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How to Treat Eclampsia?

Things to note:
  • Place patient in left-lateral position.
  • Clear airway. If necessary, insert oropharyngeal airway.

Medical Treatment:
If necessary:
  • Oxygen via nasal prongs or facial mask to maintain a saturation of >90%.
To prevent eclamptic seizures, magnesium sulphate is recommended for patients with severe pre-eclampsia, including imminent eclampsia. In some cases this allows for delivery to be delayed to improve neonatal outcome. When used for prevention of eclampsia, magnesium sulphate is administered for 24 hours, and then stopped. Women with severe preeclampsia should be managed under specialist care.
In high-care setting:
  • Magnesium sulphate, IV, 4 g in 200 mL sodium chloride 0.9% over 20 minutes.
Follow with:
  • Magnesium sulphate, IV infusion, 1 g/hour until 24 hours after delivery, or after the last convulsion.
Where infusion pumps are not available:
  • Magnesium sulphate, IM, 5 g every 4 hours different IM sites, until 24 hours after delivery or following the last convulsion.
Stop magnesium sulphate if knee reflexes absent or if urine output < 100 mL/ 4 hours or respiratory rate <16 breaths/minute.
If respiratory depression occurs:
  • Calcium gluconate 10%, IV, 10 mL given slowly at a rate not exceeding 5 mL/minute.
Eclamptic seizure in progress despite magnesium sulphate administration
  • Lorazepam, IV/IM, 4 mg.
    • Maximum dose: 8 mg.
  • Clonazepam, IV, 2 mg.
    • May be repeated after 5 minutes.
    • Maximum dose: 4 mg.
If above not available:
  • Diazepam, IV, 10-20 mg, not faster than 2 mg/minute.

When to refer:
  • All cases of eclampsia to a high or intensive care facility.