Midwifery (RM)
Management of Eclampsia: Immediate Management
Eclampsia is a seizure in a woman with pre-eclampsia or pregnancy-related hypertension until another cause is established. Immediate management protects airway and the woman from injury, terminates and prevents seizures, controls severe hypertension, and prepares urgent definitive care.
Purpose
- Maintain airway, breathing, and circulation during and after seizure
- Prevent recurrent seizures, aspiration, injury, and stroke
- Stabilize mother and fetus and expedite appropriate birth planning
Indications
- A pregnant or postpartum woman with a generalized seizure
- Seizure with hypertension, headache, visual symptoms, or other pre-eclampsia features
- Recurrent seizure after a previous eclamptic episode
Equipment
- Emergency call and resuscitation trolley
- Airway, oxygen, suction, and monitoring equipment
- Magnesium sulphate and prescribed antihypertensive medicines
- IV and blood supplies, urinary catheter, and fluid-balance equipment
- Fetal monitoring and referral or theatre resources
Preparation
- Ensure airway, suction, oxygen, magnesium antidote pathway, antihypertensive, blood, theatre, and neonatal support.
- Use closed-loop emergency communication.
Procedure steps
- Call for help, note seizure onset, protect the woman from injury, remove hazards, and do not restrain or place objects in her mouth.
- Position laterally when possible, maintain airway, provide oxygen, suction secretions when needed, and assess breathing after convulsion.
- Check circulation, blood pressure, glucose, consciousness, and fetal status when maternal stabilization permits.
- Establish IV access and administer magnesium sulphate according to emergency protocol; treat recurrent seizure as prescribed.
- Control severe blood pressure with prescribed treatment and monitor response.
- Avoid unnecessary vaginal examination during active instability and prevent aspiration.
- Insert urinary catheter when ordered, monitor output, and balance fluids cautiously.
- Assess for trauma, pulmonary oedema, stroke, abruption, and fetal compromise.
- Arrange urgent obstetric, anaesthetic, neonatal, and theatre or transfer management after stabilization.
- Document seizure times, assessments, medications, response, communication, and plan.
Precautions
- Never leave the woman alone and never put anything in her mouth during a seizure.
- Monitor magnesium toxicity, respiratory depression, and fluid overload.
- Protect privacy and prevent injury without restraint.
- Birth is planned after stabilization; do not attempt unsafe delivery during active seizure.
Aftercare
- Continue high-dependency maternal and fetal monitoring and prepare for delivery.
- Provide post-event explanation and emotional support after stabilization.
Nursing considerations
- Prioritize ABC and safety before detailed assessment.
- Reassess continuously because seizures may recur.
Patient education
- Explain the event and emergency treatment after the woman is conscious and stable.
- Provide information about ongoing monitoring, birth planning, and postpartum risk.
Documentation
- Record seizure onset and duration, airway and breathing, vital signs, glucose, medicines and times, fetal status, response, communication, and plan.
- Document injury and handover.
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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