Oh Downton Abbey, how could you?
Alright, who was watching the fourth episode of Season Three? Spoiler Alert if you haven’t yet seen it and plan on soon
don’t
read
on.
Like many across the US watching PBS Masterpiece’s Downton Abbey last night, our household reeled as we watched the latest episode of Downton. The loss of the much loved Lady Sybil to eclampsia was shocking and senseless to us in this day and age, but less than a hundred years ago, the maternal mortality rate was dramatically higher than it is today. In 1920, whether from infection, hemorrhaging, or toxemia (eclampsia), the possibility of death during or following a pregnancy was a concern for most pregnant women no matter how poor or how wealthy.
What is preeclampsia and eclampsia?
Preeclampsia is a pregnancy-related problem. The symptoms of preeclampsia include new high blood pressure after 20 weeks of pregnancy along with other problems, such as protein in your urine. Preeclampsia usually goes away after you give birth. In rare cases, blood pressure can stay high for up to 6 weeks after the birth.
Preeclampsia can be deadly for the mother and baby. It can keep the baby from getting enough blood and oxygen. It also can harm the mother’s liver, kidneys and brain. Women with very bad preeclampsia can have dangerous seizures. This is called eclampsia.
Less than 1 percent of women who have preeclampsia experience seizures.1 Eclampsia is life-threatening for both a mother and her fetus. During a seizure, the oxygen supply to the fetus is drastically reduced.
Sudden seizures can occur before, during, or (rarely) up to 6 weeks after delivery (postpartum). Postpartum seizures are most common during the first 48 hours after delivery.
Symptoms of preeclampsia and eclampsia
Preeclampsia is often a silent condition, the signs subtle or dismissed as just a ‘normal’ part of pregnancy – making prescribed bed rest particularly frustrating to a woman who feels fine. Sometimes there are symptoms:
Swelling (Yes a little in your feet might be fine, but around your face? hands? Get it checked.)
Sudden weight gain (Those repeated weighing measurements are not just some torture device; they have an important purpose. Watch for more than two pounds a week
Nausea or vomiting
Pain in the stomach area just beneath the ribs and/or shoulder
Migraine-like headache (If it doesn’t go away with your obstetrician-approved over-the-counter medication, call your provider that day.)
Vision changes (From flashing lights and light sensitivity to blurry vision, if your vision changes contact your provider immediately.)
Confused, muddled thinking, racing pulse, sense of anxiety (More than usual, see a doctor)
How is preeclampsia diagnosed and treated?
Today, the number of women who die as a result of eclampsia, or suffer complications from preeclampsia is much lower than in Lady Sybil’s time thanks to prenatal blood pressure monitoring, urine tests, and the use of magnesium sulfate and other anticonvulsants to treat seizures in women with eclampsia and prevent seizures in women who have preeclampsia. But the precise cause of preeclampsia and eclampsia is not known and there is no cure, only management and treatment. Which is why it is critical that all pregnant women get regular monitoring from their obstetrician or midwife.
During these visits, your blood pressure is measured with a blood pressure cuff. A sudden increase in blood pressure often is the first sign of a problem. You also will have a urine test to look for protein, another symptom of preeclampsia. If you have high blood pressure, tell your doctor right away if you also have a headache or belly pain. These symptoms of preeclampsia can occur before protein shows up in your urine.
Treatment of preeclampsia
The only cure? The end of pregnancy and even then as in Lady Sybil Crawley’s case the impacts of preeclampsia and eclampsia can be seen upto six weeks post partum.
If diagnosed your doctor may suggest:
-magnesium sulfate or another anticonvulsant, if you have severe preeclampsia to prevent seizures
-blood pressure medication to lower your blood pressure until post partum
-corticosteroids if you have severe preeclampsia or HELLP
-Bed rest or reduced activity (Dependent on the severity of the preeclampsia this might be just keep off your feet for a certain amount of time each day, bed rest at home, or bed rest in the hospital)
-Toward the end of pregnancy or if the preeclampsia is particularly severe, it maybe suggested to induce labor, or to perform a Cesarean section.
For Lady Sibyl Crawley and women of that time, change in the treatment and management of preeclampsia and eclampsia was just around the corner, just not in time. Today, we still have no cure, and preeclampsia and eclampsia are still very serious medical conditions, but we do have treatment and management plans. For the healthiest pregnancy, we encourage keep up with your prenatal appointments with a obstetrician or midwife throughout your pregnancy.
(TMC for Women offers a free Healthy Pregnancy class one Sunday afternoon each month, with info on nutrition, exercise, fetal development and more. Especially useful for women and couples early in pregnancy, the next class is 4 p.m., Feb. 17, Sagebrush Room, Marshall Conference Center – and registration is not required.)
Resources
Tucson Medical Center Health Encyclopedia
Mayo Clinic
Julie Reed
kimberlyromo
Rachel H Miller
TMC for Women
Tucson Medical Center
It’s so sad how many women died, and that wasn’t so very long ago.