woman, her treatment and death in a public hospital, and the special duties of the state stemming from said condition must be taken into account. In that regard, it must be examined whether or not the state was able to provide adequate healthcare services to Ms. Cristina Britez Arce during her pregnancy and on the morning of June 1, 1992, bearing in mind that this medical care cannot be confined to one single conduct or to one given moment, but must be examined comprehensively. 77. Regarding this, the Commission notes, first of all, that although the State argues that Ms. Britez did not go for pregnancy checkups until the 29th week of her pregnancy, it has not submitted information demonstrating that, at that time, she would have been given specific healthcare information or recommendations to prevent hypertension, despite their knowledge from her clinical records about preeclampsia in a previous pregnancy. 78. Second, the Commission observes at least two important risk factors that have not been dismissed and which the physicians who took care of Ms. Britez during her checkups should have taken into account, such as: 1) a substantial increase in weight, and 2) prior history of preeclampsia in a previous pregnancy. To this must be added the fact that Ms. Britez, in one of her checkups, presented a blood pressure reading of 130/90, which may be a sign of preeclampsia according to the WHO parameters mentioned earlier. 79. Thus, although the Commission cannot assert that Ms. Britez was suffering from preeclampsia and that it was that illness that led to her death, it can observe that, bearing in mind that preeclampsia and eclampsia trigger high rates of maternal mortality, the attending physicians had the special duty of providing protection and should have provided Ms. Cristina Britez diligent and reinforced medical care, especially considering that, in these cases, “maternal deaths can occur among severe cases, but the progression from mild to severe can be rapid, unexpected, and occasionally fulminant.”111 80. The state of Argentina did not provide the necessary documentation to the case file in order to sufficiently demonstrate that it took the steps it should have taken in terms of maternal health services; for example, it did not provide Ms. Britez’s clinical record, which would have made it possible to learn about whether or not basic tests had been administered to detect possible risks to her health and life, along with the fact that said clinical record, which was used as the basis for the expert reports that were prepared internally , was repeatedly questioned by her next of kin in the domestic legal system. The Commission also observes that it does not have information indicating that a comprehensive diagnosis for Ms. Britez had been undertaken on a timely basis, so that she could be given specialized treatment to prevent her life, health, and integrity from being affected, keeping in mind the above-mentioned antecedents of risk. 81. Third and finally, the Commission observes that, on the basis of the expert reports mentioned above, the cause of Ms. Britez’s death was undiagnosed or untreated preeclampsia and, as mentioned, there was no exhaustive checkup based on the techniques that were required and which did not involve any complexity, although it involved a pregnancy including factors that would tend to establish it as a high-risk pregnancy. The Commission observes that the above was ruled by some experts as “very poor care,” pointing out in addition that “there had been poor management of the woman which led to the death of the fetus” (see paragraphs 34 and 50 above). The Commission also notes that, according to the charges of the prosecution, Ms. Britez’s hypoglycemia could well have been related to the high stress she suffered from when notified that her child had died, to which the prosecutor asked the following question: “Why did they not wait for the result before subjecting her to another element of stress such as labor or birth?” As indicated by the prosecutor, at that time, the above had led Ms. Britez to a condition of eclampsia and ultimately to an irreversible cardiopulmonary arrest. As indicated, the Commission cannot establish the cause of Ms. Britez’s death; nevertheless, the information that has been provided does reasonably indicate that Ms. Britez was subjected to a situation of anxiety and stress. 82. In connection with the above, the Commission notes that the investigation that was undertaken did not ultimately ascertain the responsibilities of the physicians involved, basically because it did not manage to clearly and convincingly clarify the causes of Ms. Britez’s death (see above paragraphs 29 and 50). In that respect, nor did that investigation make it possible to consider or substantiate that the physicians acted 111 WHO, WHO Recommendations for prevention and treatment of preeclampsia and eclampsia, 2014. 19