Seizure on day 11 after birth — postpartum eclampsia emergency station

Team-based emergency station: late postpartum eclampsia in a woman with no antenatal hypertension. Tests immediate seizure management, magnesium and blood pressure control with named doses, active exclusion of the mimics, closed-loop team leadership, and communication with a frightened partner. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 27-year-old woman gave birth vaginally 11 days ago at 40 weeks. Her pregnancy was entirely normal and every antenatal blood pressure was recorded below 130/80 mmHg. She was brought to the emergency department by ambulance after a witnessed generalised tonic-clonic seizure at home lasting 90 seconds. She is now drowsy but rousable. Blood pressure 186/118 mmHg, pulse 104 bpm, oxygen saturation 96 per cent on room air, temperature 36.8 degrees Celsius, capillary glucose 5.4 mmol per litre. Her partner and her 11-day-old baby are with her. You are the obstetric registrar; the consultant is 20 minutes away.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar in a tertiary emergency department. An emergency physician, a nurse and a midwife are available; the obstetric consultant has been called and is 20 minutes away. The assessor runs the clock and feeds new observations. ^[2]

Candidate instruction. Lead the management of this woman. Verbalise your actions, your drug orders with doses, your differential, your escalation triggers, and your communication with the team and with her partner. ^[2]^[4]

References6Show

[1]Chames MC, Livingston JC, Ivester TS, Barton JR, Sibai BM Late postpartum eclampsia: a preventable disease? Am J Obstet Gynecol, 2002.PMID 12066093
[2]Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
[3]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
[4]Brown MA, Magee LA, Kenny LC, et al. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice Hypertension, 2018.PMID 29899139
[5]Alhazmi AM, Albulushi A Targeted antihypertensive therapy after hypertensive pregnancy: Lactation-safe choices, treatment thresholds, and outcomes (2015-2025) Curr Probl Cardiol, 2025.PMID 41077107
[6]Garneni M, Huang A, Obionu I, Mahmoud Z Persistent and de novo postpartum hypertension: a scoping review of pathophysiology, evaluation, and management NPJ Cardiovasc Health, 2026.PMID 42082630

Seizure on day 11 after birth — postpartum eclampsia emergency station

Station brief

References6Show

[1]Chames MC, Livingston JC, Ivester TS, Barton JR, Sibai BM Late postpartum eclampsia: a preventable disease? Am J Obstet Gynecol, 2002.PMID 12066093
[2]Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
[3]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
[4]Brown MA, Magee LA, Kenny LC, et al. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice Hypertension, 2018.PMID 29899139
[5]Alhazmi AM, Albulushi A Targeted antihypertensive therapy after hypertensive pregnancy: Lactation-safe choices, treatment thresholds, and outcomes (2015-2025) Curr Probl Cardiol, 2025.PMID 41077107
[6]Garneni M, Huang A, Obionu I, Mahmoud Z Persistent and de novo postpartum hypertension: a scoping review of pathophysiology, evaluation, and management NPJ Cardiovasc Health, 2026.PMID 42082630