The death of Reut Cohen, who passed away in her eighth month of pregnancy along with the twins she was carrying, has left a family searching for answers and a medical community reflecting on the dangers of a “silent” killer. While her family has raised the possibility of preeclampsia, an official cause of death has not yet been determined. The tragedy highlights a harrowing gap in maternal healthcare: the space between the onset of a severe complication and the moment it becomes clinically obvious.
Preeclampsia is one of the most complex challenges in obstetrics because it often masquerades as the mundane. In the third trimester, fatigue, swelling, and general discomfort are considered hallmarks of a healthy, progressing pregnancy. However, when these sensations mask a systemic failure of the placenta and a spike in blood pressure, the window for intervention can close with terrifying speed.
As a physician and medical writer, I have seen how easily “normal” pregnancy symptoms can be used to dismiss early warning signs. The danger lies in the fact that preeclampsia does not always announce itself with a dramatic crash; for many women, it begins as a subtle drift toward instability that is only recognized once the condition has reached a critical stage.
The Deception of ‘Normal’ Fatigue
The primary challenge in detecting preeclampsia early is that its initial symptoms are non-specific. A woman may feel exhausted or experience mild swelling in her ankles—symptoms that are common to nearly every pregnancy. By the time the “classic” signs appear, the disease is often in its end stage.
“That is the million-dollar question,” says Dr. Orit Bernholtz, a specialist in high-risk pregnancy and endocrinology at Meuhedet Health Services in the Jerusalem district. She notes that medical professionals often identify the disease only when it has progressed to high blood pressure, protein in the urine, or liver function abnormalities. At that point, symptoms like pulmonary edema or blurred vision may emerge, but these are indicators of a crisis already in motion.
To understand why this happens, one must look at the pathology. Preeclampsia is not a sudden event but a process that begins early in pregnancy with the abnormal implantation of the placenta. While the clinical diagnosis may happen in the third trimester, the biological failure began months prior. While blood markers can now help predict risk, there is currently no treatment that can “cure” the underlying placental dysfunction in its early stages.
Identifying the Red Flags
Because the disease can develop in women with no prior risk factors, vigilance is the only reliable tool. While some women may have higher risk profiles—such as those with obesity, diabetes, chronic hypertension, or those carrying multiples—anyone can develop the condition.
Medical professionals emphasize a set of “red flags” that should never be dismissed as part of a normal pregnancy. When these symptoms appear, immediate medical evaluation is required.
| Normal Pregnancy Sensation | Preeclampsia Red Flag |
|---|---|
| Mild ankle/foot swelling | Sudden swelling in face and hands |
| General tiredness | Severe, persistent headaches |
| Occasional shortness of breath | Acute difficulty breathing/pulmonary congestion |
| Mild indigestion/heartburn | Sharp pain in the upper right abdomen |
| Occasional blurred vision | Seeing spots or significant visual disturbances |
The Path to Diagnosis and the HELLP Variant
Diagnosis relies on a combination of blood pressure monitoring and laboratory tests. A blood pressure reading of 160/110 mmHg or higher is generally categorized as preeclampsia with severe features. Doctors also screen for proteinuria (protein in the urine) and conduct blood panels to check kidney function, liver enzymes, and platelet counts.
A particularly dangerous variant is HELLP syndrome—an acronym for Hemolysis, Elevated Liver enzymes, and Low Platelets. HELLP is an aggressive form of the condition that can occur even in the absence of high blood pressure or protein in the urine, making it an exceptionally misleading diagnosis.
“Because many other diseases can cause changes in liver function during pregnancy, it can be very misleading,” Dr. Bernholtz explains. In these ambiguous cases, doctors may use the sFlt-1/PlGF ratio—an advanced blood test that examines specific proteins to assess the likelihood of developing the condition.
The Critical Decision: When to Deliver
The only definitive treatment for preeclampsia is the delivery of the baby and the placenta. However, this creates a medical paradox when the condition arises early in the pregnancy. Doctors must balance the life-threatening risk to the mother against the complications of extreme prematurity for the infant.
In cases where time can be bought, physicians administer corticosteroids to accelerate the maturation of the fetus’s lungs and magnesium sulfate to protect the fetal brain from hemorrhage. This 48-hour window is often the difference between survival and long-term disability for a premature newborn, but It’s a gamble that cannot be taken if the mother’s condition is deteriorating rapidly.
The risks of inaction are severe. For the mother, preeclampsia can lead to eclampsia (seizures), brain hemorrhage, and death. For the fetus, it can cause placental abruption or intrauterine growth restriction. In the Western world, hypertensive disorders of pregnancy remain among the leading causes of maternal mortality.
Preventive Steps and Support
For women with a history of preeclampsia, the best defense is early intervention. This often includes pre-pregnancy evaluations and the use of low-dose aspirin to reduce risk. It is also vital for partners and family members to remain alert. If a pregnant woman appears to be suffering in a way that exceeds the typical discomfort of pregnancy, insisting on a medical re-evaluation can be life-saving.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
The investigation into the death of Reut Cohen continues as officials work to determine the exact cause of the tragedy. The findings may provide critical insights into the timing of symptom onset and the efficacy of early detection protocols in high-risk twin pregnancies.
Do you have experience with high-risk pregnancy or thoughts on maternal health awareness? Share your story in the comments below or share this article to help other expecting parents recognize the red flags.
