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Lesson

Eclampsia & Preeclampsia

12 min Medical

Objective: Treat new seizure in pregnancy or early postpartum as eclampsia until proven otherwise — magnesium first per protocol, left-lateral positioning, OB-capable destination.

Why This Is Hard

You get a seizure call, you reach for a benzo. In pregnancy and up to 6 weeks postpartum, ACOG / NAEMSP model EMS guidance says magnesium sulfate is first-line for presumed eclampsia. BP may not even be high when you arrive. Glucose still gets checked. This is not “just a seizure” and not a trauma-in-pregnancy copy (that lesson is here).

Say out loud
  • Pregnant or postpartum ≤6 weeks?
  • Glucose, airway, left lateral / uterus off the cava
  • Magnesium is the eclamptic drug class — benzos if it will not stop
  • OB-capable destination, not “closest forever”

Preeclampsia vs Eclampsia (Education)

  • Preeclampsia: hypertension in pregnancy plus end-organ clues (headache, visual change, RUQ pain, edema that is more than ankles, pulmonary edema). ACOG EMS companion guidance treats severe-range BP in pregnancy as time-critical.
  • Eclampsia: new-onset seizure without another obvious cause in that window. Most eclamptic seizures are brief. Status still happens.
  • Can occur postpartum. Ask about a recent delivery. The 6-week window is the teaching net.

Street Sequence

  1. Protect the airway; recovery position / left lateral if gravid and not in spinal precautions that forbid it. Manual uterine displacement if they need to stay supine.
  2. Glucose. If it is hypo, treat that (see diabetic emergencies).
  3. Magnesium per protocol (IV loading infusion is the ACOG EMS teaching path; IM split-dose if no IV). This site does not publish grams. Watch ventilation — mag toxicity is real (see magnesium lesson).
  4. If seizure continues past about 5 minutes despite mag, treat as status: benzos per your seizure protocol, and think other causes.
  5. After the seizure: BP every 15 minutes. Severe-range BP is a separate protocol (anti-hypertensives where authorized). Destination: hospital that can deliver and manage OB critical care.

Field Pitfalls

  • Benzo-first habit that never considers mag.
  • Calling a postpartum seizure “psych” or “drug” without an eclampsia look.
  • Supine hypotensive syndrome while you “wait and see.”

Practice

60-second drill

Partner: 32-year-old, delivered 10 days ago, seized once, now post-ictal, BP 180/110. Name drug class first, position, and destination type.

Related: Seizure & Status, Magnesium, Trauma in Pregnancy.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.

1. New seizure in a patient who delivered 2 weeks ago should make you think:
2. ACOG/NAEMSP EMS teaching for presumed eclampsia uses:
3. A gravid patient who seized and is now supine and hypotensive:
4. Eclamptic patients should go to:
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