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Eclampsia Has Its Fifteen Minutes of Fame

Thursday, February 7th, 2013

It’s always very exciting when a women’s health issue finds its way into the spotlight through popular media. Though some issues are difficult to talk about and even sad sometimes, talking about them helps raise awareness, which can bring us all closer to effective treatments and cures.

On Sunday night’s episode of the popular series “Downton Abbey,” a main character named Lady Sybil Branson died shortly after she delivered a baby due to a condition called eclampsia.  Eclampsia has been identified as a clinical condition since the times of Hippocrates. The term “Eclampsia” comes from the Greek meaning “lightning” and the description of convulsions or spasms appeared in the medical literature as early as the 17th century. It is a life threatening disorder which kills the baby 30 percent of the time and the mother may die 10 to 15% of time, as seen in the episode of Lady Sybil.

The incidence of eclampsia is high in developing countries, e.g., 13 – 17 per 1000 deliveries in Africa compared to 1 in 2000 in the United Kingdom.  The maternal death rate for the developing countries may be more than 25%.

To understand eclampsia, you should first understand preeclampsia. Preeclampsia is a pregnancy complication that causes dangerously high blood pressure and rapid weight gain. It is an insidious process that is little understood and occurs after 20 weeks of pregnancy.  In its more progressive form, preeclampsia adversely affects fetal growth and causes the baby to be smaller than expected. Women with preeclampsia need to be closely monitored for the duration of their pregnancy. Eclampsia is a continuum of preeclampsia. Women who suffer from eclampsia have seizures during or after birth. In today’s society, with about four million births per year, eclampsia occurs in approximately 1 in 2,000 pregnancies.  In underdeveloped countries, the prevalence of eclampsia is over twenty times higher!

Though the show is set in the 1900’s, eclampsia and preeclampsia still negatively affects women in the United States and all around the world today and there is no known understanding and effective treatment for the condition because there is no animal model and it only occurs in humans.  The treatment for preeclampsia is delivery.  A medicine to control seizures (magnesium sulfate) is used to prevent seizures when preeclampsia is diagnosed, but it still makes for a very risky pregnancy and delivery.  Eclampsia becomes much more frequent as a patient approaches term.  About 50% of eclamptic seizures occur before delivery, 25% during delivery and about 25% within 48 hours after delivery.  In fact, eclamptic seizures may occur up to seven days postpartum.

During your pregnancy, your doctor will perform tests to find out whether or not you have preeclampsia. Usually preeclampsia has no symptoms, i.e., pain or bleeding.  However, if you are in your late second or third trimester and you experience symptoms such as abnormal swelling, sudden weight gain, headaches, abdominal pain, nausea, and vision changes, you should see your doctor immediately. These are all signs that the preeclampsia has progressed, and it’s important that your doctor evaluate your condition with the possible recommendation of immediate delivery.   Eclampsia should be managed in a specialized, well-equipped medical center and not at home (as was the case with Lady Sybil).  A combined team of an obstetrician or perinatologist, obstetric anesthesiologist, and neonatologist with experience in management of eclamptic patients is essential.

The best way to prevent maternal or fetal death due to eclampsia is to make sure all of the doctors and nurses are ready to handle the emergency should it arise.

Now that eclampsia has been discussed in popular media via “Downton Abbey,” more women should seek early prenatal care and should know what to look out for during their pregnancy, so that more might be treated in time, and they and their babies don’t suffer the serious health problems associated with it.

– Yvonne S. Thornton, M. D., M. P. H.

Avoid High Altitudes if You’re Expecting

Thursday, January 24th, 2013

If you’ve ever tried baking at a high altitude, you know that the decreased oxygen is truly enough to ruin a batch of cookies. When we travel to destinations that are 7,000 feet above sea level or more, our surroundings change drastically because there is less oxygen there than closer to the ground. You can imagine then the negative effects high altitude might have on women who are pregnant. Oxygen is absolutely vital to a baby’s development, which is why activities like smoking are so dangerous. Does this mean women who live at high altitudes have to move when they become pregnant?

If you’re pregnant and you live in a high altitude area such as Denver, you do not need to move to an area with more oxygen. Since you spend all of your time at that level, you’re used to the oxygen level, and your body has already adjusted itself to accommodate. Besides, high areas in the United States like Denver are only around 5,000 feet above sea level. Even women who are used to these high altitudes shouldn’t be traveling to areas any higher than what they’re used to though. If you’re pregnant and accustomed to lower lands, do not travel to high altitudes. Studies show that you could easily restrict oxygen flow to the baby by doing so, which could have serious consequences such as impaired fetal growth, preeclampsia, and fetal mortality. If you must travel to an area at a higher altitude while pregnant, make sure you take things very slowly and check in with your doctor beforehand. If you start to feel lightheaded or weak, sit down and spend as little time in the location as possible.

For the most part, travel during your pregnancy is safe, assuming you’re not going to be miles away from medical care around your due date. However, traveling to high altitudes you’re not used to could be dangerous because your baby needs as much oxygen as possible during your pregnancy. If you’re already used to high altitudes, don’t feel as though you need to move. Assuming you’ve been there for at least a few months, your body has already adjusted to meet the demands of lower oxygen levels.

 – Yvonne S. Thornton, M. D., M. P. H.