Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=214719
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Lady Sybil

Courtesy of PBS

Lady Sybil (Jessica Brown Findlay) rests shortly before giving birth to her first child.


Downton death draws attention to eclampsia

by Erica Tempesta
Jan 29, 2013


branson crop

Courtesy of PBS

Lady Sybil in better times, with her husband and former chauffeur, Tom Branson.

Lady Sybil, writhed and seized while loved ones helplessly watched her succumb to the life-threatening pregnancy complication her doctor gravely referred to as “eclampsia.”

Millions of  “Downton Abbey” viewers mourned the loss of the beloved character after Sunday’s dramatic, yet mostly accurate portrayal of postpartum eclampsia. Eclampsia, a hypertensive disorder, is the medical term for seizures during pregnancy that are not related to a preexisting medical condition.

“The episode of ‘Downton Abbey’ focused on the health of the mother and that is a big piece of it,” said Eleni Tsigas, executive director of the Preeclampsia Foundation in Melbourne, Fla. “That is a major concern because the mother’s health is definitely at risk. It is definitely a leading cause of mothers dying in childbirth, but it is also very dangerous for the baby.”

Eclampsia is not a condition of the past. In the U.S. up to 300,000 pregnant or postpartum women develop a hypertensive disorder of pregnancy each year according to the foundation.

About 300 women die while 75,000 others face severe complications, including organ failure, blood loss and premature birth, the foundation said.

Eclampsia is often classified with preeclampsia, the development of high blood pressure and protein in urine during the late second or third trimester of pregnancy. Eclampsia can develop from preeclampsia, or occur suddenly during pregnancy, during delivery or postpartum.

“You can’t prevent it,” said Lauren Streicher, a Chicago obstetrician and gynecologist, “but you can sometimes predict it.”

Streicher, an assistant clinical professor at Northwestern University’s Feinberg School of Medicine, said there can be warning signs to preeclampsia, including sudden headaches, rapid weight gain and swelling of the hands and feet.

On the episode, Dr. Richard Clarkson, who cared for Lady Sybil her entire life, was concerned about his patient’s headache, swollen ankles and spacy mental state. During delivery he was certain that she had eclampsia and insisted she be taken to the local hospital for an emergency cesarean section. Sir Philip Tapsell, a society obstetrician, dismissed Clarkson’s concerns. All seemed fine as Lady Sybil gave birth to a girl.

The only way to cure preeclampsia is to deliver the baby. Streicher said the delivery of the baby via C-section in this situation would be appropriate. It would not necessarily save her life, but may save the life of the baby.

Tsigas said it is not uncommon that Lady Sybil delivered her baby and then had issues. “In the U.S. most of the maternal deaths happen postpartum,” she said.

“Magnesium sulfate today has been proven to be the absolute best medication to administer to prevent a woman from having eclampsia,” Tsigas said.

During the 1920s the chances of Lady Sybil dying were certainly much greater. Magnesium sulfate was not in wide use at the time.

“They did a really good job of characterizing the disease and the symptoms that she was having,” Tsigas said. “Those were all very accurate.”

She said the only inaccuracy of the episode occurred when the doctors helplessly stood to the side and did nothing while Lady Sybil convulsed. The doctors could have given her anticonvulsants or tried to keep her airways open.

“Just basic seizure intervention would have been done even at that time,” she said.

Both Tsigas and Streicher agree that proper prenatal care and knowledge of the warning signs are fundamental.

“There is no reason that a woman should be having seizures in this day and age if she is being properly cared for, if she is getting health care on time, if she recognizes the signs and symptoms,” Tsigas said. “That’s one of the reasons we advocate very strongly for patient education.”