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# Preeclampsia and eclampsia: monitoring, magnesium sulphate checks, care during a seizure and warning signs

- Safe practice

In preeclampsia the nurse measures blood pressure well, watches for signs of severity and magnesium toxicity, and knows what to do if the woman has a seizure.

Updated Nov 13, 2026

## Key points

- Hypertension in pregnancy: systolic 140 or more and/or diastolic 90 or more, from week 20 or in the first 4 weeks after birth.
- Severity: 160/110 or more, headache, flashing lights or blurred vision, tinnitus, epigastric or right upper quadrant pain, clonus, low urine output.
- Before and during magnesium: patellar reflex present, respiratory rate over 16 per minute and urine output above the protocol threshold.
- If reflexes disappear, breathing slows, consciousness falls or urine drops, call at once; with respiratory depression stop the infusion and support breathing.
- During a seizure: stay with her, turn her on her side, protect her from injury, do not hold her down and put nothing in her mouth.

## What it is

Preeclampsia is a hypertensive disorder that usually starts after week 20 and can progress to eclampsia, with seizures. Hypertensive disorders cause about one in six maternal deaths worldwide. In Colombia every pregnant woman with hypertension criteria is referred as an emergency to a higher level of care. Magnesium sulphate is the anticonvulsant of choice; it more than halves the risk of eclampsia. It is a high-alert medicine, and nursing safety rests on monitoring. This page gives the checks; doses follow the institutional protocol.

## What it requires

- Eclampsia: seizure or coma in a woman with a hypertensive disorder from week 20 or in the first three weeks after birth.
- Signs of organ damage include low platelets, HELLP syndrome, raised creatinine, acute pulmonary oedema and fetal growth restriction.
- Magnesium sulphate lowers blood pressure and can add to the effect of antihypertensives.
- The woman with severe preeclampsia or eclampsia is accompanied by health staff at all times.

## Components

- The obstetric emergency kit of Res. 3280 (Annex 7): IV cannulas, infusion sets, crystalloids, magnesium sulphate and antihypertensives.
- An infusion pump, a urinary catheter with a collection bag and a urine measuring chart.
- Oxygen, suction and airway equipment, and calcium gluconate at the bedside.

## How it is applied (and why)

- Measure blood pressure at rest with the right cuff and repeat it as the protocol sets — the criteria depend on correct readings.
- Ask about headache, visual or hearing changes and epigastric pain, and look for oedema of face and hands — they announce eclampsia.
- With severe criteria, place two IV lines with 16 or 18 gauge cannulas — rapid access for drugs and fluids.
- Give oxygen to keep saturation above 95 % — protects the woman and the fetus.
- Insert a urinary catheter with a bag and record hourly urine output — oliguria is a severity sign and guides magnesium.
- Before and during the magnesium, check reflexes, respiratory rate, level of consciousness and urine output — toxicity shows there first.
- Give magnesium by infusion pump with an independent double check — it is a high-alert medicine.
- Monitor the fetal heart rate — severe preeclampsia can compromise the fetus.
- Keep calcium gluconate and airway equipment at the bedside and never leave her alone — a seizure or toxicity can start suddenly.
- During transfer check vital signs, consciousness, reflexes and fetal heart every 15 minutes and urine every hour — as Res. 3280 sets.

## In nursing practice

- Eclamptic seizure: call for help, turn her on her side, move objects away, cushion her head, time the seizure; then airway and oxygen. The team gives magnesium per protocol.
- Respiratory depression from magnesium in a woman who is not ventilated: ventilate by hand or machine, stop the infusion and give the antidote per protocol.
- Draw the samples the team orders (blood count with platelets, LDH, transaminases, creatinine) and chase the results: they show HELLP and kidney damage.
- Symptoms can appear after birth: teach the warning signs at discharge.

## Common mistakes

- Measuring with the wrong cuff or without rest.
- Starting or continuing magnesium without checking reflexes, breathing and urine output.
- Holding the woman down or putting something in her mouth during a seizure.
- Leaving the woman alone, or not recording hourly urine output.

## Test yourself

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

## Which three checks must be normal before and during a magnesium sulphate infusion?

Patellar reflex present, respiratory rate over 16 per minute, and urine output above the protocol threshold.

## What is the antidote for magnesium sulphate toxicity?

Calcium gluconate, given per protocol after stopping the infusion and supporting breathing.

## What should the nurse do during an eclamptic seizure?

Call for help, turn the woman on her side, protect her from injury, not restrain her, put nothing in her mouth, then secure airway and oxygen.

## How often are vital signs, reflexes and fetal heart checked during the transfer of a woman with severe preeclampsia?

Every 15 minutes, with urine output recorded every hour (Res. 3280 de 2018).

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## Elsewhere in DurgiPedia

- [Hypertensive emergency: target-organ signs](https://durgical.com/en/clinical-exam/hypertensive-emergency-target-organ-signs/)

## Connections

## Related 4

- [Measuring blood pressure correctly: cuff size, position and common errors](https://durgical.com/en/nursing/measuring-blood-pressure-correctly-cuff-size-position-and-common-errors/)
- [Seizure precautions and care during a seizure](https://durgical.com/en/nursing/seizure-precautions-and-care-during-a-seizure/)
- [High-alert medications](https://durgical.com/en/nursing/high-alert-medications/)
- [Fluid balance: recording intake and output](https://durgical.com/en/nursing/fluid-balance-recording-intake-and-output/)

## Related conditions 3

- [Preeclampsia](https://durgical.com/en/conditions/preeclampsia/)
- [Eclampsia](https://durgical.com/en/conditions/eclampsia/)
- [HELLP syndrome](https://durgical.com/en/conditions/hellp-syndrome/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-3280-de-2018.pdf) (Ministerio de Salud y Protección Social de Colombia, 2018); [Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577)](https://perinatal.bvsalud.org/wp-content/uploads/2023/08/CLAP1577.pdf) (Organización Panamericana de la Salud, CLAP/SMR, 2011); [Pre-eclampsia (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/pre-eclampsia) (World Health Organization, 2026); [First Aid for Seizures](https://www.cdc.gov/epilepsy/first-aid-for-seizures/index.html) (Centers for Disease Control and Prevention, 2024).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/preeclampsia-and-eclampsia-monitoring-magnesium-sulphate-checks-care-during-a-se/