Death on Downton Abbey: All-Too-Realistic

TV shows about law and medicine are sometimes realistic, sometimes not.  When Downton Abbey’s Lady Sybil died of eclampsia seizures just after giving birth, some wondered if such a death would happen today.   The answer is both yes and no.

Lady Sybil had undiagnosed pre-eclampsia, a condition that affects as many as one in ten pregnant women. It causes high blood pressure  and protein in the urine from kidney malfunction. It’s also known as “Pregnancy-Induced Hypertension.”  Symptoms include unrelenting headaches, vision disturbances, and swelling of the hands, face and feet (although some ankle swelling is common in pregnancy).

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 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. Today’s drugs can help control the high blood pressure, and there are more sophisticated monitors (ultrasound and heart monitors) to check the baby’s status.

According to several medical experts, one part 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 condition that needs to be watched out for because itstill  happens, and can be devastating for mom and baby.  Pre-natal care is the key to avoiding serious problems with pre-eclampsia.

Pre-eclampsia is most often seen in first-time pregnancies, in pregnant teens, and in women over 40. Other risk factors include:

• A history of high blood pressure prior to pregnancy
• A history of preeclampsia
• Having a mother or sister who had pre-eclampsia
• A history of obesity
• Carrying more than one baby
• History of diabetes, kidney disease, lupus, or rheumatoid arthritis

Here’s more on pre-eclampsia from the NIH.