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15th October 2014

Could a blood test have saved Sybil in Downton Abbey?

[Spoiler Alert!] Fans of the international smash hit TV series Downton Abbey would probably rather forget the emotional episode in season 3 in which the estate-fleeing rabble rouser Sybil was set to deliver her interbellum love child and things went terribly wrong.

Swollen ankles, delirium and intense pain gave way to seizures and we looked on as our favourite Grantham sister and Branson’s beloved wife slipped away. As the drama unfolded, doctors on site quarrelled about the exact cause of her suffering, but later agreed it was eclampsia that took her life.

Eclampsia is a life-threatening complication in pregnancy, and involves seizures, agitation, and a possible slip into a coma. It’s more likely that you’ve heard the term pre-eclampsia, a condition that precedes eclampsia, and is brings with it a jump in high blood pressure and high levels of protein in urine.

Recent research indicates that the process leading to pre-eclampsia actually might begin quite early, and stems from a reaction of the mother’s immune system against the fetus and the placenta. This reaction interferes with the placenta’s implantation in the uterus, and the supply of oxygen to the placenta becomes uneven.

Towards a definitive test

In the early 20th century, there were already a few ways to test for pre-eclampsia. Back then, high blood pressure was a warning sign, as it still is today. Swollen limbs were also considered a reason for concern, although today they are considered a less reliable indicator.

Like in Sybil’s case, pre-eclampsia is most common in the late stages of a first pregnancy. For that reason, nowadays pregnant women take regular urine and blood pressure tests, with visits to the doctor and exams happening more frequently as the due date approaches.

However, the current process for diagnosis leaves women vulnerable if they develop pre-eclampsia earlier in their pregnancies. A woman’s condition can also change quickly between appointments.

To address these issues, tests are being developed to detect the risk of pre-eclampsia earlier on in pregnancy. Soon, doctors might be able to detect the condition in women with a blood test before any symptoms appear.

The test detects the levels of two proteins found in blood and that are found in abnormal levels in pregnant women that go on to develop pre-eclampsia. One of these proteins raises blood pressure and inhibits the production of Placental Growth Factor, or PIGF, while the soluble endoglin, or sEng, affects blood vessel function.

Researchers hope that by measuring the levels of PIGF and sEng, pre-eclampsia will be detected before the pregnancy enters its later stages.

That way, if women have abnormal levels of these two proteins in the blood, they can receive immediate treatment and have their pregnancy monitored more attentively. The test is cheap, and has high levels of sensitivity.

Pre-eclampsia is the most common serious illness occurring during pregnancy. The effect of a test allowing for early detection will have a significant impact in the lives of many women.

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