Eclampsia
Eclampsia Management Protocol
An interactive guide for managing an obstetric emergency.
Immediate Priorities
This section outlines the critical first steps in managing an eclamptic seizure. The immediate priority is maternal stabilization, focusing on airway, breathing, and circulation (ABC) while preparing for definitive seizure control.
Call for Help
Involve senior obstetric, anaesthetic, paediatric, and blood bank specialists immediately.
Position Patient
Place in the left lateral recumbent position to avoid aortocaval compression and prevent aspiration.
Airway & Oxygen
Maintain an oral airway and provide 100% oxygen via a non-rebreather mask (8–10 L/min). Monitor SpO2 > 95%.
IV Access
Establish one or two wide-bore intravenous (IV) lines immediately.
Monitor Vitals
Continuously monitor pulse, respiration, and blood pressure (every 15 mins initially).
Catheterize
Insert a Foley catheter with a urometer to monitor hourly urine output.
Seizure Control Protocol
This section provides the protocol for controlling eclamptic seizures, with a primary focus on the administration and monitoring of Magnesium Sulphate (MgSO4), the first-line treatment. Understanding the regimen, toxicity signs, and antidote is critical for patient safety.
Magnesium Sulphate (MgSO4) Regimen
Loading Dose
Administer 4 grams IV over 5–10 minutes.
(Some sources suggest 4–6 grams over 20–30 mins).
Maintenance Dose
Follow with an infusion of 1 gram/hour for at least 24 hours post-delivery.
(Some sources suggest 2 grams/hour).
Recurrent Seizures
If a seizure recurs, give an additional 2-gram IV bolus over 10 minutes.
MgSO4 Toxicity Monitoring
Monitor hourly. If signs are present, STOP infusion immediately.
- Loss of deep tendon reflexes (e.g., knee jerk)
- Respiratory depression (rate < 12/min)
- Confusion or somnolence
- Hypotension
- Urine output < 25 ml/hour
Antidote
Administer 10 mL of 10% Calcium Gluconate IV slowly over 10 minutes.
Alternative Anticonvulsants & Intubation
These are second-line options if MgSO4 is contraindicated or fails.
- Intravenous Diazepam: Inferior in efficacy to MgSO4.
- Thiopentone Sodium: For status eclampticus, under anaesthetic supervision.
- Phenytoin: Less effective than MgSO4.
- Intubation: Consider for unconscious patients, uncontrolled seizures, or signs of aspiration/hypoxia.
Blood Pressure Management
Aggressive but controlled reduction of severe hypertension is crucial to prevent maternal stroke. The goal is to lower BP to a safer range without compromising placental perfusion. Select a first-line agent below for the specific protocol.
Target Blood Pressure Range
Systolic: 140–160 mmHg | Diastolic: 90–100 mmHg
First-Line Parenteral Antihypertensives
Select a medication to view its protocol.
Fluid Balance Management
Meticulous fluid management is essential to prevent both pulmonary and cerebral edema. The core principle is fluid restriction due to intravascular depletion and endothelial dysfunction. Use the calculator below to guide fluid administration.
Key Principles
- Restrict Fluids: Aim for an infusion rate of ~1 mL/kg/hour.
- Avoid Dextrose/Crystalline Overload: Can worsen tissue edema and ARDS.
- Crystalloids First: Ringer's lactate or normal saline are the first choice for volume.
- Use Diuretics Cautiously: Only for confirmed pulmonary edema. Do not use for oliguria alone.
- Monitor CVP: Indicated for severe hypertension with oliguria.
24-Hour Fluid Limit Calculator
Delivery Planning
Delivery of the placenta is the only definitive cure for eclampsia. The decision on timing and mode of delivery is made once the mother is stabilized, balancing maternal and fetal risks. Eclampsia itself is not an absolute indication for an emergency Cesarean section.
Timing of Delivery
- At Term (≥37 weeks): No advantage in delaying delivery. Proceed once mother is stable.
- Preterm (<37 weeks): A compromise between maternal and fetal health. The goal is to stabilize and deliver if condition fails to improve within 6-8 hours.
- Preterm (<34 weeks): Administer corticosteroids for fetal lung maturity. Consider expectant management only if mother and fetus are stable and can be closely monitored in a tertiary center.
Mode of Delivery
- Vaginal Delivery: Preferred if the cervix is favorable and there are no obstetric contraindications. Induction with amniotomy and oxytocin can be performed.
- Cesarean Section: Considered for unfavorable cervix, obstetric contraindications (e.g., malpresentation), or unresponsive/worsening maternal/fetal condition. Epidural anaesthesia is preferred if coagulopathy is not present.
Management of Complications
Eclampsia is a multi-system disorder that can lead to various severe complications. This section provides a quick-reference guide for managing these potential issues. Click on each complication to see the recommended management steps.
Monitoring Checklist
Continuous and meticulous monitoring is crucial for both mother and fetus throughout the management of eclampsia and into the postpartum period. This section provides checklists for key monitoring parameters.
Maternal Monitoring
- Level of consciousness
- Vital signs (BP, HR, RR, SpO2)
- Deep tendon reflexes (hourly)
- Urine output (hourly)
- Headache, visual changes, epigastric pain
- Lab results (CBC, LFTs, U&Es, Coags)
Fetal Monitoring
- Continuous Electronic Fetal Monitoring (EFM)
- Note: Fetal bradycardia is common immediately post-seizure.
Postpartum Monitoring
- Observe in HDU/ICU
- Continue frequent BP checks
- Gradually taper antihypertensives
- Consider neuroradiologic imaging for neurological symptoms
