# Eclampsia Management

> Eclampsia for FMGE obstetrics: convulsion timing, magnesium sulphate Pritchard and Zuspan regimens, toxicity monitoring, antidote and delivery planning.

- Canonical URL: https://prepelephant.com/topics/fmge/obstetrics-and-gynaecology/eclampsia-management
- Exam / course: FMGE · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Eclampsia Management", PrepElephant, https://prepelephant.com/topics/fmge/obstetrics-and-gynaecology/eclampsia-management

## Direct answer

Eclampsia is a generalised tonic-clonic convulsion in a woman with preeclampsia, most often in the third trimester or intrapartum but also up to several weeks after delivery. Immediate care follows ABC — left lateral position, airway and oxygen support — plus magnesium sulphate, the anticonvulsant of choice that the Collaborative Eclampsia Trial proved superior to diazepam and phenytoin. The Indian Pritchard regimen loads with 4 g intravenous magnesium sulphate slowly plus 10 g intramuscularly (5 g each buttock), then maintains with 5 g intramuscularly every 4 hours, monitored by reflexes, a respiratory rate of 16 or more and urine output of 25 to 30 mL per hour, with 10% calcium gluconate as antidote. Once stabilised, delivery is planned — convulsions are no bar to vaginal birth when conditions favour it.

## What you must remember

- Definition: seizures in a preeclamptic woman not attributable to other causes, typically after 20 weeks, some up to about four weeks postpartum (late eclampsia); fits occur before, during and after delivery.
- Impending signs: severe headache, visual blurring, epigastric pain, vomiting and hyperreflexia.
- Pritchard regimen: 4 g slow IV plus 10 g IM loading (5 g per buttock), then 5 g IM 4-hourly; Zuspan regimen: 4 g IV loading then 1 to 2 g per hour infusion.
- Toxicity ladder: reflexes vanish around 9 to 10 mEq/L, respiratory depression around 12, cardiac arrest higher; monitoring is clinical — reflexes present, respirations at least 16, urine at least 25 to 30 mL per hour.
- Antidote: calcium gluconate 10%, 10 mL intravenously, with airway and breathing support at the first sign of toxicity.
- Control blood pressure of 160/110 or more with intravenous labetalol or hydralazine, restrict fluids, and deliver once stable.
- Killers: cerebral haemorrhage, pulmonary oedema and aspiration; perinatal loss follows prematurity, abruption and placental insufficiency.

## Common confusion

The classic error is reaching for diazepam or phenytoin — magnesium sulphate treats and prevents fits and beat both in the Collaborative Eclampsia Trial. The second trap is stopping magnesium too early: current guidance continues 24 hours after delivery or the last fit. A postpartum fit with hypertension is still eclampsia, not epilepsy, until proved otherwise.

## Exam-focused takeaway

FMGE eclampsia questions are regimen and safety numbers: Pritchard loading (4 g IV + 10 g IM), 4-hourly 5 g maintenance, the monitoring triad, and calcium gluconate as antidote. Expect the emergency vignette — a convulsing primigravida — answered by left lateral position, airway care, magnesium loading, blood pressure control and delivery after stabilisation. The timing question (fits after delivery) and the magnesium-versus-diazepam comparison repeat almost every cycle.

## Frequently asked questions

### What is the drug of choice for eclampsia?

Magnesium sulphate, which controls and prevents fits better than diazepam or phenytoin, as shown by the Collaborative Eclampsia Trial.

### What is the Pritchard regimen?

Loading with 4 g magnesium sulphate slow IV plus 10 g IM (5 g into each buttock), then 5 g IM every 4 hours, continuing 24 hours after delivery or the last fit.

### How is magnesium toxicity detected and treated?

Clinically — loss of patellar reflexes around 9 to 10 mEq/L, then respiratory depression below 16 per minute and falling urine output; treat with calcium gluconate 10% 10 mL IV, stopping magnesium and supporting respiration.

### Can eclampsia occur after delivery?

Yes — fits are common within 48 hours of birth, and late eclampsia appears up to about four weeks postpartum, so hypertensive postpartum women remain under watch.

### When is the eclamptic mother delivered?

Once stabilised — seizures controlled, airway safe, severe hypertension treated — with the route decided obstetrically; vaginal delivery is acceptable in advanced labour with a stable fetus.