Doctors Revision

Obstetrics

Eclampsia

The occurrence of one or more generalized tonic-clonic seizures in a woman with pre-eclampsia, occurring after 20 weeks gestation, during labour, or postpartum, in the absence of other neurological conditions.

Open in the interactive guide
On this page

Referral and warning signs

When to refer

MEDICAL EMERGENCY requiring IMMEDIATE management and URGENT TRANSFER to Hospital (H/RR) capable of intensive monitoring, MgSO4, BP control, delivery (incl C/S), neonatal care.

Red flags

  • Occurrence of seizure(s)
  • Uncontrolled severe hypertension
  • Signs of end-organ damage
  • Signs of fetal distress
  • Coma / Altered consciousness

Signs and symptoms

  • Generalized tonic-clonic seizures.
  • Often preceded by severe pre-eclampsia symptoms (headache, vision changes, epigastric pain).
  • Hypertension (>=140/90).
  • Proteinuria.
  • Post-ictal confusion/drowsiness.
  • Potential coma.
  • May have signs of end-organ damage.

Risk factors

  • Pre-eclampsia (esp. severe/progressing).
  • Risk factors for pre-eclampsia.

Diagnosis

Clinical assessment

Seizure(s) in pregnant/postpartum woman + evidence of pre-eclampsia (HTN +/- proteinuria), after excluding other causes (epilepsy, malaria, meningitis, stroke, hypoglycemia).

Investigations

  • Urgent vitals check (BP).
  • Urine protein.
  • Blood glucose.
  • Assess for severe PE complications (HELLP labs - FBC, LFTs, RFTs).
  • Malaria test (endemic).
  • Consider CT/MRI head if atypical.

Diagnostic criteria

New onset tonic-clonic seizures + evidence of pre-eclampsia.

Management

Non-pharmacological management

  • Immediate (During Seizure): Call for help, Protect from injury, Left lateral position post-seizure, Maintain airway (suction), Oxygen.
  • General: Stabilize (ABCDE), Continuous monitoring, Urinary catheter, Careful fluid balance.

Pharmacological treatment

  • Control Seizures: Magnesium Sulphate (MgSO4) DRUG OF CHOICE. Loading Dose (4g IV over 20min + 10g IM total). Maintenance Dose (5g IM Q4H). Monitor for Toxicity (RR, Reflexes, Urine Output). Antidote (Calcium Gluconate). If Recurrence (2g IV slowly). If MgSO4 unavailable (Diazepam IV loading + infusion - less effective).
  • Control Severe HTN (BP >=160/110): IV Labetalol/Hydralazine or Oral Nifedipine (as per Severe PE protocol).
  • Delivery: Stabilize mother FIRST, then plan delivery (vaginal/C-S) usually within 6-12h regardless of gestation.

Monitoring

Continuous vitals, RR, reflexes, urine output (hourly). FHR. Monitor for recurrent seizures. Monitor BP.

Complications

  • Maternal: Stroke, Pulmonary oedema, AKI, Liver failure/rupture, HELLP, DIC, Aspiration, Arrest, Death.
  • Fetal/Neonatal: Hypoxia, IUGR, Preterm birth, Abruption, Stillbirth/Death.

Prevention

  • Early detection/management of pre-eclampsia.
  • Timely MgSO4 for severe pre-eclampsia.
  • Appropriate timing of delivery.

Patient education

  • (Post-recovery): Explanation of eclampsia. Importance of MgSO4/antihypertensives. Reason for delivery. Postpartum monitoring. Future pregnancy risks/management. Contraception.

Uganda-specific notes

Leading cause of maternal death. Prompt MgSO4 (even pre-referral) critical. Airway management essential. Urgent transfer vital.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 16, Section 16.3.8

Scroll to Top