Eclampsia is a new seizure in a woman with preeclampsia, usually after 20 weeks of pregnancy or up to several weeks after delivery. It is life threatening for both mother and baby, and magnesium sulfate is the first-line treatment.
Key symptoms
- Severe headache
- Blurred vision or flashing lights
- Pain in the upper right abdomen
- Swelling of the face and hands
- Generalized seizure
What you find on exam
- Blood pressure: 160/110 or higher is severe
- Airway, breathing and oxygen saturation after the seizure
- Brisk reflexes and level of consciousness
- Weeks of pregnancy, fundal height, fetal heart rate
Tests
- Urine protein
- Blood count, liver enzymes and kidney function for HELLP
- Blood glucose to rule out other causes
- Continuous fetal monitoring
Treatment basics
- Protect the airway, give oxygen and position on the left side
- IV or IM magnesium sulfate 4 to 6 g loading dose
- Lower severe blood pressure with labetalol, hydralazine or nifedipine
- Calcium gluconate for magnesium toxicity
- Plan delivery once the mother is stable
Red flags
- Repeated seizures
- Blood pressure of 160/110 or higher
- Loss of reflexes or slow breathing on magnesium
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.