• Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
    • May occur sooner with gestational trophoblastic disease
  • Suspect in any pregnant patient who is >20wk or <4wk postpartum who develops seizures

Differential Diagnosis



3rd Trimester/Postpartum Emergencies


  1. Delivery
  2. Seizure treatment
    • Magnesium: Load 4-6 g IV over 15 min followed by 2-3 gm/hr
      • Can give up to 10 gm IM (5 g in each buttock)
      • Observe for loss of reflexes, respiratory depression
      • Must adjust dose in patients with renal failure
    • If seizures recur:
    • Contraindications to magnesium[1]:
  3. BP Control
    • Lower to Sys 130-150, dia 80-100
      • Labetalol
        • Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
        • Option 2: Initial 20mg; then IV infusion of 1-2mg/min
      • Hydralazine
        • 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
  4. Persistent seizure


  • Admit, emergent OB/GYN consultation

See Also


  • EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
  • Uptodate
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