Eclampsia
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults, Updated for the 2023 Edition
O15.0-2/O15.9
DESCRIPTION
Generalised tonic-clonic seizures after 20 weeks of pregnancy or within 7 days after delivery associated with hypertension and proteinuria. Exclude any other obvious cause of the seizure before making the diagnosis. Management will include preventing further seizures, controlling the blood pressure, referral to a high-care unit, and delivery of the baby if not already post-delivery.
GENERAL MEASURES
Place patient in left-lateral position.
Clear airway. If necessary, insert oropharyngeal airway.
Abort seizures with magnesium sulphate [sulfate].
MEDICINE TREATMENT
If necessary:
- Oxygen via nasal prongs or face mask to maintain a saturation of >90%.
Treatment
Where infusion pumps are not available:
-
Magnesium sulphate [sulfate], IV, 4 g in 200 mL sodium chloride 0.9% over 20 minutes.
Follow with:
-
Magnesium sulphate [sulfate], IM, 5 g every 4 hours administered at different sites, until 24 hours after delivery or following the last convulsion.
In high-care setting:
-
Magnesium sulphate [sulfate], IV, 4 g in 200 mL sodium chloride 0.9% over 20 minutes (loading dose).
Follow with:
-
Magnesium sulphate [sulfate], IV infusion, 1 g every hour, until 24 hours after delivery, or after the last convulsion (maintenance dose).
STOP MAGNESIUM SULPHATE [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 exceeding 5 mL/minute.
Recurrent eclamptic seizure despite magnesium sulphate [sulfate] loading dose administration:
-
Magnesium sulphate [sulfate], IV, 2 g over 10 minutes.
For agitated and restless women with eclampsia:
- Lorazepam, IV/IM, 4 mg.
- May be repeated after 10-15 minutes.
- Maximum dose: 8 mg.
OR
- Clonazepam, IV, 2 mg.
- May be repeated after 5 minutes.
- Maximum dose: 4 mg.
OR
If above not available:
- Diazepam, IV, 10–20 mg, not faster than 2 mg/minute.
|
Notify the person who will resuscitate the newborn that a benzodiazepine and/or magnesium has been given to the mother. |
REFERRAL
Refer all eclampsia cases to a high or intensive care facility.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026
Chapter 6 Obstetrics_6.4 Hypertensive Disorders in Pregnancy_6.4.2 Eclampsia