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 17^th 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.