Doctor Q&A: 'Downton Abbey' highlights dangers of eclampsia
Sunday's episode of "Downton Abbey," a PBS drama set in 1920s England, highlighted the dangers of eclampsia when the character Lady Sybil Crawley suffered from the pregnancy-related seizures.
In the program, the family's longtime physician noticed symptoms. A well-regarded London doctor disagreed, and drama ensued.
At MultiCare OB/GYN Associates in Tacoma, Dr. James Lin sees many high-risk pregnancies, including women with pre-eclampsia. Some patients are transferred to MultiCare from around the state to receive a higher level of care.
Dr. Lin says MultiCare is in a unique position to handle high-risk pregnancies because the health care system offers resources for both the mother and baby, including MultiCare Regional Maternal-Fetal Medicine Specialists and a Neonatal Intensive Care Unit at MultiCare Tacoma General Hospital.
"To use a sports analogy, MultiCare has a deep bench," Dr. Lin said. "When we need to act fast, we have this covered for the mother and for the newborn, as well."
Since the intervention for pre-eclampsia is early delivery, a physician must balance the health of the mother with the prematurity of the baby.
"At all times we have two patients instead of one," Dr. Lin said. "If you think of Mom as the universe of the baby, and she's getting sick, then how good could it be for the passenger in that universe?"
Dr. Lin mentioned that every pre-eclampsia case is different.
"Pre-eclampsia can range from mild to severe, so we mange it and deliver when we get to that point" when pre-eclampsia is severe, Dr. Lin said. "I teach my residents that every patient is an individual, and one size never fits all."
The TV episode raised many questions about eclampsia and pre-eclampsia (previously known as "toxemia of pregnancy"). For answers, we turned to MultiCare's OB/GYN physicians and the MultiCare Health Library. (If you're pregnant, find an OB/GYN physician or other health provider here.)
What are eclampsia and pre-eclampsia?
Eclampsia is pregnancy-related seizure activity that is caused by severe pre-eclampsia. Fewer than 1 percent of women who have pre-eclampsia experience seizures.
Pre-eclampsia is a pregnancy-related blood circulation problem that causes high blood pressure and affects the mother's kidneys, liver, brain, and placenta. Its cause is unknown.
In the 1920s, it appeared there was nothing that could be done to help the pregnant woman, aside from immediate delivery. What can be done for women with pre-eclampsia today?
Is there a cure today for pre-eclampsia?
A woman with any signs of pre-eclampsia is closely monitored by her doctor or nurse-midwife. Pre-eclampsia can be treated in the hospital with bed rest, medicine, and close monitoring of the mother and fetus. If not treated, pre-eclampsia may damage the mother's liver or kidneys and can cause seizures (eclampsia). In rare cases, coma and death of the mother and fetus can follow.
Can eclampsia occur even after the baby is delivered?
Delivery is the only true "cure" for pre-eclampsia. This has to be balanced with how far along the pregnancy is and whether it is safe for the fetus to be delivered. Within the first few days following delivery, the mother's blood pressure usually returns to normal. With severe pre-eclampsia, it may take at least 6 weeks for blood pressure to return to normal. Magnesium sulfate is a medicine used to treat women who have eclampsia and to prevent seizures in women who have pre-eclampsia.
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.
How far along in a pregnancy does pre-eclampsia occur?
Pre-eclampsia typically occurs after the 20th week of pregnancy. It can develop much earlier in a multiple or molar pregnancy than in a normal pregnancy. Pre-eclampsia most commonly occurs during first pregnancies. Pre-eclampsia can develop gradually or suddenly and may remain mild or become severe.
What are the signs of preeclampsia?
Signs of pre-eclampsia include:
- Elevated blood pressure (generally 140/90 millimeters of mercury [mm Hg] or higher). This could be higher systolic blood pressure (the first number), or higher diastolic blood pressure (the second number), or both. Any large increase in blood pressure should alert a woman and her doctor to possible risk.
- Persistent headache.
- Vision problems.
- Pain in the upper right abdomen.
- Lab results indicating elevated uric acid and/or protein in the urine (proteinuria).
- Swelling of the hands and face that does not go away during the day. This symptom of normal pregnancy may be a sign of pre-eclampsia if it is accompanied by other signs of pre-eclampsia.
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