Eclampsia
General measures Medicine treatment Referral O15.0-2/O15.9 GENERAL MEASURES Stabilise prior to urgent referral. Ensure safe airway. Place patient in left lateral position. Insert a Foley’s catheter and monitor urine output hourly. Monitor BP and check reflexes every 30 minutes. MEDICINE TREATMENT Administer oxygen. Magnesium sulfate, IV, 4 g as a loading dose diluted with 200 mL sodium chloride 0
General measures
Medicine treatment
Referral
O15.0-2/O15.9
GENERAL MEASURES
- Stabilise prior to urgent referral.
- Ensure safe airway.
- Place patient in left lateral position.
- Insert a Foley’s catheter and monitor urine output hourly.
- Monitor BP and check reflexes every 30 minutes.
MEDICINE TREATMENT
- Administer oxygen.
- Magnesium sulfate, IV, 4 g as a loading dose diluted with 200 mL sodium chloride 0.9% and infused over 20 minutes
AND
- Magnesium sulfate, IM, 10 g given as 5 g in each buttock
- Then IM, 5 g every 4 hours in alternate buttocks
CAUTION: USE OF MAGNESIUM SULFATE
Stop magnesium sulfate if knee reflexes become 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 > 5 mL/minute
If recurrent eclamptic seizures despite magnesium sulfate loading dose administration:
- Magnesium sulfate, IV, 2 g, diluted with 100 mL sodium chloride 0.9%, over 10 minutes.
LoE:IVb24
If seizures still persist and are continuous, there may be another cause of the seizures: treat as for status epilepticus (see: Seizures and status epilepticus).
AND
If systolic BP ≥ 160 and/or a diastolic BP ≥ 110 mmHg and patient becomes alert:
- Nifedipine, oral, 10 mg (not sublingual) as a single dose.
- May be repeated after 30 minutes if diastolic BP remains ≥ 110 mmHg or if systolic BP remains ≥ 160 mmHg.
LoE:Ia25
REFERRAL
Urgent
All cases.
Click here to access the pdf.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026
Chapter 6: Obstetrics and Gynaecology_6.4.2.5 Eclampsia