Severe pre-eclampsia and eclampsia — three pillars

Diagnosis: pre-eclampsia — new hypertension ≥140/90 after 20 weeks with proteinuria/end-organ features. Severe features present: BP ≥160/110, cerebral/visual symptoms, hyperreflexia.^[10]

Three pillars (parallel):

1. Magnesium sulphate seizure prophylaxis: 4 g IV over 20 minutes, then 1 g/h for 24 hours (including postpartum). Recurrent seizure: 2 g IV bolus. Monitor reflexes, respiratory rate and urine output; antidote calcium gluconate 10 mL of 10% IV. Magpie supports prophylaxis; Collaborative Eclampsia Trial supports treatment superiority over diazepam/phenytoin.^{[2][3][9][15]}
2. BP control toward ~140–150 / 90–100 (Adebayo acute-treatment target; avoid overshoot): labetalol 20 mg IV, then 40 mg then 80 mg every 20 minutes (cumulative maximum 300 mg; Vigil-De Gracia), or hydralazine 5 mg IV every 20 minutes up to five doses, or nifedipine 10 mg oral (Vermillion). Never ACEI/ARB (NICE NG133).
3. Delivery is the only cure — urgent obstetric involvement; continuous CTG; left lateral tilt; NICE NG133 limits maintenance fluids to 80 mL/hour in severe pre-eclampsia unless there are other ongoing losses.^[20][12]

Labs: FBC (platelets), LFT, U&E, coag, urine PCR; watch for HELLP.^[11]