This document provides guidance on recognizing and managing eclampsia and severe preeclampsia. The key principles are to stabilize the mother, treat and prevent seizures, control blood pressure, monitor fluid balance, and be aware of potential complications. Magnesium sulfate is the anticonvulsant of choice for preventing and treating seizures. Delivery should be expedited if there are repeated seizures, fetal distress, or an unfavorable cervix. Close monitoring of vital signs, urine output, reflexes and other factors is important both during treatment and in the postpartum period to watch for worsening symptoms or delayed onset of eclampsia.

1. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
LiverpoolAssociates in Tropical Health
Eclampsia and severe
preeclampsia
Eclampsia and Severe
Pre-eclampsia

2. Aims
 To recognise eclampsia and severe pre-
eclampsia
 To practise an effective response to a
woman with eclampsia (fit) or severe
pre-eclampsia
 To achieve competence in those skills

3. Principles of management
 Stabilise mother and then deliver fetus
 Treat and prevent fits
 Treat blood pressure
 Attention to fluid balance
 Be aware of and prevent complications

4. Signs and Symptoms of Pre-Eclampsia
• Headache
• Blurred vision
• Upper epigastric pain
• Hyperreflexia/clonus
Diagnosis:
BP > 140/90
Urine protien +

5. Eclampsia - recognition
 Fitting or unconscious

6. Management of fits

7. Fitting or unconscious
 Call for help
 Recovery position
 Open and maintain airway
 iv access and give magnesium sulphate
 1 litre Ringer’s lactate to be given very
slowly iv

8. Magnesium sulphate
 The anticonvulsant of choice
 Loading dose is given IV and IM
 4g given IV (dilutent N/S!)
 10g IM (diluent 2% Lignocaine)
 Give 5g to each buttock
 If unable to give IV loading dose give IM
loading dose only

9. Magnesium Sulphate: Maintenance
dose
IV route
 Magnesium sulphate (10g) in 1000 ml normal
Saline IV infusion at rate of 1g/hour
OR
IM route
 After loading dose continue with 5 g IM every 4
hours
Continue maintenance dose until 24 hours
after birth or 24 hours after last convulsion

10. Magnesium caution!
 Do not give the next dose of magnesium if
 Absent knee jerk
 Urine output less than 100 mls in last 4
hours
 Respiratory rate less than 16 breaths per
minute

11. • If respiratory rate less than 16 breaths /
minute stop magnesium and give
calcium gluconate 1 g iv over 10
minutes

12. Magnesium Sulphate
 If convulsions recur give an additional
2-4g iv over 10-15 minutes
 Consider giving lower dose (2g) if
patient is small and/ or weight is less
than 70kgs

13.  Magnesium sulphate has various
concentrations
 For IV injection concentration of
magnesium should not exceed 20%
 20% solution=200mg/ml

14. Diazepam
 Only use if magnesium not available or
magnesium toxicity develops

15. Blood pressure
 Uncontrolled blood pressure leads to
intracranial haemorrhage and death
 Monitor
 Treat if BP diastolic >110 mm Hg or
systolic >160 mmHg
 Nifedipine, hydralazine, labetalol
according to local protocol

16. Delivery
 Assess fetal heart, gestational age, lie of the
baby and assess cervix
 Vaginal delivery or CS?
 Vaginal if no maternal or fetal distress, no
obstetric contraindication and cervix
favourable
 CS if repeated fits, fetal distress or
unfavourable cervix

17. Fluid
 Careful fluid balance required
 Capillaries are ‘leaky’ therefore control fluid
input to prevent pulmonary oedema
 Monitor closely via fluid in and output chart
 Restrict iv fluids to 30 drops per minute

18. Complications of (pre) eclampsia
 Brain
 Lung
 Liver
 Clotting (abruption, DIC)
 Heart
 Kidney
 Eye
 Fetal
 Death

19. Monitor!
 HR
 BP
 Urine Output
 RR
 Reflexes
 Fluid in and output
 Temperature
 Fundi
 Bloods (platelets, clotting, Hb,
renal function)

20. After delivery
 Monitor, monitor, monitor
 Remember (pre-)eclampsia get worse or
first fit can occur in post partum period
 Continue magnesium for 24 hours after
delivery or after last fit – no need to “tail
off”

21. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
LiverpoolAssociates in Tropical Health
??

22. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
LiverpoolAssociates in Tropical Health
RECAP
Recognition of Eclampsia and Severe pre-
eclampsia
Management of fits and blood pressure
Decision on delivery
Monitoring of patient
Complications