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# Eclampsia

Eclampsia is new seizures in a pregnant or recently delivered woman with preeclampsia. It is an emergency for mother and baby.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [White matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/)
- [Occipital lobe](https://durgical.com/en/anatomy/superior-occipital-gyri/)
- [Liver](https://durgical.com/en/anatomy/liver/)
- [Kidneys](https://durgical.com/en/anatomy/kidney/)

## In embryology

- [Placenta: structure, circulation and functions](https://durgical.com/en/embryology/placenta-structure-circulation-and-functions/)

## Why it happens

- [Cerebral blood flow, brain metabolism and intracranial pressure](https://durgical.com/en/physiology/cerebral-blood-flow-brain-metabolism-and-intracranial-pressure/)
- [Placenta](https://durgical.com/en/histology/placenta/)

## What it is

New-onset generalised tonic-clonic seizures, or coma, in a woman with preeclampsia that are not explained by another brain disorder. It can happen before, during or after delivery, most often around birth and in the first days postpartum.

## Who gets it

Hypertensive disorders of pregnancy, including preeclampsia and eclampsia, are among the leading direct causes of maternal death worldwide and in Latin America, together with haemorrhage and infection. Eclampsia is far more common and more deadly where access to antenatal care and timely delivery is limited.

## Causes

- Complication of preeclampsia (placental disease with endothelial dysfunction)
- Can appear in women whose blood pressure was only mildly raised, or postpartum without a previous diagnosis
- Seizures are linked to cerebral vasogenic oedema and loss of cerebral blood-flow autoregulation

## Risk factors

- Preeclampsia, especially with severe features or HELLP syndrome
- First pregnancy and adolescent mothers
- Previous preeclampsia or eclampsia
- Chronic hypertension, diabetes, [kidney](https://durgical.com/en/anatomy/kidney/) disease, obesity
- Multiple pregnancy and hydatidiform mole
- Little or no antenatal care

## Pathophysiology

Abnormal remodelling of the spiral arteries leaves the placenta under-perfused, and it releases anti-angiogenic factors that injure the maternal endothelium. In the brain, very high or rapidly rising pressure overwhelms autoregulation, causing vasogenic oedema mainly in the posterior [white matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/) (posterior reversible encephalopathy) that lowers the seizure threshold.

## Classification

- Antepartum eclampsia (before labour)
- Intrapartum eclampsia (during labour)
- Postpartum eclampsia (after delivery, including late postpartum, beyond 48 hours)

## Symptoms and signs

- Generalised tonic-clonic seizure, usually brief, followed by a postictal phase
- Warning symptoms before the seizure: severe persistent headache, blurred vision, flashing lights
- Right upper quadrant or epigastric pain
- Brisk reflexes and agitation or confusion
- High blood pressure; proteinuria and oedema are common but not always present

## Red flags

- Repeated seizures or failure to wake between them
- Blood pressure in the severe range (systolic ≥160 or diastolic ≥110 mmHg)
- Focal neurological signs or sudden blindness (possible stroke or haemorrhage)
- Shortness of breath from pulmonary oedema
- Abdominal pain with vaginal bleeding or a rigid uterus (placental abruption)
- Fetal heart rate abnormalities after the seizure

## Diagnosis

**Clinical**
Diagnosed clinically: a seizure in a woman with preeclampsia or with hypertension and proteinuria or signs of organ involvement, when no other cause is evident. Assessment includes airway, breathing, blood pressure, consciousness, reflexes and fetal well-being.

**Tests**
Complete blood count with platelets, [liver](https://durgical.com/en/anatomy/liver/) enzymes, LDH, creatinine, uric acid and urine protein to look for HELLP syndrome and organ damage; coagulation tests; glucose and electrolytes to exclude other causes of seizure.

**Imaging**
Not needed for typical cases. CT or MRI of the brain when there are focal signs, atypical timing or persistent coma; MRI often shows posterior white-matter oedema. Obstetric ultrasound and fetal monitoring assess the baby and the placenta.

## Differential diagnosis

- Epilepsy or other pre-existing seizure disorder
- Stroke, intracerebral or subarachnoid haemorrhage, cerebral venous thrombosis
- Hypoglycaemia or electrolyte disturbance (hyponatraemia)
- CNS infection (meningitis, encephalitis) or brain tumour
- Drug or toxin-related seizures and thrombotic thrombocytopenic purpura

## Goal of treatment

Protect the airway and the mother during the seizure, stop and prevent further seizures, control severe hypertension to avoid stroke, and plan delivery once the mother is stable, which is the definitive treatment.

## Treatment

**Acute**
Call for help, protect the woman from injury, place her on her left side, secure the airway and give oxygen; do not try to stop the seizure by restraint.

**Medical**
Magnesium sulfate is the drug of choice to stop eclamptic seizures and to prevent recurrence; it is superior to diazepam and phenytoin. Calcium gluconate is the antidote for magnesium toxicity.

**Medical**
Antihypertensives for severe-range blood pressure, such as intravenous labetalol or hydralazine, or oral immediate-release nifedipine.

**Procedure**
Delivery after the mother is stabilised, by induction or caesarean section depending on obstetric conditions; the seizure itself is not an indication for immediate caesarean.

**Follow-up**
Nursing priorities: hourly patellar reflexes, respiratory rate, oxygen saturation and urine output while on magnesium; blood pressure, fluid balance (risk of pulmonary oedema), level of consciousness and continuous fetal monitoring, continued for at least 24 hours after delivery or the last seizure.

## Complications

- Aspiration pneumonia, hypoxia and injury during the seizure
- Stroke and intracranial haemorrhage, a leading cause of death
- HELLP syndrome, acute kidney injury, pulmonary oedema and disseminated intravascular coagulation
- Placental abruption
- Fetal hypoxia, preterm birth and stillbirth
- Maternal death

## Prognosis

With prompt magnesium sulfate, blood pressure control and timely delivery most women recover without neurological sequelae, and brain imaging changes usually resolve. Mortality remains significant where care is delayed. There is a higher risk of hypertensive disorders in later pregnancies and of cardiovascular disease later in life.

## Prevention

- Regular antenatal care with blood pressure and urine protein checks
- Low-dose aspirin from early pregnancy in women at high risk of preeclampsia, and calcium supplementation where dietary intake is low
- Magnesium sulfate for women with preeclampsia with severe features
- Teaching pregnant and postpartum women the warning signs (severe headache, visual changes)

## Test yourself

Think of the answer, then tap the question to see it.

## What is the drug of choice to treat and prevent eclamptic seizures?

Magnesium sulfate; it is more effective than diazepam or phenytoin for eclampsia.

## Which bedside signs suggest magnesium toxicity, and what is the antidote?

Loss of patellar reflexes, respiratory depression and low urine output; calcium gluconate is the antidote.

## What is the definitive treatment of eclampsia?

Delivery of the baby and placenta, once the mother is stabilised.

## Can eclampsia occur after delivery?

Yes. Postpartum eclampsia occurs mostly in the first 48 hours but can appear days to weeks after birth.

## What brain imaging pattern is typical in eclampsia?

Posterior reversible encephalopathy: vasogenic oedema mainly in the parieto-occipital white matter.

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## Related conditions

- [Preeclampsia](https://durgical.com/en/conditions/preeclampsia/)
- [Placental abruption](https://durgical.com/en/conditions/placental-abruption/)
- [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/)
- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)
- [Intracerebral haemorrhage](https://durgical.com/en/conditions/intracerebral-haemorrhage/)
- [Postpartum haemorrhage](https://durgical.com/en/conditions/postpartum-haemorrhage/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Eclampsia](https://medlineplus.gov/ency/article/000899.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); [Maternal mortality](https://www.who.int/news-room/fact-sheets/detail/maternal-mortality) (World Health Organization, 2025).

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Source: https://durgical.com/en/conditions/eclampsia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/eclampsia/