ECLAMPSIA: Seizure in Pregnancy/Postpartum
New-onset tonic-clonic seizure in patient with preeclampsia or unexplained in pregnancy
All Pathways
Obstetrics & GynecologyEmergency
Eclampsia & Severe Preeclampsia Management (ACOG 2020)
Eclampsia & Severe Preeclampsia Management (ACOG 2020): ECLAMPSIA: Seizure in Pregnancy/Postpartum → Eclampsia: Immediate Actions → Magnesium Sulfate - ...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action Eclampsia: Immediate Actions
Protect patient, establish airway, give magnesium
- Call for help - activate emergency response
- Position patient on left side
- Protect from injury - padded bed rails
- Suction secretions, maintain airway
- Apply oxygen via face mask
- Establish IV access
03Action Magnesium Sulfate - Loading
Immediate seizure control and prevention
- Loading: MgSO4 4-6g IV over 15-20 minutes
- If seizure recurs: additional 2g IV bolus
- Maintenance: 1-2g/hour continuous IV infusion
- Monitor: reflexes, respiratory rate, urine output
- Keep calcium gluconate at bedside (antidote)
04Action Acute Blood Pressure Control
Target: <160/110 mmHg within 30-60 minutes
- FIRST LINE: Labetalol 20mg IV, then 40mg, then 80mg q10min (max 300mg)
- OR Hydralazine 5-10mg IV q20min (max 20mg)
- OR Nifedipine IR 10-20mg PO q20min (max 50mg in 1hr)
- If refractory: Nicardipine or Esmolol infusion
- Avoid precipitous drops - risk of placental hypoperfusion
- Continuous fetal monitoring during treatment
05Decision Gestational Age Assessment
Determine timing of delivery
06Action ≥34 weeks: Deliver
Delivery indicated for severe preeclampsia at ≥34 weeks
- Stabilize BP and initiate magnesium
- Mode of delivery based on obstetric factors
- Induction of labor appropriate if cervix favorable
- Cesarean if urgent maternal/fetal indications
- Continue magnesium through delivery and 24h postpartum
07Decision HELLP Syndrome Present?
Hemolysis, Elevated Liver enzymes, Low Platelets
- Hemolysis: LDH >600, schistocytes, bilirubin >1.2
- Elevated liver enzymes: AST/ALT >2x normal
- Low platelets: <100,000/μL
08Action HELLP Syndrome Management
High-risk - delivery usually indicated
- Delivery is definitive treatment
- Platelet transfusion if <20K or <50K with bleeding/surgery
- Correct coagulopathy with FFP if needed
- Monitor for liver hematoma/rupture (RUQ pain)
- CT/MRI if suspect hepatic complications
- Dexamethasone controversial - limited evidence
09Outcome Patient Stabilized - Continued Care
Ongoing monitoring and supportive care
10Outcome Postpartum Monitoring
Continue monitoring, gradual resolution expected
- Continue magnesium 24-48 hours postpartum
- BP monitoring every 4 hours
- Most patients improve within 48 hours
- May worsen initially postpartum - remain vigilant
- Antihypertensives for BP >150/100
- Counsel on recurrence risk (15-25% next pregnancy)
- Path rejoins step 09Shared downstream outcome
11Action <34 weeks: Stabilize & Consider Expectant
Balance prematurity risks vs. disease progression
- Betamethasone 12mg IM x2 doses, 24h apart
- Stabilize BP and initiate magnesium
- Expectant management at facility with maternal-fetal medicine
- 24-48h for steroid benefit if stable
- Serial labs: CBC, LFTs, Cr q6-12h
- Continuous fetal monitoring
12Warning Indications for Immediate Delivery
Do NOT delay for steroids
- Uncontrolled severe hypertension despite maximum therapy
- Eclampsia
- Pulmonary edema
- Placental abruption
- DIC
- Non-reassuring fetal status
- Persistent severe symptoms despite treatment
- Path rejoins step 07Shared downstream outcome
- Path rejoins step 06Shared downstream outcome
Guideline Source
ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address chronic hypertension in pregnancy
- Antihypertensive dosing may need institutional adjustment
- HELLP syndrome requires additional specialized management
- Does not address atypical preeclampsia presentations
Applicable Regions
USEUGlobal
UK: NICE guidelines may vary slightly on thresholds
US: Based on ACOG 2020 guidelines
Version 1Next review: 2027-01-01
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Related Resources
Frequently Asked Questions
What is the Eclampsia & Severe Preeclampsia Management (ACOG 2020)?
The Eclampsia & Severe Preeclampsia Management (ACOG 2020) is a emergency clinical algorithm for Obstetrics & Gynecology. It provides a structured decision tree to guide clinical decision-making, based on ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia.
What guideline is the Eclampsia & Severe Preeclampsia Management (ACOG 2020) based on?
This algorithm is based on ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia (DOI: 10.1097/AOG.0000000000003891).
What are the limitations of the Eclampsia & Severe Preeclampsia Management (ACOG 2020)?
Known limitations include: Does not address chronic hypertension in pregnancy; Antihypertensive dosing may need institutional adjustment; HELLP syndrome requires additional specialized management; Does not address atypical preeclampsia presentations. Individual patient factors may require deviation from these recommendations.
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