EM Vivas · Pre-eclampsia and eclampsia (ED)
Eclampsia in the ED — magnesium and the three pillars
Viva on eclamptic seizure management and Magpie/Collaborative Eclampsia Trial evidence.
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ACEMFRCEMABEM
Prompt
A woman at 37 weeks has a generalised seizure in triage. BP 170/110 after the fit. Discuss your minute-by-minute management and the evidence for magnesium.
Interpretation
Reveal interpretationShowHide
Protect airway, left lateral, high-flow oxygen, IV access. Treat as eclampsia until proven otherwise. Load magnesium 4 g IV over 20 min then 1 to 2 g/h; further 2 g if seizes again. Magnesium is superior to diazepam/phenytoin for recurrent seizures (Collaborative Eclampsia Trial) and halves eclampsia risk in pre-eclampsia (Magpie).[2][3] Control severe BP with labetalol/hydralazine/nifedipine; call obstetrics for delivery; continue Mg 24 h postpartum; monitor for Mg toxicity (loss of reflexes first).
References5ShowHide
- [2]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial. Lancet, 2002.PMID 12057549
- [3]Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet, 1995.PMID 7769899
- [9]Lu JF, Nightingale CH Magnesium sulfate in eclampsia and pre-eclampsia: pharmacokinetic principles Clin Pharmacokinet, 2000.PMID 10803454
- [15]Abdul MA, Nasir UI, Khan N, Yusuf MD Low-dose magnesium sulphate in the control of eclamptic fits: a randomized controlled trial Arch Gynecol Obstet, 2013.PMID 22930148
- [10]Leeman L, Dresang LT, Fontaine P Hypertensive disorders of pregnancy Am Fam Physician, 2016.PMID 26926408