The Pitt is nothing if not diverse in its vast array of medical emergencies. On the Season 2 finale, it delved into a series of conditions that are unique to pregnancy, with one patient finding herself unexpectedly saddled with a trio of dangerous conditions as she neared her due date.
Judith Lastrade came in via ambulance at an estimated 36 weeks of pregnancy. She was complaining of a headache for the last two days, which the paramedics report had reached a 10/10 level of severity and was accompanied by blurred vision and an elevated blood pressure, along with swelling, also known as edema, in her legs.
Judith was concerned she was having a stroke, but Dr. Robby quickly diagnosed her with severe preeclampsia and started to dig into the history of her pregnancy. However, Judith was aiming for a "wild pregnancy" with a "free birth," and had not sought any prenatal care—which likely would have caught her condition before it progressed this far.
So, what exactly is preeclampsia, and what makes it severe? Here's how this pregnancy-related condition progresses.
Preeclampsia is a hypertensive condition that usually develops around the 20th week of pregnancy. It's unknown what causes a woman to develop preeclampsia, but one theory is that it is related to problems with the blood supply to the placenta, according to the Cleveland Clinic.
Many women won't experience symptoms of preeclampsia before they are diagnosed at a routine check-up with their OB, when they are found to have high blood pressure and excessive protein in their urine.
Others may experience one or more associated symptoms, like headaches, visual disturbances, water retention, or peripheral edema.
What Is Severe Preeclampsia?
Severe preeclampsia, which is also called preeclampsia with severe features, is a progression of preeclampsia that involves an even higher blood pressure, and may also include decreased organ function, fluid in the lungs, and low platelet counts.
After developing eclampsia, Judith's baby girl was delivered via emergency C-section right there in the ER.Photograph by Warrick Page/HBO Max
After Judith's labs came back, Dr. Abbot added HELLP syndrome to her list of diagnoses. According to the Cleveland Clinic, there is some discourse among experts about whether HELLP Syndrome is a form of severe preeclampsia or a disease process of its own.
HELLP syndrome typically comes on during the third trimester, and involves hemolysis (H), which is the destruction of red blood cells, elevated liver enzymes (EL), and low platelet counts (LP), which is an important component that allows blood to clot properly. It is usually seen in patients with preeclampsia, but about 20 percent of cases of HELLP do not involve high blood pressure or protein in the urine.
What Is Eclampsia?
Eclampsia is simply severe preeclampsia with the addition of seizures.
Related: ‘The Pitt’: What Is Viral Meningitis, and What Does It Have To Do With Dr. Al-Hashimi’s Seizures?
How Do You Treat These Conditions?
When preeclampsia is caught early, it is closely monitored by the patient's healthcare team. If it progresses to severe preeclampsia early in the pregnancy, the patient may be hospitalized for the remainder of the pregnancy.
The goal is to remain pregnant for as long as possible to allow the baby to develop as much as possible but, unfortunately, the only cure for these conditions is to deliver the baby. That's why Judith underwent an emergency C-section in the emergency room after she started seizing during the season final of The Pitt.
However, in rare cases, preeclampsia may persist, or even arise, after the baby is born.
Depending on the severity of the case, the patient may also receive an infusion of magnesium sulfate, which treats the seizures associated with preeclampsia—and which Judith was given before her seizures began.
Related: 'The Pitt' Season 3 Cast: Who’s Returning and Who’s Leaving the PTMC?
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