Management of Eclampsia

Seizure Control and Prevention

The American College of Obstetricians and Gynecologists recommends magnesium sulfate as the first-line agent for eclamptic seizures, with a standard loading dose of 4-6 g IV over 10-15 minutes, followed by maintenance dosing, which approximately halves the seizure rate in patients with preeclampsia 1, 2.
Magnesium sulfate should be continued for 24 hours postpartum in most cases, as recommended by clinical guidelines 1.

The European Society of Cardiology recommends urgent antihypertensive treatment for blood pressure >160/110 mmHg lasting >15 minutes, with first-line agents including oral nifedipine, IV labetalol, and IV hydralazine 3, 4, 5, 2.
The American Heart Association recommends oral nifedipine 10 mg PO, repeat every 20 minutes to maximum 30 mg, and IV labetalol 20 mg bolus, then 40 mg after 10 minutes, then 80 mg every 10 minutes to maximum 220 mg, for acute severe hypertension 5, 2.

The American College of Cardiology states that ACE inhibitors, such as enalapril, are absolutely contraindicated in the second and third trimesters due to risk of fetal renal dysgenesis 6.
The European Society of Cardiology warns against combining magnesium sulfate with calcium channel blockers, such as nifedipine, without careful monitoring, as this can cause precipitous blood pressure drops and myocardial depression 1, 6.
The American College of Obstetricians and Gynecologists recommends limiting total fluid intake to 60-80 mL/hour to prevent pulmonary edema in preeclamptic patients 1, 6.

The American College of Obstetricians and Gynecologists recommends planning delivery at 35 weeks with eclampsia, once maternal condition is stabilized, as the presence of a seizure with severe hypertension constitutes an indication for delivery regardless of gestational age 2, 6.
Magnesium sulfate should be continued through delivery and for 24 hours postpartum, as recommended by clinical guidelines 1, 2, 6.