Lisbon Hospital
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Death of pregnant woman in Lisbon “points to poor clinical practice”

Yet another case where Portuguese health service appears to have failed

Following on from the recent death of a baby in Portimão Hospital, and the suspension of two surgeons in Faro for alleged malpractice involving three deaths and eight seriously impacted patient outcomes, another tragedy in the Portuguese State health service has seen investigators conclude that there may well have been poor clinical practice.

The conclusion of a report by IGAS – the general inspectorate of health – into the death of a pregnant young Indian woman during transfer from one hospital to another has been passed on to the Public Prosecutor’s Office “because there is suspicion of evidence of a crime”, explains SIC Notícias today.

This was the case that proved the ‘final straw’ for former health minister Marta Temido. She said she felt no alternative, in the context of rising issues in the health service, but to resign.

The 34-year-old Indian woman had entered Hospital Santa Maria, in the closing stages of her pregnancy, “without any data showing medical vigilance of the pregnancy”.

She was manifesting high blood pressure and difficulty breathing. Due to lack of space in the neonatal department, the decision was made to stabilise the woman and transfer her to nearby São Francisco Xavier hospital. The transfer was done with one doctor and nurses accompanying her –  but during the journey, she suffered cardiac arrest from which she never fully recovered. Reanimation efforts were performed, in order for the baby to be delivered by C-section at São Francisco Xavier, but the young mother died in intensive care a few days later.

According to IGAS, says SIC, there was poor clinical practice in the decision to transfer the woman in the first place. In other words, birth should have been induced immediately. By deciding to transfer the woman, “orientations on the transfer of pregnant women were not followed”.

Responsibilities are being levelled against Santa Maria’s then chief of service and director.

According to TVI, the IGAS report points to three “fatal errors” by the medical team: “First: was in not immediately provoking the birth; second was to have opted to send the  woman by ambulance to another hospital; and third was not to have decided to return to Santa Maria Hospital, as soon as the gravity of the clinical picture was perceived. Given the fact that this occurred 30 seconds after the start of transport – and the gravity of the clinical picture – the team should have returned to the hospital of origin, which it did not do,” says the report, quoted by the television station.

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