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'Downton Abbey' death had clues that might have spared Lady Sybil

Sybil (Jessica Brown Findlay) and Branson (Allen Leech) share a moment with their daughter in Downton Abbey.

Carnival Film & Television Limited

Sybil (Jessica Brown Findlay) and Branson (Allen Leech) share a moment with their daughter in Downton Abbey.

Most of the viewers of Downton Abbey who saw Lady Sybil die in childbirth Sunday night were left with a long list of questions accompanying their shock and grief.

What did she die of? Was the diagnosis clear? Could she have been saved? In a show with punctilious art direction, how realistic was this death?

Lady Sybil died of eclampsia, a condition of unknown cause that used to be called "toxemia of pregnancy." (Dr. Clarkson, the family doc pushed aside in favor of silk-stocking-trade physician Sir Philip, used the term.) It is most common in the late stage of first pregnancies. Sybil Branson, 24, was nearing the due date for her first child, so that part's right.

Eclampsia, strictly speaking, isn't present until the woman has a seizure. By that time, the patient, the doctors (and the baby, if not yet born) are in deep trouble. The job is to diagnose what's happening before then, when the condition is known as preeclampsia.

In Sybil's case, there were a lot of clues.

The hallmark of preeclampsia is elevated blood pressure. Taking the blood pressure with stethoscope and inflatable cuff was about the only test a doctor could perform on a woman delivering at home. Sybil's pressure appears to have been up.

Equally important, however, were the other signs and symptoms she showed. As the blood pressure rises, headache and nausea are common. As it gets worse, a woman often gets delirious. As it gets even worse, it can lead to seizures — eclampsia — stroke, coma and death.

Long before then — when there was still time to diagnose her condition correctly — Sybil had "peripheral edema" — the fancy term for swelling of the legs.

Preeclampsia damages the cells lining veins and arteries; they leak fluid into the tissues. Because of gravity, the most common place to notice this is the ankles. Dr. Clarkson saw it early. Sir Philip dismissed the finding, saying the youngest of the Grantham daughters might just have thick ankles. (Not likely!) Message: Have a family doctor who knows you.

Preeclampsia also causes a protein called albumin to spill into the urine rather than stay in the blood. Dr. Clarkson suggests testing Sybil's urine.

The treatment of preeclampsia is delivery. If Lord Grantham had listened to the country doc and sent his daughter to the hospital for a Caesarean section, would she have lived? We'll never know.

One thing is clear, however. Having seizures and dying after delivery is unusual. In a study published last year of 39,000 births in a hospital in India, 1 percent of the women had eclampsia, and only one-quarter of those occurred after delivery.

The mechanism of Sybil's death was a little unclear.

Seizures can cause a pause in breathing. But people rarely suffocate from them. The doomed young woman may have had a massive bleed in her brain. Before she relaxed in the dusky pallor of death, she had what looked like "decerebrate posturing" — an arching of the neck that occurs as the brain is squeezed through the base of the skull.

Nobody knows what caused preeclampsia in the early 1920s or causes it now. It appears to be an out-of-control state of inflammation.

There was another message, too: Beware the "VIP syndrome." Among Sir Philip's mistakes was his apparent desire not to discomfit the Grantham family by sending Sybil to the hospital. However, doctors who treat you differently because you are an important person can be dangerous to your health.

.FAST FACTS

Show hits close to home

For many Americans, Lady Sybil's story is personal. Every year, up to 300,000 pregnant and postpartum women in the United States develop a hypertensive disorder such as preeclampsia and/or eclampsia, according to the Preeclampsia Foundation. About 75,000 of them suffer organ failure, massive blood loss, permanent disability, death, premature birth and/or death of their babies, according to the foundation. And sometimes doctors still miss the signs, just as Sir Philip did on Downton Abbey. "Women need to be aware of symptoms, keep prenatal appointments, and report between visits if they don't feel well,'' said foundation executive director Eleni Tsigas. "Sometimes they have to be persistent in getting medical attention.'' Go to preeclampsia.org for more information.

'Downton Abbey' death had clues that might have spared Lady Sybil 01/30/13 [Last modified: Friday, February 1, 2013 1:04am]

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