By Riva Preil
Downton Abbey fans across the world were shocked and heart-broken over the tragic death of Sybil Grantham Branson due to pre-eclampsia. Even though Sybil is a fictitious character, pre-eclampsia is very real and lethal. Therefore, I have decided to blog about this condition in order to raise public awareness and knowledge.
Pre-eclampsia, the most common of dangerous pregnancy complications, is not fully understood. However, researchers believe that it is caused by shallow implantation of the placenta which does not receive enough oxygen through maternal blood flow. This results in the body creating an immune response against the placenta and paternal antigens. Furthermore, inflammatory chemicals are secreted which act on vascular endothelium and create vasoconstriction (narrowing) of blood vessels. This results in elevated blood pressure, and it also causes a rise in protein levels. Blood pressure readings of >140/90 on two separate occasions (spaced apart six hours minimum) along with proteinuria (> 300 mg of protein in 24 hour urine sample) is considered pre-eclampsia. Pre-eclampsia is also often correlated with edema (swelling) of the hands and face, headaches, vision difficulties, and epigastric pain, however these are not included in the diagnostic criteria.
Pre-eclampsia may develop as early as the 20th week of pregnancy, however it usually does not present until the 32nd week and beyond. It affects approximately 6-8% of pregnancies, and it may even develop until six weeks post partum (the first 24-48 hours are the most dangerous). It is more common during a woman’s first pregnancy compared to subsequent pregnancies, and it is also more likely to develop in women who have pre-existing diabetes, hypertension, renal disease, obesity, and autoimmune disease (ex. Lupus). The only treatment to date for pre-eclampsia is removing the “offending placenta” from the mother either via delivery (labor induced or Caesarean section delivery) OR abortion. Pre-eclampsia untreated can develop into eclampsia, a fatal condition characterized by seizures. Therefore, maternal blood pressure monitoring as well as being aware of the aforementioned signs and symptoms is crucial.