4.6 Eclampsia

4.6.1 Diagnosis

Convulsions during the third trimester of pregnancy, most commonly in a context of pre-eclampsia.
Eclampsia can also occur within 48 hours after delivery (and up to 6 weeks after delivery).

Consider other causes of convulsions, such as meningitis and severe 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 4.5.4). Continue treatment for 24 hours after delivery or 24 hours after the last seizure, whichever was more recent.
– Nursing care, hydration, Foley catheter insertion; monitoring as for severe pre-eclampsia (Section 4.5.4).
– Oxygen: 4 to 6 litres/minute.
– If SBP ≥ 160 mmHg or DBP ≥ 110 mmHg: antihypertensive treatment as for severe pre-eclampsia (Section 4.5.4).
– Delivery within 24 hours, either vaginally or by caesarean section, depending on the state of the cervix, gestational age and condition of the foetus.

4.6.3 Secondary prophylaxis

Administer acetylsalicylic acid PO, as for pre-eclampsia (Section 4.5.5).

Ref Notes

If magnesium sulfate is not available, use diazepam: 10 mg 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.