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Pre-eclampsia & eclampsia
High BP in pregnancy (or after it) is pre-eclampsia until proven otherwise. Check the BP and urine in every pregnant or recently postpartum woman with headache, visual symptoms or epigastric pain. Control severe hypertension, give magnesium for eclampsia or severe disease, and remember that delivery is the cure. Built for revision, not live patient decisions.
Settle them, and check the basics
BP · magnesiumRed flags — what each should make you think
Pre-eclampsia doesn't end at delivery. It can first appear, or get worse, in the days and weeks after birth. Any postpartum woman with headache and high BP needs assessing for it, even if her pregnancy was normal.
Eclampsia / severe pre-eclampsia
- ☎Obstetric emergency team
- ↙Left lateral tilt
- MgMagnesium sulfate
- BPTreat BP ≥160/110
- 💧Fluid restriction
- 👶Plan delivery
Understand the patient
diagnose · gradeDiagnosis (NICE NG133)
- New hypertension (≥140/90) after 20 weeks, plus one or more of:
- Proteinuria (urine protein:creatinine ratio ≥30 mg/mmol)
- Maternal organ dysfunction: kidney (creatinine ≥90), liver (raised transaminases ± RUQ pain), neurological (eclampsia, altered mental state, blindness, stroke, clonus, severe headache, scotomata), haematological (platelets below 150, DIC, haemolysis)
- Uteroplacental dysfunction (fetal growth restriction, abnormal Doppler, stillbirth)
Monitoring on magnesium
- Hourly urine output, reflexes, RR and SpO₂
- Toxicity: loss of reflexes, respiratory depression, cardiac arrest → stop infusion, give IV calcium gluconate
- Reduce dose in renal impairment/oliguria
Targets and drugs
- Aim for BP 135/85 or lower
- Labetalol first line; nifedipine if unsuitable; methyldopa as a further option
- Placental growth factor (PlGF)-based testing helps rule pre-eclampsia in or out between 20 and 37 weeks
Work A–E — assess and act as you go
The diagnoses you must not miss
tap to open eachWhat points toward it, what would rule it in, and how to manage it.
Tonic-clonic seizure in pregnancy or postpartum, with or without prior hypertension.
Clinical.
Magnesium sulfate, left lateral, BP control, deliver once stable.
RUQ/epigastric pain, nausea, malaise; may have only mild hypertension.
FBC (platelets), blood film/LDH (haemolysis), LFT.
Obstetric/critical care team, magnesium, BP control, delivery.
Constant abdominal pain, tender firm uterus, PV bleeding (may be concealed), fetal distress.
Clinical; CTG.
Obstetric emergency — resuscitation, delivery. See the PV bleeding page.
Severe headache, focal signs, reduced GCS.
CT/MRI head.
BP control, neurosurgery/neurology input.
Investigate — what to order, when, and what it tells you
test with a question in mindUrine
Bloods
Fetal
How the plan comes together
disposition · handoverobstetric assessment
Pregnant (over 20 weeks) or postpartum women with raised BP should be assessed by the maternity team.
labour ward / HDU
Severe hypertension, eclampsia, HELLP, or any severe feature.
Hand over: BP trend, magnesium times/doses, bloods, fluid balance, fetal status.
Pregnant or postpartum with high BP and headache? Think pre-eclampsia. Treat severe BP, give magnesium for seizures or severe disease, restrict fluids, and get the obstetric team now. Nicely done getting here.
Clerking template
copy or downloadPre-eclampsia & eclampsia — documentation structure
A structure and prompt list to help you document and think systematically. It is not a completeness check and cannot guarantee nothing is missed — use your trust's own proforma, your seniors, and your clinical judgement.
Test yourself
active recallCover the answer, say it out loud, then reveal. Retrieval beats re-reading.
0 / 11 knownFrequently asked questions
quick answersWhat are the red flags for pre-eclampsia and eclampsia?
- BP ≥160/110 — think severe hypertension — treat now
- Seizure — think eclampsia — magnesium
- Severe headache, visual disturbance — think severe pre-eclampsia
- RUQ / epigastric pain, vomiting — think HELLP / liver involvement
- Low platelets, haemolysis, high ALT — think HELLP
- Clonus, brisk reflexes — think imminent eclampsia
- Postpartum (up to 6 weeks) — think pre-eclampsia can still occur
What is the initial management of pre-eclampsia and eclampsia?
- Obstetric emergency team — obstetrician, anaesthetist, midwife
- Left lateral tilt — airway, oxygen
- Magnesium sulfate — 4 g IV over 5–15 min, then 1 g/h for 24 h; further 2–4 g bolus if another seizure
- Treat BP ≥160/110 — labetalol (oral or IV), nifedipine, or IV hydralazine per protocol
- Fluid restriction — usually 80 mL/h unless ongoing losses
- Plan delivery — once stable
Always alongside senior support and your local guideline.
What diagnoses must you not miss in pre-eclampsia and eclampsia?
- Eclampsia — seizure
- HELLP syndrome — haemolysis · liver · platelets
- Placental abruption — pain + bleeding
- Intracranial haemorrhage / PRES — headache · neuro
Open each one in the must-not-miss section for what points toward it, how to rule it in, and how to manage it.
What investigations should a junior doctor order for pre-eclampsia and eclampsia?
- Urine — Proteinuria ≥30 mg/mmol.
- Bloods — FBC, U&E, LFT, LDH, clotting, G&S.
- Fetal — Growth, Doppler, wellbeing.
Admit or discharge: how is the plan decided for pre-eclampsia and eclampsia?
- Obstetric assessment — Pregnant (over 20 weeks) or postpartum women with raised BP should be assessed by the maternity team.
- Labour ward / hdu — Severe hypertension, eclampsia, HELLP, or any severe feature.
Is there a clerking template for pre-eclampsia and eclampsia?
Yes — there is a free clerking template for pre-eclampsia and eclampsia on this page, structured as presenting complaint, red flags asked, history, examination (A–E), investigations, differentials, plan and escalation. You can copy it or download it as a Word document. Jump to the template.
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