By David Brown

Published: Friday, February 1, 2013, 9:05 p.m.
Updated: Saturday, February 2, 2013

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 at one point.) 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; it can lead to seizures ­— eclampsia — stroke, coma and death.

Long before then, 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.

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, and he reports elevated protein.

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.

David Brown is a staff writer for The Washington Post.

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