When Downton Abbey's Lady Sybil died of eclampsia seizures just after giving birth, many viewers wondered: Could it really happen? The answer is yes.
Lady Sybil had undiagnosed pre-eclampsia, a condition that affects as many as one in ten pregnant women. It causes high blood pressure (typically at or above 140/90) and protein in the urine from kidney malfunction. It's also called "Pregnancy-Induced Hypertension." That's why blood pressure and urine are checked at every prenatal visit. Symptoms include unrelenting headaches, vision disturbances, and swelling of the hands, face and feet (although some ankle swelling is very common in pregnancy anyway).
When pre-eclampsia is severe, the flow of blood from the mother's placenta to the baby can be impaired. That's why these babies can be growth-restricted, just as Lady Sybil's baby was. But even worse, if not taken seriously by obstetricians and midwives, pre-eclampsia can make a baby vulnerable to loss of oxygen during the birthing process, with brain damage as a final and terrible outcome.
Doctors still don't know what causes many women to get high blood pressure during pregnancy. The main treatment -- delivering the baby if not too premature -- is the same now as it was in the Downton Abbey era of post-World War One Britain. We also have drugs that can help control the high blood pressure, and more sophisticated monitors (ultrasound and heart monitors) to check the baby's status.
One heart-wrenching bit of Lady Sybil's agony that wasn't realistic is the way her doctors stood by helpless as she was having full-blown seizures from eclampsia after giving birth. Then as now, magnesium sulfate was available to help ease seizures.
But pre-eclampsia remains a scary condition that needs to be watched out for because it happens all too often, and can be devastating for mom and baby.
Here's more on pre-eclampsia from the NIH.
Here's a discussion on our firm's website about medical malpractice issues relating to pre-eclampsia and other aspects of prenatal care.