Eclampsia / Severe Pre-eclampsia — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Severe features / seizure
   Hypertension in pregnancy/postpartum — seizure or severe features? (Severe pre-eclampsia features: BP ≥160/110; or pre-eclampsia with end-organ involvement (platelets <100,000, raised creatinine, raised liver enzymes/RUQ pain, pulmonary edema, cerebral or visual symptoms). Eclampsia = seizure in pregnancy or postpartum.)
   • Eclampsia (seizure) → Eclampsia (seizure)
   • Severe pre-eclampsia (no seizure) → Severe pre-eclampsia
   • No severe features → No severe features
2. [End] No severe features
   Pre-eclampsia/gestational hypertension without severe features: close maternal-fetal monitoring (BP, symptoms, labs, fetal monitoring), control BP to target, assess timing of delivery; escalate immediately if severe features appear.
3. [End] Severe pre-eclampsia
   1) Magnesium sulfate for seizure prophylaxis: loading 4–6 g IV (over 15–30 min) → maintenance 1–2 g/h, continued to 24 h postpartum (contraindicated in myasthenia gravis; rescue overdose with calcium gluconate). 2) First-line antihypertensives for severe hypertension (sustained ≥160/110): labetalol 20 mg IV → 40 → 80 mg q10min (or hydralazine 5–10 mg, or immediate-release nifedipine 10 mg PO), target SBP 140–150, DBP 90–100. 3) Assess and plan delivery. Monitor mother and fetus.
4. [End] Eclampsia (seizure)
   1) Protect the airway, lateral position, prevent aspiration and injury, oxygen. 2) Magnesium sulfate loading 4–6 g IV (over 15–30 min) → 1–2 g/h, an extra 2 g for recurrence; if magnesium fails/contraindicated, use a benzodiazepine or levetiracetam. 3) Control severe hypertension (labetalol/hydralazine/nifedipine, target SBP 140–150). 4) Once the mother is stable, deliver as soon as possible. Monitor for magnesium toxicity (loss of deep tendon reflexes, respiratory depression).

Source guidelines & references

• ACOG Practice Bulletin: Gestational Hypertension and Preeclampsia
• WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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