Obstetric Anaesthesia Annual Scientific Meeting 2025

A case of misunderstanding: clinical decision-making bias in a patient presenting with acute kidney injury and deranged liver function tests.

A 31-year-old 36+3/40 pregnant Afro-Caribbean woman, G2P1, presented to the triage unit of a District General hospital with vomiting and feeling generally unwell. Known sickle-cell carrier. As clinical complexity increases among the UK maternal population, an MDT approach to patient management is essential to ensure a high standard of patient care. Acute fatty liver of pregnancy (AFLP) is a very rare condition. It occurs in about 1 in 20,000 pregnancies. Innate and/ or intuitive cognitive biases can lead to delayed recognition and diagnostic error. Methods to combat decision-making bias include:

•Simulation (reinforces rule-based cognition using algorithms; allows familiarity to develop with unfamiliar scenarios and ‘pitfalls’)

•Multi-disciplinary involvement in complex cases and cross-specialty teaching

•Personal reflection to reinforce behaviours that reduces bias in the long-term and awareness of the detrimental effects of fatigue/ cognitive overload and sleep deprivation.

•Cognitive forcing strategies should be practiced/ employed by clinicians to recognise failings of memory, to appreciate the problem within the wider clinical context and reflect on past assumptions.

Obstetric Anaesthesia Annual Scientific Meeting 2025

A case of misunderstanding: clinical decision-making bias in a patient presenting with acute kidney injury and deranged liver function tests

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