Preeclampsia and Eclampsia Misdiagnosis in Georgia: When Pregnancy Complications are Ignored

Many families later find a set of entries like these from a single 34-week prenatal visit. A pounding headache for two days, charted as migraine. Swelling in the face and hands, charted as normal for the third trimester. A blood pressure of 148/96, charted as “patient anxious,” with no repeat. Pain under the right ribs, charted as reflux. Each entry looks harmless on its own. Read together, they describe the classic setup for preeclampsia misdiagnosis.

Every warning sign in that visit reached the chart, and each one got a harmless name. A malpractice claim in a case like this turns on proving that renaming, and on showing that a reasonably careful provider would have read the same entries differently. The mother did not fail to say the right thing. Recognizing a warning sign is the provider’s job.

Preeclampsia is a blood pressure disorder that can turn severe within hours

ACOG’s criteria for hypertension in pregnancy set the line at 140/90. Two readings at or above that level, taken at least four hours apart after 20 weeks of pregnancy, meet the definition of preeclampsia when they come with protein in the urine or signs that organs are under strain.

ACOG no longer sorts the condition into mild and severe. It now describes preeclampsia with or without severe features, and severe-range blood pressure begins at 160/110. From there, the disease can move along a spectrum toward eclampsia, which means seizures, or HELLP syndrome, which attacks the blood and the liver. The placenta drives the disorder, so delivering it is the only cure. ACOG estimates that preeclampsia complicates 2 to 8 percent of pregnancies worldwide. In a chart, a high reading should be followed by a repeat reading, a urine protein result, and a documented plan.

Hours matter because the disease does not wait for the next appointment.

Most preeclampsia misdiagnosis is a renaming problem, not a blindness problem

Preeclampsia can be misdiagnosed, and it usually happens in plain sight. The headache, the swelling, and the high reading get written down. Then each is attributed to something benign, so nobody orders the repeat check or the labs that would have confirmed what was happening.

We know that pattern from other kinds of cases. Davis Adams resolved a $2,500,000 settlement after a child with signs alarmingly consistent with diabetic ketoacidosis was discharged home. We also resolved a $3,250,000 settlement after an ER physician appeared unconcerned by a young mother’s abnormal vital signs. Neither case involved preeclampsia, and past results do not guarantee future outcomes. What those cases share with this one is a symptom that was recorded and then explained away.

A headache becomes migraine and sudden swelling becomes normal pregnancy

A note reading “HA x2 days, hx migraines, Tylenol” can close the most important question in the visit. ACOG lists a new headache that does not respond to medication and has no other explanation as a severe feature. Blurred vision or spots get charted as eye strain. Swelling in the face and hands, or several pounds gained in a week, gets filed under ordinary late-pregnancy changes. A high reading gets blamed on nerves. When a family later says the OB/GYN ignored high blood pressure and protein in urine during pregnancy, the chart often shows the provider saw both and gave each a reason that required no follow-up.

Pain under the right ribs gets written off as heartburn or gallbladder

Triage note: “epigastric pain, worse after eating, likely GERD.” Pain in the upper middle abdomen or under the right ribs is a recognized sign of liver involvement in preeclampsia. It also overlaps with reflux and gallbladder trouble, both common late in pregnancy. Nausea and vomiting in the third trimester get treated as a stomach virus. That same pain is often the first clue to HELLP syndrome, the variant most likely to slip past a blood pressure cuff.

One reading, no repeat, no labs

Some misses come from what never happened in the exam room or on the phone. When we review a prenatal chart, these gaps show up again and again:

• An elevated reading dismissed as white coat hypertension, with no recheck
• Urine not tested for protein at a routine visit
• No repeat blood pressure four hours after a high reading
• No platelet count, liver enzyme panel, or creatinine ordered
• A phone triage call where a woman with a headache is told to lie down and rest
• Home readings the patient reported that never made it into the chart

White coat hypertension is a real phenomenon. It is also a label that gets reached for too quickly, because a repeat reading takes only minutes.

HELLP syndrome can damage the liver and platelets before blood pressure looks alarming

A normal blood pressure reading does not rule out HELLP, and that is the trap.

HELLP stands for hemolysis, elevated liver enzymes, and low platelets. In plain terms, red blood cells are breaking apart, the liver is being injured, and the blood is losing its ability to clot. ACOG uses a platelet count below 100,000 as one marker, along with liver enzymes at twice the normal upper limit. The Preeclampsia Foundation’s overview of HELLP syndrome notes that it can appear without the dramatic blood pressure numbers that usually prompt concern. That is why right-rib pain charted as reflux carries so much weight when we review these records.

When HELLP syndrome is missed, the injury can reach the liver itself. Bleeding beneath the liver’s surface, rupture, liver failure, and kidney injury are recognized complications. A family searching because a mother suffered liver failure after HELLP was missed usually has one question for the record. Were labs ordered on the day she reported the pain?

After delivery, the danger window stays open for about six weeks

Here is an illustrative sequence. A mother is discharged on day two after an uncomplicated delivery. On day five, she arrives at a different hospital’s emergency department with a headache and some trouble catching her breath. The triage note reads “headache, history of migraine.” It does not record that she gave birth five days earlier. She goes home with migraine medication and a follow-up recommendation.

Preeclampsia does not always end with delivery. The Mayo Clinic describes postpartum preeclampsia as usually developing within 48 hours of birth, though it can appear up to six weeks later. The failure points repeat from case to case. Discharge instructions may never name the warning signs. An ER physician may never ask about a recent delivery. A headache or shortness of breath may be treated as a standalone complaint with no link to the pregnancy.

Information gets lost between facilities, and emergency room malpractice claims in this setting often start with one missing question on the triage form: when did she give birth? Whether the answer would have changed the workup is something the records and a qualified expert can address.

Higher risk should mean a closer watch, and the checkpoints are well defined

Page one of a prenatal chart often lists the risks: a first pregnancy, chronic hypertension, sometimes twins. Those entries set the bar for every visit that follows. Georgia law measures care by the standard of care, which means what a reasonably careful provider would have done with the same information.

For a pregnancy at risk of preeclampsia, guidelines expect providers to check blood pressure at every visit and to test urine for protein. When preeclampsia is suspected, they expect labs, including a platelet count, liver enzymes, and creatinine to measure kidney function. A chart with a high-risk label followed by routine-visit-only care is the kind of pattern an expert reviewer reads closely.

First pregnancy, chronic hypertension, and other flags that raise the bar

Recognized risk factors include a first pregnancy, chronic hypertension, diabetes, kidney disease, a multiple pregnancy, prior preeclampsia, and age at either end of the reproductive range. The U.S. Preventive Services Task Force also identifies Black patients as facing higher risk, a gap it ties to social and structural factors rather than biology. The Task Force recommends low-dose aspirin after 12 weeks for patients at high risk. An expert may look at whether the chart shows the risk was identified and aspirin was addressed. A missing note does not prove negligence by itself, since the conversation may have happened and gone undocumented.

Severe-range readings start a clock on admission, medication, and delivery

The two time stamps that matter most are the first severe-range reading and the decision to deliver. A chart might show a 164/112 in labor and delivery triage late at night. The delivery order might not appear until the next afternoon.

Under ACOG guidance, a severe-range reading confirmed on repeat calls for prompt treatment with blood pressure medication, typically in the hospital. Magnesium sulfate is the guideline medication for seizure prevention in preeclampsia with severe features. Corticosteroids are recommended when delivery before 34 weeks is anticipated. On timing, ACOG calls for delivery at 37 weeks when there are no severe features. With severe features at or beyond 34 weeks, it calls for delivery once the mother is stabilized. Once eclampsia occurs, delivery follows stabilization regardless of how far along the pregnancy is.

Severe features before 34 weeks are where clinical judgment widens. ACOG allows continued monitoring in some of those pregnancies at facilities equipped for it, so a delay is not automatically a breach. When preeclampsia progressed to eclampsia seizures because of delayed delivery, families tend to focus on the day of the seizure. The record usually points to the day before.

Whether earlier delivery would likely have changed the outcome is the question an OB or maternal-fetal medicine expert answers.

Mother and baby can both be injured, and each may have a claim for different losses

For the mother, the injuries track the disease. Eclamptic seizures, stroke, liver rupture, and kidney failure are all documented complications. So is placental abruption, where the placenta separates from the uterine wall before delivery. Some mothers recover fully. Others live with one plain consequence, such as weakness on one side after a stroke. In the worst cases, a mother dies.

For the baby, the harm usually comes through the placenta. A struggling placenta can restrict growth over weeks. An abruption or a delayed delivery can cut off oxygen and cause hypoxic-ischemic encephalopathy (HIE), a brain injury that often leads to cerebral palsy. A rushed early delivery brings the risks of prematurity, and some pregnancies end in stillbirth. Injuries like these can form the basis of a birth injury claim brought on the child’s behalf.

Compensation follows documented needs. For the mother, that can mean medical bills, lost income, and pain and suffering. For a child, the largest category is often future care: therapy, equipment, home modifications, and attendant care across a lifetime. Estimates compiled by Cerebral Palsy Guidance put lifetime care for cerebral palsy above $1 million. Life-care planners and economists translate those needs into numbers, which is why average settlement figures tell a family almost nothing about their own case.

Time stamps decide these cases more than anyone’s memory

In an infective endocarditis matter we handled in Atlanta, a woman’s fevers spanned several weeks before anyone identified the cause. The experts we consulted named the specific tests that were never ordered: blood cultures and an echocardiogram. Preeclampsia records get read the same way. An OB expert can point to the platelet count that was never drawn or the repeat reading that never happened.

The records that matter most are prenatal visit notes, blood pressure flowsheets, and urine and lab results with their order times. Triage notes, phone messages, and patient portal threads show what was reported between visits. Fetal monitoring strips and growth ultrasounds show how the baby was doing. Discharge instructions show what the mother was told to watch for. The most telling comparison is often the time of the first severe reading set against the time of the delivery decision.

A lawyer can request and organize these records, then work with qualified experts to evaluate whether the standard of care was met.

Families often worry about whether they complained enough. That energy is better spent saving what already exists, much of it on a phone or in a kitchen drawer:

• Home blood pressure logs, including handwritten notes and app readings
• Screenshots of patient portal messages and the replies
• A written timeline of what was reported, what was said back, and the date of each

A family may remember “they said it was normal.” The record tells us who said it, when, and what was in front of them.

No Georgia case can be filed until an OB expert swears the care fell short

Georgia puts a sworn expert opinion at the front of every medical malpractice case. Under O.C.G.A. § 9-11-9.1, the complaint must be filed with an affidavit from a qualified expert that identifies at least one negligent act or omission. Georgia generally requires that expert to practice or teach in the same specialty as the provider being sued. In a preeclampsia case, that usually means an OB/GYN or a maternal-fetal medicine physician.

For a family, this means the expert review comes first. Records have to be gathered and read by the right specialist before anything is filed, and that is a barrier families cannot clear alone. The requirement also works as a filter. If a qualified obstetric expert reads the chart and concludes the care was reasonable, everyone learns that before a case begins. The mother’s claim and the baby’s claim may also follow different deadlines.

When a mother dies, Georgia law decides who may bring the claim

In a wrongful death case Davis Adams helped try in Jefferson County, the defense offered $0 to settle before trial. The jury returned a $10,000,000 verdict in June 2013, a record for that county. Past results do not guarantee future outcomes, and that case did not involve preeclampsia. It does show that a defendant’s position before trial is not the final word.

If a mother dies from preeclampsia, eclampsia, or HELLP complications, Georgia law sets the order of who may bring a wrongful death claim. Under O.C.G.A. § 51-4-2 and related sections, the right belongs first to a surviving spouse, who shares the recovery with any children, then to the children, then to the parents. Georgia measures the claim by the full value of the life of the person who died, including the economic and the intangible parts of the life she would have lived.

Georgia has specific rules for claims involving a stillborn child, and whether one applies depends on the facts of the pregnancy.

Some of these cases are hard to prove, and the reasons are specific

Not every bad outcome is malpractice, and a qualified expert will say so when the facts point that way. Defense lawyers in these cases tend to press three questions.

Would earlier delivery have changed anything? In early-onset cases, delivering sooner can mean a baby born at the edge of viability. When the alternative was extreme prematurity, causation is genuinely contested, and an expert may conclude the outcome would likely have been the same.

Did the chart show reasoning? A provider who documented why a reading was rechecked later, or why monitoring continued instead of delivery, may have exercised the kind of judgment the law protects, even when the result was terrible.

Was the presentation typical? Preeclampsia without protein in the urine, or HELLP without marked hypertension, gives the defense room to argue the signs were not there to read.

Other facts strengthen a claim. Experts point to a severe-range reading with no documented response, labs never ordered after right-rib pain was reported, and a delivery decision that came hours or days after the guideline trigger. We would rather tell a family early which side of that line their records fall on.

What Georgia families ask after a pregnancy complication was missed

These are the questions we hear most often from Georgia families trying to make sense of a preeclampsia, eclampsia, or HELLP complication.

How much can you sue for wrongful pregnancy?

Wrongful pregnancy is usually a different claim, one about an unwanted pregnancy after something like a failed sterilization. It is not the claim for a missed preeclampsia diagnosis, where value depends on the injuries, future care needs, and what the records prove.

Can you sue for malpractice for misdiagnosis?

Yes, when a provider fell below what a reasonably careful provider would have done and that failure caused harm. The law calls those pieces duty, breach, causation, and damages, and Georgia requires the expert affidavit before filing. Not every missed diagnosis meets that test.

How long can you sue for medical malpractice in GA?

Georgia generally allows two years from the date of injury. Under O.C.G.A. § 9-3-71, there is also an outer limit of five years from the negligent act. Different rules may apply to a child’s claim or a wrongful death claim, and exceptions may apply, so a lawyer can review the dates in your situation.

Does the baby have a separate claim from the mother?

Often, yes. The baby may have a claim for the baby’s own injuries, with different damages and possibly a different deadline, and an attorney can confirm how the claims apply to your facts.

Is preeclampsia the same as gestational hypertension?

No. ACOG defines gestational hypertension as high blood pressure after 20 weeks without protein in the urine or signs of organ involvement, and it can progress to preeclampsia.

Can a hospital or nurse be responsible, not just the OB?

Sometimes. Nurses, triage staff, ER physicians, and hospitals may share responsibility alongside the obstetrician. Hospitals may be responsible for employee negligence in some situations, and liability depends on contracts and facts.

If your warning signs were written down and then explained away

What you reported, what got written, and what happened next is exactly what a review examines. You may still be replaying those visits and wondering whether you said enough. The chart can answer what memory cannot. Davis Adams offers a free evaluation, and many cases are handled on a contingency-fee basis, with terms and expenses outlined in the fee agreement.

If you’d like help understanding what your records show, you can request a confidential consultation. We’re here to talk.

This article is for general informational purposes only and is not legal advice. Every case depends on its own facts, medical records, and expert review. Reading this page does not create an attorney-client relationship.