4.6 Eclampsia

4.6.1 Diagnosis

Convulsions during the third trimester of pregnancy, most commonly in a context of preeclampsia. Eclampsia can also occur within 48 hours after delivery.

Consider other causes of convulsions, such as meningitis and cerebral malaria (their incidence is increased in pregnant women).

4.6.2 Management

– Protect against injury, maintain airway, place in recovery position.

– Seizures: magnesium sulfate1  as for severe pre-eclampsia (Section 4.5.5). Continue treatment for 24 hours after delivery or 24 hours after the last seizure, whichever was more recent.

– Nursing care, hydration, urinary catheter insertion; monitoring as for severe pre-eclampsia (Section 4.5.5).

– Oxygen: 4 to 6 litres/minute.

– If systolic BP is ≥ 160 mmHg or diastolic BP is ≥ 110 mmHg: antihypertensive treatment as for severe pre-eclampsia (Section 4.5.5).

– Delivery imperative within 12 hours, either vaginally or by caesarean section, depending on the state of the cervix, gestational age and the condition of the foetus.

4.6.3 Secondary prophylaxis

Acetylsalicylic acid PO, as for pre-eclampsia (Section 4.5.6).

Ref Notes

If magnesium sulfate is not available, use diazepam: 10 mg by slow IV (or by rectal route), then 40 mg in a 500 ml of 5% glucose administered over 24 hours. Ventilation equipment must be immediately available.