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Oh, Downton Abbey! Why Lady Sybil? Why eclampsia?

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Editor’s note: This post originally cited a statistic that preeclampsia will occur in 20 percent of pregnancies.  That figure has been edited to reflect the actual stat, which is closer to eight percent.

WARNING! This post references last night’s episode of Downton Abbey. If you have not yet watched, avert your eyes. If you have, read on!

It seems mine was not the only heart broken after last night’s episode of Downton Abbey.

Since the most recent episode concluded the social media world has been abuzz with chatter about the killing-off of one of the show’s most beloved characters – Sybil – who passed away after complications giving birth to her first and only child, a healthy baby girl.

The diagnosis: eclampsia.

Fans of the show raced to their Facebook and Twitter feeds to digest the news. Many wanted answers to the same questions: What exactly is eclampsia? How does it happen?  And is it really fatal?

We’ve already seen Downton Abbey accurately portray health history, such as the show’s version of the influenza epidemic of 1918.  So how did they do this time?

According to Carrie Ann Terrell, M.D., director of Obstetrics, Gynecology and Women’s Health at the University of Minnesota Medical School and director of the Women’s Health Specialists Clinic, the Downton Abbey writers got it right again.

Pre-eclampsia occurs in up to eight percent of pregnancies in the U.S. and is a collection of symptoms including high blood pressure and swelling. If not accurately diagnosed and treated, it progresses into seizures known as eclampsia, a life-threatening complication of pregnancy.

Often, elevated blood pressure and abnormal levels of protein in the urine are the most common predictors of the condition.

“If the disease affects the kidneys we’ll see increased protein in the urine,” said Terrell. “If it affects the liver we see elevated liver enzymes, and if it affects the placenta we see fetal growth restriction and other problems. When it affects the brain we see seizures.”

Today, as it was in the 1920’s, the precise cause of pre-eclampsia is unknown and there aren’t any prevention strategies women can employ. The only cure for pre-eclampsia is delivery of the baby.

The good news for modern moms-to-be: these days there is a little more that can be done if pregnancies are preterm.

“If a pregnancy is preterm, we can sometimes try to keep the woman pregnant and treat symptoms of the disease, rather than deliver right away,” said Terrell. “We can use anti-seizure medications, high blood pressure medications and bed rest. These are used to ‘buy time’ until delivery is absolutely indicated.”

So, it seems that – unlike in Downton Abbey-era England – pre-eclampsia and eclampsia does not have to be a death sentence today. Through proper monitoring and care, both the mother and baby can often make it through the pregnancy.

Terrell urges if you are pregnant and have any symptoms mentioned below, please let your provider know.

  • Headaches
  • Nausea
  • Right upper quadrant pain
  • Vision changes
  • Severe swelling often involving hands and face as well as legs

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