As a preeclampsia survivor and advocate, I’m grateful to see this life-threatening condition on screen—but I have some hard-earned thoughts about what The Pitt got right, and where it missed the mark.
The Emmy award-winning medical drama The Pitt closed its second season earlier this month with a main storyline about a major pregnancy health risk that affects close to 15 percent of all pregnancies and one in five preterm births.
Spoiler for those who have not seen it: A woman in late-stage pregnancy presents with a severe headache and explains she has not received prenatal care, calling it a “wild pregnancy.” The patient goes on to be diagnosed by the Pitt care team with preeclampsia, a hypertensive disorder of pregnancy that is most identified through high blood pressure and protein in urine.
As the patient’s condition worsens, including a horrible seizure leaving her nonverbal and her baby at risk, she is diagnosed with eclampsia and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. The patient is ultimately (unbelievably) spared as her baby is surgically removed, and both are cleared to head to obstetrics and the neonatal unit, respectively.
We still do not know what causes preeclampsia. More research is needed to fully understand, prevent and treat it.
Dr. Robby on ‘The Pitt’
As a two-time preeclampsia survivor and CEO of the Preeclampsia Foundation, I want to wholeheartedly thank The Pitt producers for featuring preeclampsia, HELLP syndrome and eclampsia in their season finale. Hypertensive disorders of pregnancy, which include all three disorders plus gestational hypertension, are not rare: They affect 15 percent of all pregnancies. We need greater awareness of hypertensive disorders of pregnancy, the signs and symptoms, and the importance of fast, reliable intervention by medical professionals to save the lives of mothers and their babies.
That said, I have thoughts—as does the broader community of preeclampsia survivors.
Our foundation received hundreds of inbound comments, requests and feedback from our community following The Pitt episode. Some wanted more information, while others just wanted to commiserate about what was a triggering, emotional episode for many of us.
Our own patient education and support manager, Danielle Babcock Sapienza, said:
“When I saw the patient seizing, it reminded me of my own near-death experience in the ER five days postpartum. My presenting symptoms were also a headache that wouldn’t quit, along with sudden swelling. Awareness is SO critical. Following my traumatic birth, I turned to the Preeclampsia Foundation as a source of information and now lead efforts to educate and support others.”
Many in our community were frustrated with the example of a “free birth” patient who refused prenatal medical care. Plenty of women with the best prenatal care go on to get eclampsia or HELLP syndrome, but earlier diagnosis and treatment often improve outcomes, and the complete ignorance of The Pitt patient made her case horrific and likely preventable.
Often, our community consists of women who, despite receiving prenatal care and doing their best to manage their health and the health of their growing baby, still went on to experience a hypertensive disorder of pregnancy. Despite their best efforts, they may have endured horrible outcomes like stroke, seizure and even, tragically, the death of a child. Dr. Robby summed it up when he said, “We still do not know what causes preeclampsia. More research is needed to fully understand, prevent and treat it.”
As the CEO of the 25-year-old nonprofit organization dedicated to improving outcomes of hypertensive disorders of pregnancy, I would be remiss not to explain if The Pitt was real life, it’s unlikely the patient depicted on screen would have survived. With platelets that low and other organ failure, a real patient would more likely suffer death, or at the very least, be taken to the ICU.
What The Pitt did get right is this: Free birth or not, even educated patients who attend every prenatal appointment can still be unaware of the symptoms that put their and their baby’s lives at risk. High blood pressure, which is not always monitored from home, and severe headache are probably the best-known symptoms of preeclampsia. Less well-known symptoms, or symptoms that can be overlooked by patients and providers, include sudden swelling (edema), upper right abdominal pain, blurred vision, nausea, vomiting or just a general feeling of unease or dread.
Another preeclampsia survivor, Amanda Guisbond, said:
“I had been warned of the risks of preeclampsia given my age and health history. At my 36-week prenatal visit, I had perfect blood pressure and no swelling. Just days later, when my abdomen hurt, my feet were swollen, and I felt severe anxiety, I didn’t know to act. Thankfully, I was scheduled for another prenatal visit where the nurse, trembling, clocked my systolic blood pressure at 200. My midwife hugged me and sent me to the hospital, where they confirmed I had preeclampsia, administered magnesium, and prepared me for surgery to save my son.”
We’ve discovered that while many moms know what preeclampsia is, most cannot identify symptoms and are in disbelief that it will happen to them. We aim to create more awareness.
If you are pregnant, preeclampsia can happen to you. To my amazing moms-to-be, please know that we at the Preeclampsia Foundation are working every day to ensure that you and your care providers can recognize and respond quickly to the signs and symptoms of hypertensive disorders of pregnancy. “Still at Risk” is our new, national initiative—sponsored by the U.S. Department of Health and Human Services—to standardize a postpartum wristband and improve awareness and outcomes for moms at risk of preeclampsia after birth.
Thank you again to The Pitt for igniting this conversation and creating greater awareness of the major risks of preeclampsia, eclampsia and HELLP. Our community is grateful for the spotlight and the opportunity to educate families about the symptoms to know … and never to ignore.
