Eclampsia And Tragedy

What happened to Lady Sybil on "Downton Abbey"?


We watched. Did you? If you haven’t yet seen last night’s episode of "Downton Abbey," beware: Spoiler Alert!

Here’s what happened: Sybil’s confined to bed by her family doctor because she’s having off and on contractions and feeling ill. As the show progresses Sybil’s symptoms start piling up – headache, swelling and confusion. Lord Grantham calls in an obstetric specialist (who turns out to be totally arrogant and a complete jerk). Pretty soon, Sybil’s in labor.

The family doctor is really, really worried about her because of her weird symptoms, which get worse with each scene. The specialist, on the other hand, is totally dismissive and essentially overrules his concerns and those of the Downton women. Lord Grantham sides with the obstetrician even though the family doctor is lobbying hard for Sybil to be transferred to the hospital and delivered by C-section STAT! Sybil delivers her baby girl, who is healthy and is tucked into bed by her mother for a rest. Next thing you know, the whole family rushes to her room because Sybil’s in screaming pain, hallucinating and having seizures. Both doctors are in the room and finally, the obstetrician concedes that yes, she has eclampsia (aka toxemia of pregnancy) and there’s nothing they can do to save her. Sybil dies, the family is devastated and Cora (Sybil’s mother) is furious with Lord Grantham for overruling the family doctor.

We could talk about all kinds of issues here including why Lord Grantham is such an idiot, why Sybil’s family was having dinner while she was in labor and how on earth Sybil could be so gorgeous, even while dying. But we’ll just stick to the million-dollar question:

What killed Sybil? Eclampsia – a serious hypertensive disorder that includes seizures. It’s often accompanied by HELLP Syndrome, a serious and often fatal disorder that affects the blood’s ability to clot, which leads to massive bleeding. Eclampsia also causes liver and kidney failure, pulmonary edema and, as it did with Sybil, death.

Does eclampsia still exist today? You bet, but in countries where women can access medical care, death from eclampsia is unusual – not unheard of, but rare. In other countries, however, where women can’t get to a doctor or hospital, they die because, like Sybil, they don’t have access to life-saving medications, lab tests and life support. Here in the U.S., not very many women get eclampsia because, when doctors see signs of preeclampsia (a related hypertensive disorder that does not include seizures), they start medical treatment to keep things from getting out of control. Depending on the severity of a woman’s condition, they may also deliver her baby by induction or C-section because bottom line – the cure for preeclampsia and eclampsia is birth.

About 20 percent of pregnant women experience hypertension during pregnancy. That doesn’t mean they have preeclampsia. Their high blood pressure could be due to any number of reasons including weight gain, fatigue, genetics and even stress. While high blood pressure is part of preeclampsia, it’s a symptom, not a cause. Nobody really knows what causes preeclampsia or how to prevent women from developing it. They know how to treat it though.

Here’s what the American College of Obstetricians and Gynecologists (download pdf) notes about hypertension, preeclampsia and eclampsia:

What is gestational hypertension? It’s high blood pressure that occurs during the second half of pregnancy and usually goes away after birth.

What is preeclampsia? It’s a serious medical condition affecting all organs of the body. For example, when it places stress on the kidneys, they don’t filter proteins out of the urine. That’s why high blood pressure plus protein in the urine are classic signs of preeclampsia. Other symptoms include headaches, visual problems, rapid weight gain and swelling in the hands, feet and face.

What's the difference between preeclamsia and eclampsia? Eclampsia indicates the woman's disease has progressed to the point of having seizures and potentially coma. That can be deadly for both she and her baby.

Who gets preeclampsia? About 5 percent to 8 percent of pregnant women will get preeclampsia. Some women are at higher risk than others including first time mothers, women who’ve had preeclampsia in previous pregnancies, women with chronic hypertension before pregnancy, obese mothers, older mothers, African Americans, mothers of multiples and women with immune disorders like lupus or blood diseases.

How is it diagnosed? By physical exam and lab tests on blood and urine.

How is it treated? Women with preeclampsia are hospitalized and monitored. If she’s relatively stable and her baby isn’t close to due, she might stay in the hospital for a while. If she’s not stable, appears to be getting sicker or her baby is ready to be born, she might be delivered by induction of labor or C-section. Birth is the cure. Treatment to manage symptoms and prevent disease progression include drugs to bring blood pressure down, diuretics to reduce swelling and a mineral administered IV called magnesium sulfate, which reduces chances for seizures. In most cases, with proper medical treatment, women avoid reaching the eclampsia stage. Only about 0.2 percent of women develop eclampsia.

Back in the olden days and still today in many parts of the world, eclampsia is among the top three reasons why women die in childbirth. Here in the U.S., in these modern times, however, preeclampsia is dangerous, but most women and their babies survive.

For all of you who’ve been pining away to be a "Downton Abbey" girl, maybe you’d better watch what you wish for. Personally, I want to have someone cook all my meals, clean my house, do my hair and of course, I’d love to have a reason to wear ball gowns more often. But live back in those days and have babies? Not so much.

Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and five children. Got a question for Jeanne? Email it to and it may be answered in a future blog post.

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