Television viewers were stunned by the unexpected death of Lady Sybil, a beloved character on the PBS hit British drama “Downton Abbey.” After giving birth on the most recent episode, Sybil died of a pregnancy-related hypertensive disorder called pre-eclampsia/eclampsia—a condition many in this country may not have heard of, but one that continues to affect women in developing countries worldwide.
Pre-eclampsia is a serious complication of pregnancy in which a woman, usually after the 20th week of pregnancy, develops high blood pressure and protein in her urine (proteinuria). If left untreated, this condition may develop into eclampsia, which causes lethal convulsions. While Sybil said that she had a severe headache and swollen ankles, a woman may develop this condition without any symptoms until she begins to convulse and death ensues.
Even today, an estimated 15-35 percent of global maternal deaths are attributed to these hypertensive disorders despite the availability of lifesaving measures. Centuries ago, “toxemia” (or toxins in the blood) of pregnancy was recognized as an often fatal condition with hypertension, proteinuria and convulsions that afflicted only pregnant women and was often fatal to both mother and baby. Given that it can also occur after childbirth, as happened in Sybil’s case, it is important that detection begins during pregnancy and continues through labor and after delivery.
Treatment options evolved over time, and by the 1920s when “Downton Abbey” takes place, most treatment involved either immediate delivery by cesarean section or the use of morphine and chloral hydrate (a heavy sedative) to calm the convulsions until an expedited birth was possible. While C-section still has a place in the treatment of eclampsia today, in the early 20th century, the infection, hemorrhage (or excessive bleeding) and other complications that often accompanied surgery meant that the death rate was greater for women in the C-section group than those in the sedation group. Even if Sybil had had a C-section in the recent PBS episode, she may have survived the severe pre-eclampsia and eclampsia, but not the surgery.
Today, prevention, early detection and treatment of severe pre-eclampsia or eclampsia can prevent most deaths from this disorder. Tragically, many women around the world still lack access to health care workers who are trained and able to provide the magnesium sulfate injection that can prevent or stop convulsions, the antihypertensive drugs that can reduce blood pressure, and the expedited delivery that is the only real cure for the disorder.
Jhpiego is innovating to make prevention and treatment of this condition accessible to women around the globe, so that this needless loss of the lives of mothers and newborns will truly become a relic of history. For more information on pre-eclampsia/eclampsia, take a look at the Prevention, Detection and Management toolkit developed by the U.S. Agency for International Development’s flagship Maternal and Child Health Integrated Program, which is led by Jhpiego. The toolkit can be found at: https://www.k4health.org/toolkits/preeclampsia-eclampsia. Learn how you can become involved in Jhpiego’s work (www.jhpiego.org) to help women in the developing world gain access to lifesaving treatment for pre-eclampsia/eclampsia.