alert any where.
I will come up with a report which would be given to hospital. Will you be able to help me in quick review.
Once again thanks for your time and support. You have provided me good pointers.
By the way can it be medico-legal case? What is your feeling on how would hospital react to my appeal of not paying my baby bill?
Regards XXXXXXX
1. Urine Albumin was not done before. It was done only during 36wks (26-Jul) when she identified with BP. BP reading of 160/110 mg and lab test reports are of the same day.
2. We didn't do Fundus. My wife mentioned she has vision blurriness very slightly but she didn't stress on that as she was going through other bigger problems.
3. Gardinal they must given. It was panic for the hospital team for couple of hrs when she got admitted. Even post surgery Dr. kept her under close observation with special care as BP was not coming down. Dr. herself staying in hospital for one night shows it was very critical case. After BP identifications, the reactive actions are really good. To my unfortunate, they couldn't identify earlier such that they could have some proactive measures.
4. We used consult Dr. every week. There are times when we consulted twice in a week in the third trimester. Every alternate week we have done sonography. Unfortunately there was no alert any where.
I will come up with a report which would be given to hospital. Will you be able to help me in quick review.
Once again thanks for your time and support. You have provided me good pointers.
By the way can it be medico-legal case? What is your feeling on how would hospital react to my appeal of not paying my baby bill?
Regards XXXXXXX
Brief Answer:
WOULD DEFINITELY REVIEW YOUR REPORT
Detailed Answer:
It is sad that fundus was not done.
A fundoscopy done on the day that the high reading was obtained would have told you for sure , a fairly good estimate, about how long the BP had been high.
You yourself said that between 34 - 36 weeks, the doctor was not able to examine her.
That is another big point - no doctor worth her salt would have missed the growth lag in the baby which was severe, over the 2 week span, particularly given her past history which is quite ominous.
I would definitely go through the report and help in reviewing it.
THank you for the appreciation, and I fully sympathize and empathize with your situation, I hope your baby is doing well now.
REgarding medico legal case, am not an expert on medico legal aspects, and the area is still shaky in XXXXXXX with many loopholes for escape.
Most corporate hospitals do not entertain such appeals, as they are quite well connected, and have various defence mechanisms ready.
However, please go ahead as your case is quite valid.
What hospital was it by the way, and have you discussed this with your doctor.
Since you have mentioned that she was so supportive and caring all throughout, she should ideally help you on this ?
WOULD DEFINITELY REVIEW YOUR REPORT
Detailed Answer:
It is sad that fundus was not done.
A fundoscopy done on the day that the high reading was obtained would have told you for sure , a fairly good estimate, about how long the BP had been high.
You yourself said that between 34 - 36 weeks, the doctor was not able to examine her.
That is another big point - no doctor worth her salt would have missed the growth lag in the baby which was severe, over the 2 week span, particularly given her past history which is quite ominous.
I would definitely go through the report and help in reviewing it.
THank you for the appreciation, and I fully sympathize and empathize with your situation, I hope your baby is doing well now.
REgarding medico legal case, am not an expert on medico legal aspects, and the area is still shaky in XXXXXXX with many loopholes for escape.
Most corporate hospitals do not entertain such appeals, as they are quite well connected, and have various defence mechanisms ready.
However, please go ahead as your case is quite valid.
What hospital was it by the way, and have you discussed this with your doctor.
Since you have mentioned that she was so supportive and caring all throughout, she should ideally help you on this ?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. XXXXXXX
I have uploaded the drafted complaint. Pasting the same below. Feel free to update the text and paste me back.
http://www.onphospital.com/
In 34-36 wks, Doctor spoke to XXXXXXX but never examined her physically. Last 2 physical checkups are on 14th and then 26th. In between there was one sonography. Apart from we might have met her 4-5 times where she used to talk.
I don't want Doctor to be in trouble because of us. She really helped us in tough times. However I will show this to her before submitting. Let me see how much she can do.
Thanks in advance.
Regards XXXXXXX
Complaint :
I VENKATA XXXXXXX XXXXXXX KOTTAKOTA ( husband of your patient : BAMMIDI XXXXXXX , ID No: 6GN122278 ) would like register a complaint on hospital BP check up process.
XXXXXXX was carrying and she completed 36 wks by 26-07-2014. On that day we visited hospital at around 12PM for ANC checkup as she was really uncomfortable. As per standard procedure in the hospital, staff nurse checked the BP and noted reading of 126/72 (please refer to attachment) at around 12-30 PM. Dr. XXXXXXX Sathe madam checked XXXXXXX and identified stomach swell and asked us to test PIH profile and 4 positions BP checkup at casualty.
We then went to casualty given blood and urine for lab tests. Then XXXXXXX went to 4 positions BP checkup. No body told me anything. After 30 mins, I started feeling some thing is happening. I went to Dr. Sathe madam and she told XXXXXXX BP is very high around 200/110 and she needs to be admitted immediately. I was really confused and shocked because just 30mins before I saw the reading and it was normal.
XXXXXXX got admitted around 1-30PM and as her BP was not coming under control Dr. Meenal told they have to do C-Section immediately as there was high risk to Mother and Baby. XXXXXXX delivered Baby boy at 3-28PM with weight of 1.6 kgs. Dr. Sunanya told me they are shifting the baby to NIC because of the low weight. Another shock to me that baby is underweight because on 16 / 17 th XXXXXXX underwent sonography scan and the report approx fetal weight is 1948 gms. I understand that there will be difference because of approx but I felt 300 gms difference is too much that after 1 week or 10 days.
After 3 days probably I met Dr. XXXXXXX and she mentioned the baby is having problem with intestine. Dr. XXXXXXX explained me that because Mother had high BP, the blood and oxygen supply to the baby is reduced. She mentioned typically in these cases the development of some organs will be compromised and in your baby case it has impacted intestine. And she even mentioned the baby development is more of 33-34 wks.
Then I started analysis what was wrong and where it went wrong. We had very regular checkups. The root cause of the problem was with BP readings. Now I don't know it is the machine / nurses who has taken reading. Irrespective of anything we got penalised.
When I looked the BP Chart (please refer to attachment) on 11-07-2014 the BP reading was 148/70 and weight was 62. And on 14-07-2014 the BP reading was 130/80 and weight was 64. The weight growth was normal as expected in the complete chart except this time. It clearly indicates that XXXXXXX got BP around 11-07-2014. Another support evidence is baby weight was also around 33-34 wks. On 11th she completed 34 wks. Even Urine Ab 3+ shows that it is not instant and the BP is there from some days. Last 2 weeks she expressed her discomfort many times with various doctors especially during admission. Every one told us you can't be so sensitive. On 21-07-2014, she even requested Dr, Sathe madam to do C-Section on that day itself because of XXXXXXX discomfort.
I don't have any problem with Dr. XXXXXXX Sathe. Madam denied C-Section on 21-07-2014 referring to our baby wellness. She has given really full support through out pregnancy tenure. There has been really tough times where she helped us to over come them. Madam has really accommodated us with lot of patience in multiple instances. The BP readings provided to her never gave any alert and mislead her. Last 4 yrs we met many doctors. She is one of most admiring Doctor for us. For XXXXXXX Dr. Sathe is almost demigod.
Just before 10 days of the surgery, XXXXXXX got admitted into the hospital on 15-07-2014 and discharged on 18-07-2014. I feel sad that no one did highlight the problem which could have been controlled. XXXXXXX has complained severe upper abdomen pain and suffered a lot. One of the Dr. has checked at night 11-30PM and it was ruled as Gastric problem.Discharge card (on 18-07-2014) recorded that BP was 110/80 mm Hg. Unfortunately post surgery on the discharge day BP was never below 150/110 even after full medication. But the post surgery discharge card says it 110/70mmHg. After couple days we had been to Dr. XXXXXXX Pai and he recorded the reading at 170/100 and changed the medication as previous medicine was not working as expected. It clearly show that BP recordings are not correct even during hospitilization. This is probably a casual approach.
It was very very precious pregnancy for us. We had 2 misfortunes one in Mar-2011 and Oct-2012. Baby suffered more than 1 month only because of mother high BP (severe PIH). To XXXXXXX and myself we had enough mental torture which can't be quantified. We are helpless when we see baby.
There are multiple evidences to support the BP recording by nurses is absolutely wrong which lead to mother severe PIH. Otherwise BP could have been controlled and I would have had definitely better results. As a reactive measure at least I would like hospital to take moral responsibility and waive off my baby complete XXXXXXX And please take some proactive measure such that it is not repeated any other couple.
I have uploaded the drafted complaint. Pasting the same below. Feel free to update the text and paste me back.
http://www.onphospital.com/
In 34-36 wks, Doctor spoke to XXXXXXX but never examined her physically. Last 2 physical checkups are on 14th and then 26th. In between there was one sonography. Apart from we might have met her 4-5 times where she used to talk.
I don't want Doctor to be in trouble because of us. She really helped us in tough times. However I will show this to her before submitting. Let me see how much she can do.
Thanks in advance.
Regards XXXXXXX
Complaint :
I VENKATA XXXXXXX XXXXXXX KOTTAKOTA ( husband of your patient : BAMMIDI XXXXXXX , ID No: 6GN122278 ) would like register a complaint on hospital BP check up process.
XXXXXXX was carrying and she completed 36 wks by 26-07-2014. On that day we visited hospital at around 12PM for ANC checkup as she was really uncomfortable. As per standard procedure in the hospital, staff nurse checked the BP and noted reading of 126/72 (please refer to attachment) at around 12-30 PM. Dr. XXXXXXX Sathe madam checked XXXXXXX and identified stomach swell and asked us to test PIH profile and 4 positions BP checkup at casualty.
We then went to casualty given blood and urine for lab tests. Then XXXXXXX went to 4 positions BP checkup. No body told me anything. After 30 mins, I started feeling some thing is happening. I went to Dr. Sathe madam and she told XXXXXXX BP is very high around 200/110 and she needs to be admitted immediately. I was really confused and shocked because just 30mins before I saw the reading and it was normal.
XXXXXXX got admitted around 1-30PM and as her BP was not coming under control Dr. Meenal told they have to do C-Section immediately as there was high risk to Mother and Baby. XXXXXXX delivered Baby boy at 3-28PM with weight of 1.6 kgs. Dr. Sunanya told me they are shifting the baby to NIC because of the low weight. Another shock to me that baby is underweight because on 16 / 17 th XXXXXXX underwent sonography scan and the report approx fetal weight is 1948 gms. I understand that there will be difference because of approx but I felt 300 gms difference is too much that after 1 week or 10 days.
After 3 days probably I met Dr. XXXXXXX and she mentioned the baby is having problem with intestine. Dr. XXXXXXX explained me that because Mother had high BP, the blood and oxygen supply to the baby is reduced. She mentioned typically in these cases the development of some organs will be compromised and in your baby case it has impacted intestine. And she even mentioned the baby development is more of 33-34 wks.
Then I started analysis what was wrong and where it went wrong. We had very regular checkups. The root cause of the problem was with BP readings. Now I don't know it is the machine / nurses who has taken reading. Irrespective of anything we got penalised.
When I looked the BP Chart (please refer to attachment) on 11-07-2014 the BP reading was 148/70 and weight was 62. And on 14-07-2014 the BP reading was 130/80 and weight was 64. The weight growth was normal as expected in the complete chart except this time. It clearly indicates that XXXXXXX got BP around 11-07-2014. Another support evidence is baby weight was also around 33-34 wks. On 11th she completed 34 wks. Even Urine Ab 3+ shows that it is not instant and the BP is there from some days. Last 2 weeks she expressed her discomfort many times with various doctors especially during admission. Every one told us you can't be so sensitive. On 21-07-2014, she even requested Dr, Sathe madam to do C-Section on that day itself because of XXXXXXX discomfort.
I don't have any problem with Dr. XXXXXXX Sathe. Madam denied C-Section on 21-07-2014 referring to our baby wellness. She has given really full support through out pregnancy tenure. There has been really tough times where she helped us to over come them. Madam has really accommodated us with lot of patience in multiple instances. The BP readings provided to her never gave any alert and mislead her. Last 4 yrs we met many doctors. She is one of most admiring Doctor for us. For XXXXXXX Dr. Sathe is almost demigod.
Just before 10 days of the surgery, XXXXXXX got admitted into the hospital on 15-07-2014 and discharged on 18-07-2014. I feel sad that no one did highlight the problem which could have been controlled. XXXXXXX has complained severe upper abdomen pain and suffered a lot. One of the Dr. has checked at night 11-30PM and it was ruled as Gastric problem.Discharge card (on 18-07-2014) recorded that BP was 110/80 mm Hg. Unfortunately post surgery on the discharge day BP was never below 150/110 even after full medication. But the post surgery discharge card says it 110/70mmHg. After couple days we had been to Dr. XXXXXXX Pai and he recorded the reading at 170/100 and changed the medication as previous medicine was not working as expected. It clearly show that BP recordings are not correct even during hospitilization. This is probably a casual approach.
It was very very precious pregnancy for us. We had 2 misfortunes one in Mar-2011 and Oct-2012. Baby suffered more than 1 month only because of mother high BP (severe PIH). To XXXXXXX and myself we had enough mental torture which can't be quantified. We are helpless when we see baby.
There are multiple evidences to support the BP recording by nurses is absolutely wrong which lead to mother severe PIH. Otherwise BP could have been controlled and I would have had definitely better results. As a reactive measure at least I would like hospital to take moral responsibility and waive off my baby complete XXXXXXX And please take some proactive measure such that it is not repeated any other couple.
Brief Answer:
AS BELOW
Detailed Answer:
I think you have highlighted relevant points.
Just stress on the fact that the baby had such a long NICU stay because the problem was not identified earlier.
The baby suffered growth restriction, instead of proper weight gain, between 34 - 36 weeks, and decreased blood flow to vital organs because of maternal hypertension.
If it had been properly identified and treated in time, this could have been averted.
I still do not understand how a doctor failed to check your wife between 34 - 36 weeks which were critical for her, just talking cannot identify swelling or hypertension or lag in fetal growth.
It is a very important point.
AS BELOW
Detailed Answer:
I think you have highlighted relevant points.
Just stress on the fact that the baby had such a long NICU stay because the problem was not identified earlier.
The baby suffered growth restriction, instead of proper weight gain, between 34 - 36 weeks, and decreased blood flow to vital organs because of maternal hypertension.
If it had been properly identified and treated in time, this could have been averted.
I still do not understand how a doctor failed to check your wife between 34 - 36 weeks which were critical for her, just talking cannot identify swelling or hypertension or lag in fetal growth.
It is a very important point.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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