What is the recommended treatment for eclampsia?

Treatment of Eclampsia

Magnesium sulfate is the first-line treatment for eclampsia, and should be administered immediately along with appropriate blood pressure management and consideration for delivery after maternal stabilization. 1

Primary Management of Eclampsia

• Magnesium sulfate is universally recommended (by 100% of clinical practice guidelines) as the first-line treatment for eclampsia 1
• For eclampsia treatment, administer magnesium sulfate with an initial dose of 4-5g IV over 5 minutes, followed by either:
  • Continuous IV infusion of 1-2g/hour, or
  • Intramuscular regimen of 10g (5g in each buttock) followed by 5g IM every 4 hours in alternating buttocks 2, 3
• Target serum magnesium level should be 3.0-6.0 mg/100mL (2.5-5 mEq/L) to control seizures 2, 3
• Monitor for magnesium toxicity by checking deep tendon reflexes (disappear at levels >4 mEq/L), respiratory rate (respiratory depression at 5-6.5 mmol/L), and urine output 2, 3

Blood Pressure Management

• Severe hypertension (BP ≥160/110 mmHg) must be treated immediately to prevent stroke and other complications 1
• First-line antihypertensive options include:
  • IV labetalol (most commonly recommended)
  • Oral nifedipine
  • IV nicardipine 1
• IV hydralazine is considered a second-line option 1
• Avoid:
  • Sublingual nifedipine (risk of precipitous BP drop)
  • Nitroprusside (risk of fetal cyanide toxicity)
  • Concomitant administration of calcium channel blockers with magnesium sulfate (risk of hypotension due to synergism) 1
• Target blood pressure should be <160/105 mmHg to prevent acute hypertensive complications 1

Additional Management

• After stabilization of the maternal condition, delivery should be considered as it is the only definitive treatment for pre-eclampsia and eclampsia 1
• If gestation is <34 weeks, administer corticosteroids for 48 hours to accelerate fetal lung maturation before delivery 1
• Provide close maternal and fetal surveillance throughout treatment 1
• Avoid diuretics as plasma volume is reduced in pre-eclampsia 1
• Have injectable calcium salt immediately available to counteract potential magnesium toxicity 2

Monitoring During Treatment

• Monitor maternal vital signs, especially respiratory rate (should remain ≥16 breaths/minute) 2
• Check deep tendon reflexes before each dose of magnesium (if absent, withhold dose until reflexes return) 2
• Ensure urine output is maintained at ≥100 mL during the four hours preceding each dose 2
• Monitor fetal heart rate, especially when using labetalol (cumulative dose should not exceed 800 mg/24h to prevent fetal bradycardia) 1
• Consider serum magnesium level monitoring, especially in patients with renal impairment 2

Post-Eclampsia Care

• Continue antihypertensive agents after delivery as hypertension may worsen between days 3-6 postpartum 1
• Switch from methyldopa to alternative antihypertensives after delivery 1
• Monitor for recurrence of pre-eclampsia symptoms, which may appear or worsen after delivery 1
• Counsel on future cardiovascular risk and recommend lifestyle modifications 1

Important Cautions

• Magnesium sulfate should not be used for more than 5-7 days in pregnancy due to risk of fetal bone abnormalities 2
• Use with caution in patients with renal impairment; maximum dosage should not exceed 20g/48 hours with frequent serum magnesium monitoring 2
• Magnesium has additive CNS depressant effects with barbiturates, narcotics, and other hypnotics; adjust dosages accordingly 2
• Aluminum toxicity can occur with prolonged parenteral administration in patients with kidney impairment 2

Eclampsia is a medical emergency requiring prompt intervention. The combination of magnesium sulfate for seizure control and appropriate antihypertensive therapy has been shown to significantly reduce maternal and fetal morbidity and mortality 4, 5.