Commonly missed or mishandled risks

Families whose prenatal warning signs were overlooked, delayed, or downplayed which can lead to complications such as preterm birth, preeclampsia/eclampsia, placental abruption, fetal distress, birth asphyxia, shoulder dystocia injuries, or NICU admissions.

Further risks:

• Preeclampsia/gestational hypertension
• Gestational diabetes or poorly controlled diabetes
• Intrauterine growth restriction (IUGR) or size discordance in multiples
• Placenta previa/accreta, vasa previa
• Advanced maternal age, prior C-section, VBAC risks
• Infections (GBS, UTIs, chorioamnionitis), Rh incompatibility
• Reduced fetal movements or non-reassuring testing

Standard of care (what should have happened)

Providers must recognize red flags, order appropriate tests, and escalate care. That typically includes:

• Risk assessment at intake and each prenatal visit
• Timely diagnostics: blood pressure and urine protein checks; glucose screening; targeted ultrasounds; fetal growth and amniotic fluid assessments; NST/BPP for non-reassuring concerns
• Clear action plans: maternal-fetal medicine referral, medication (e.g., antihypertensives, magnesium sulfate, steroids), earlier delivery when indicated
• Documented counseling on warning signs and when to seek urgent care

When these steps are skipped, delayed, or poorly communicated, preventable harm can follow.

When red flags are missed (why it gets missed)

• Inadequate risk re-assessment at follow-up visits (e.g., rising BP/proteinuria or growth lag not acted on).
• Test/result follow-up gaps (abnormal glucose screen without timely management; non-reassuring NST/BPP without escalation).
• Misinterpretation or delayed response to evolving symptoms/vitals (headache, visual changes, RUQ pain, decreased fetal movement).
• Breakdowns in handoffs and documentation—a persistent driver in malpractice exposure.
• Access/coverage gaps (fewer starting prenatal care early), increasing the chance risks go undetected.

Signs a high-risk pregnancy may have been missed

• Repeatedly elevated blood pressures or severe headaches dismissed as “normal”
• Swelling with vision changes, right-upper-quadrant pain, or brisk reflexes not evaluated
• Abnormal glucose tests without diet, medication, or monitoring
• Fundal height lagging or ultrasound showing poor growth without repeat studies
• Decreased fetal movement without NST/BPP or labor evaluation
• Placenta previa on mid-pregnancy ultrasound not re-checked or planned for delivery
• Late, rushed, or absent referrals to maternal-fetal medicine