Eclampsia & Preeclampsia
Objective: Treat a new seizure in pregnancy, or up to 6 weeks after delivery, as eclampsia until another cause is found. Give magnesium first, per protocol. Use a left-side position and a hospital that can manage obstetrics.
Why this matters
The call comes in as a seizure. The first reach is often a benzodiazepine. Do not start there. In pregnancy, and for up to 6 weeks after delivery, magnesium is the first drug for presumed eclampsia. Eclampsia is a seizure from the high-blood-pressure disease of pregnancy. The blood pressure may not be high when you arrive. Still check the sugar. Do not treat this as an ordinary seizure. This is also not the same lesson as trauma in pregnancy.
- Are they pregnant, or did they deliver within 6 weeks?
- Check the sugar and the airway. Lay them on the left side so the uterus is off the vena cava, the large vein back to the heart.
- Magnesium is the first drug. Use a benzodiazepine only if the seizure will not stop.
- Go to a hospital that can manage obstetrics. Do not choose the closest building by habit.
Preeclampsia vs Eclampsia
- Preeclampsia is high blood pressure in pregnancy plus a sign that an organ is involved. Headache, vision change, pain under the right ribs, swelling past the ankles, and wet lungs all count. Severe-range blood pressure in pregnancy is time-critical.
- Eclampsia is a new seizure in that window without another obvious cause. Most of these seizures are brief. A seizure that will not stop still happens. That is status epilepticus.
- This can happen after the baby is born. Ask about a recent delivery. The teaching window is up to 6 weeks.
Clinical sequence
- Protect the airway first. Use a recovery position, or the left side if they are pregnant and spinal precautions do not forbid it. If they must stay on their back, push the uterus off the large vein by hand.
- Check the sugar. If it is low, treat it. See diabetic emergencies.
- Give magnesium first, per protocol. The usual teaching path is an IV loading infusion. Use the IM split dose if you have no IV. This site does not publish grams. Watch breathing. Too much magnesium can stop breathing. See the magnesium lesson.
- If the seizure continues past about 5 minutes despite magnesium, treat it as a seizure that will not stop. Use the benzodiazepine in your seizure protocol. Also think about other causes.
- After the seizure, get a blood pressure when you can on a short transport. This is not a 15-minute hospital ritual. Severe-range blood pressure is a separate protocol, including blood-pressure medicine where you are authorized. Go to a hospital that can deliver and manage critical obstetric care.
Common errors
- Reaching for a benzodiazepine first and never giving magnesium.
- Calling a seizure after delivery psychiatric or drug-related without looking for eclampsia.
- Leaving a pregnant patient flat on her back so the uterus presses on the large vein.
Practice
One-minute check
A 32-year-old delivered 10 days ago, seized once, and is now sleepy after the seizure, with a blood pressure of 180/110. Name the first drug class, the position, and the type of hospital.
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.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; your protocol still decides care
- ACOG / NAEMSP / NAEMT Model EMS Guideline: Eclampsia (2025) — mag first-line; pregnancy or up to 6 weeks postpartum; benzos if status persists
- Protocol owns dose, rate, and antihypertensives. This site does not publish milligrams or grams.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.