How to Recognize Eclampsia Symptoms in Pregnancy

Eclampsia in Pregnancy: What Every Expectant Mother Needs to Know

Eclampsia is a rare but serious condition that causes seizures during pregnancy or shortly after birth. This guide explains, in clear and caring language, how to recognise danger signs, what to do in an emergency, and how families can help keep mothers and babies safe.

Quick facts — TL;DR

What: Eclampsia = seizures that occur in a pregnant or recently-delivered woman with preeclampsia.
When: Most commonly after 20 weeks of pregnancy, but can happen during labour or after birth.
Warning signs: severe headache, blurred vision, sudden swelling, belly pain, reduced baby movements.
Immediate action: Call emergency services and get to a hospital—do not wait.
Prevention: Regular antenatal care (BP checks), follow medical advice, and report warning symptoms early.

Pregnancy is an exciting time — but it's also natural to worry about what could go wrong. Eclampsia is one of the conditions expectant mothers hear about that can sound frightening. The good news is that many cases can be prevented or managed when pregnant women get regular antenatal care and know the warning signs. This page will walk you through what eclampsia is, how to spot it early, what to do in an emergency, and how to lower the risk for you and your baby.

Why this matters

Seizures during pregnancy are a medical emergency. Quick action can protect both the mother and the baby. Learning the signs and planning ahead gives families a powerful advantage.

Real story: Mary’s sudden emergency (relatable scenario)

Meet Mary. She was 28 weeks pregnant and had been feeling tired and swollen for a few days. She had missed an antenatal appointment because she was busy at work. One afternoon she developed a terrible headache and felt like the room was spinning. Within hours she had a seizure and lost consciousness.

Her family called emergency services immediately. At the hospital, doctors recognised eclampsia and gave medicines to control seizures and high blood pressure. Mary and her baby were closely monitored — because of quick action, both recovered and Mary was given a clear plan for future care.

What we learn from Mary’s story:

• Do not ignore warning signs like severe headache, vision changes or sudden swelling.
• Attend antenatal visits — blood pressure and urine checks can spot problems early.
• Know where to go in an emergency (nearest hospital with maternity services).

Quick checklist for pregnant women

1. Keep all antenatal (ANC) appointments and ask for BP checks at each visit.
2. Report headaches that are severe or do not go away, vision changes, or sudden swelling.
3. Plan emergency transport — know the fastest route to your nearest maternity hospital.
4. Talk to your partner or support person about warning signs and what they should do.

Continue: What is Eclampsia? (Next section will explain simply how preeclampsia and eclampsia differ.)

Part 2 — Causes, What Happens in the Body, & Who Is at Higher Risk

In this section we explain, in simple terms, what leads to eclampsia, what happens inside the body when it develops, and which women are more likely to get it. The goal is to help you understand why regular check-ups and early action are so important.

What causes eclampsia?

Doctors do not always know the exact single cause of eclampsia, but most cases begin with a condition called preeclampsia. Preeclampsia is when a pregnant woman develops high blood pressure and signs that her organs (like the kidneys or liver) are stressed. If preeclampsia gets worse and includes seizures, it is called eclampsia.

In plain words: problems with the placenta and the mother's blood vessels can cause high blood pressure and reduced blood flow to organs. That strain on the body can lead to a seizure in severe cases.

Diagram: How placental and blood vessel changes can lead to preeclampsia and sometimes eclampsia (placeholder).

What happens in the body during preeclampsia and eclampsia?

Here is a simple step-by-step explanation of the process — no medical jargon:

1. Poor placental blood flow: The placenta (the organ that feeds the baby) may not get enough blood due to problems with how the blood vessels develop.
2. Mother’s blood pressure rises: The mother's body reacts by constricting blood vessels, which raises blood pressure (this is preeclampsia).
3. Organs can be affected: High blood pressure and poor blood flow can stress the kidneys, liver and brain. The mother may develop protein in the urine, headaches, or vision changes.
4. Seizures in severe cases: If the brain is affected strongly, a seizure (fit) may occur — this is eclampsia. Seizures can cause loss of consciousness and are a medical emergency.

Note: Not all women with high blood pressure during pregnancy will develop eclampsia. Many women with well-managed blood pressure have healthy pregnancies. The risk drops significantly with regular prenatal care and timely treatment.

Who is at higher risk?

Some factors make preeclampsia and eclampsia more likely. If you have one or more of these, it does not mean you will get eclampsia — it means your healthcare team may watch you more closely.

• First pregnancy: Preeclampsia is more common in a woman’s first pregnancy.
• History of preeclampsia/eclampsia: If you had it in a previous pregnancy, your risk is higher.
• Chronic high blood pressure: Women who already had high blood pressure before pregnancy have a higher risk.
• Kidney disease: Underlying kidney problems increase risk.
• Diabetes: Pre-existing diabetes or gestational diabetes can raise risk.
• Multiple pregnancy: Twins, triplets or more increase the chance of preeclampsia.
• Age extremes: Very young mothers (teenagers) and older mothers (over ~35) can have higher risk.
• Obesity: Being significantly overweight before pregnancy raises risk.
• Family history: A close relative (mother or sister) who had preeclampsia increases your risk.
• Certain autoimmune disorders: Conditions like lupus or antiphospholipid syndrome may raise risk.

Quick risk summary

Risk factor	What it means
First pregnancy	Higher monitoring recommended; more likely to develop preeclampsia.
Chronic hypertension	May need medicines before and during pregnancy to control BP.
Multiple pregnancy	Extra antenatal visits and closer monitoring are usually advised.

Practical note for mothers

If you have any of the risk factors above, tell your midwife or doctor early in pregnancy. They may schedule more frequent visits, check your blood pressure often, and give advice to reduce risk. This helps detect problems early — when they are easiest to treat.

Continue: Part 3 — Signs & Symptoms (Next: how to recognise warning signs at home and when to seek help.)

Part 3 — Signs, Symptoms & Early Warning Signs of Eclampsia

One of the most important parts of preventing eclampsia is knowing the warning signs early. Many symptoms start gradually during preeclampsia before a seizure happens. Recognising these signs can save the mother’s life and protect the baby.

Common signs and symptoms you should never ignore

These symptoms can appear any time after 20 weeks of pregnancy, during labour, or even after delivery (postpartum). If any of these occur, seek medical care urgently.

• Severe or persistent headache, especially if it does not get better with rest or simple painkillers.
• Sudden swelling of the face, hands, feet or around the eyes (oedema).
• Changes in vision like blurring, seeing flashing lights, dark spots, or temporary loss of vision.
• Severe upper abdominal pain, especially under the ribs on the right side (liver area).
• Nausea and vomiting that are new and not related to morning sickness.
• Shortness of breath or difficulty breathing.
• Decreased urine output or very dark urine.
• High blood pressure detected at home or clinic (140/90 mmHg or higher).

Early warning signs of upcoming eclampsia

In some women, the body gives clear warning signs just before a seizure. These should be treated as an emergency:

• Severe headache that suddenly becomes intense.
• Sudden vision changes such as flashing lights or partial blindness.
• Confusion or difficulty thinking clearly.
• Strong upper abdominal pain, especially on the right side.
• Feeling extremely unwell or “something is wrong” — trust this instinct.

What does an eclamptic seizure look like?

An eclamptic seizure looks similar to other types of convulsions. If you witness this in a pregnant or recently delivered woman, treat it as a medical emergency.

• Sudden loss of consciousness or collapse.
• Jerking or stiffening of the arms and legs (convulsions).
• Eyes rolling back, difficulty breathing or foaming at the mouth may occur.
• After the seizure, the woman may be confused, sleepy or not remember what happened.

If a seizure happens — what to do immediately

• Lay her on her left side to keep the airway open and prevent choking.
• Do not put anything in her mouth.
• Remove sharp objects around her to prevent injury.
• Seek emergency medical care immediately.

Important: Symptoms can appear after birth

Eclampsia can happen during pregnancy, during labour, or after delivery. If a new mother develops headaches, high blood pressure or vision changes within 6 weeks after birth, she must get checked quickly — postpartum eclampsia is real and dangerous if ignored.

Continue: Part 4 — Diagnosis & Tests (Next: How doctors diagnose preeclampsia/eclampsia and when to seek urgent help.)

Part 4 — Diagnosis, Tests & When to Seek Medical Help

Early diagnosis is the key to preventing preeclampsia from becoming eclampsia. Regular antenatal visits allow health workers to detect problems early, run the right tests, and protect both mother and baby.

Why diagnosis matters

Preeclampsia can be silent at first — a woman may feel well while her blood pressure or organs are already affected. Diagnosis helps:

• Detect problems early before they become severe.
• Protect the mother’s organs and prevent seizures.
• Monitor the baby’s growth and well-being.
• Plan safe delivery at the right time and place.

How is preeclampsia diagnosed?

A healthcare provider uses a combination of blood pressure checks, urine tests and clinical signs to diagnose preeclampsia. The following are common steps used during antenatal visits:

1. Blood pressure measurement: A reading of 140/90 mmHg or higher on two separate occasions can indicate high blood pressure.
2. Urine test: To check for protein in urine (proteinuria), which shows kidney involvement.
3. Blood tests: These assess kidney function, liver enzymes, platelets, and other markers of organ stress.
4. Symptoms evaluation: Headaches, vision changes, swelling, and abdominal pain help confirm diagnosis.

Flowchart: How healthcare providers diagnose preeclampsia (placeholder – actual graphic will be added).

Tests commonly done in hospital or clinic

Test	What it checks
Blood pressure	Checks if BP is raised or worsening.
Urine protein	Shows kidney involvement (proteinuria).
Kidney & liver function tests	Identifies organ stress or damage.
Platelet count	A low count may mean risk of bleeding complications.
Ultrasound	Checks baby’s growth, fluid levels and health.

When to seek medical help urgently

See a healthcare provider or go to a hospital immediately if you experience:

• Severe headache that does not go away.
• Vision changes (blurring, flashing lights, dark spots).
• Severe upper abdominal pain (especially on the right side).
• Severe swelling of hands, face or legs.
• High blood pressure reading at home (140/90 mmHg or more).
• Reduced fetal movements or baby not kicking as usual.
• Any seizure or convulsion — treat as an emergency.

Quick advice for families

Do not wait for symptoms to “go away on their own.” Early action can prevent complications. If something feels wrong, seek help — your instincts are important.

Continue: Part 5 — Treatment & Management (Next: What happens in hospital, how eclampsia is treated, and how to keep mother and baby safe.)

5. Treatment & Management of Eclampsia

Eclampsia is a medical emergency. Treatment must begin immediately to protect the life of both the mother and the baby. Management focuses on controlling seizures, lowering dangerously high blood pressure, and ensuring safe delivery when necessary.

5.1 Immediate First Aid When a Pregnant Woman Has a Seizure

• Stay calm and call for emergency help immediately.
• Lay the woman on her left side to prevent choking.
• Loosen tight clothing around her neck.
• Do not place anything in her mouth.
• Remove harmful objects around her to prevent injury.
• Time the seizure — most last 60–90 seconds.

Once the seizure stops, take her to the nearest hospital with a maternity/ICU facility.

5.2 Hospital Management of Eclampsia

At the hospital, doctors follow a standardized treatment protocol to stabilize the mother and baby. Management includes:

• Stopping and preventing further seizures
• Controlling high blood pressure
• Monitoring mother and fetus
• Planning safe delivery (if needed)

5.3 Magnesium Sulphate (MgSO₄): The Lifesaving Drug

Magnesium Sulphate is the drug of choice for treating eclampsia seizures — not anticonvulsants like diazepam. It prevents recurrent fits more effectively and reduces maternal deaths.

Standard MgSO₄ Regimen

• Loading dose: Given to stop seizures initially
• Maintenance dose: Given every few hours to prevent recurrence

Doctors monitor breathing rate, knee reflexes, and urine output to avoid toxicity.

Antidote for toxicity: Calcium gluconate

5.4 Controlling High Blood Pressure

Severe hypertension increases the risk of stroke, kidney failure, and placental complications. Antihypertensive medications used include:

• Hydralazine
• Labetalol
• Nifedipine (oral)

Target blood pressure after treatment: 140–150 / 90–100 mmHg

5.5 Delivery of the Baby

Delivery is the only definite cure for eclampsia — but it must be timed safely. Doctors assess the mother’s stability and fetal well-being before deciding.

Delivery Decisions

• If the mother is stable → proceed with delivery
• If unstable → first stabilize, then consider delivery
• If seizures continue despite MgSO₄ → emergency intervention required
• Mode of delivery:
  • Normal vaginal delivery if mother and baby are stable
  • Cesarean section if urgent or complications exist

5.6 Care in the ICU or High-Dependency Unit (HDU)

Many women with eclampsia require close monitoring for at least 24–48 hours after delivery. Care includes:

• Blood pressure monitoring
• Urine output monitoring
• Neurological observation
• Continuation of MgSO₄ for 24 hours after last seizure or delivery

5.7 Postpartum Care

Eclampsia can still occur after delivery. Women need postpartum follow-up to prevent recurrence and manage long-term health risks such as chronic hypertension.

6. Prevention of Eclampsia

Although eclampsia cannot always be prevented, the risk can be significantly reduced through good antenatal care, early detection of preeclampsia, healthy lifestyle choices, and proper medical management. Prevention focuses on identifying at-risk mothers early and controlling blood pressure and complications before seizures develop.

6.1 Antenatal Care (ANC): The Most Effective Prevention

Regular ANC visits help healthcare providers monitor the mother's blood pressure, urine proteins, and overall health. Early detection of preeclampsia prevents progression to eclampsia.

Recommended ANC Visit Schedule

• 1st visit: 8–12 weeks
• 2nd visit: 20–24 weeks
• 3rd visit: 28–32 weeks
• 4th visit: 36–38 weeks
• Additional visits if high-risk or symptoms appear

Early booking (first trimester) is key.

6.2 Aspirin for High-Risk Pregnancies

The World Health Organization recommends low-dose aspirin for women at high risk of preeclampsia. It helps improve blood flow to the placenta and reduces the risk of severe high blood pressure disorders.

• Start between 12–16 weeks of pregnancy
• Continue until 36 weeks
• Only take if prescribed by a healthcare professional

6.3 Calcium Supplementation

In areas where dietary calcium intake is low, calcium supplements help prevent preeclampsia. Calcium strengthens the blood vessels and helps regulate blood pressure.

• Recommended dose: 1.0–1.5 g/day (in divided doses)
• Begin as early as possible in pregnancy

6.4 Lifestyle and Self-Care for Prevention

Healthy lifestyle habits play a major role in reducing blood pressure and preventing preeclampsia. Pregnant mothers should:

• Maintain a healthy, balanced diet rich in fruits and vegetables
• Limit excess salt and processed foods
• Drink enough clean water daily
• Avoid alcohol, drugs, and smoking
• Engage in safe physical exercise (e.g., walking 30 minutes daily)
• Get enough rest and reduce stress

6.5 Monitoring and Early Warning Systems at Home

Women with high-risk pregnancies or early signs of preeclampsia can reduce complications by monitoring their health at home.

What to Monitor at Home

• Blood pressure (if a home BP machine is available)
• Sudden swelling of face, hands, or feet
• Headaches that don’t go away
• Changes in urine (foamy, decreased output)
• Baby movements

6.6 Birth Preparedness Plan

Preparing early for delivery ensures that in case of emergencies like eclampsia, the mother can reach a well-equipped facility in time.

• Select a health facility with maternity and emergency care
• Save funds for transport and medical costs
• Keep emergency contacts ready
• Packed hospital bag by 7–8 months

6.7 Community and Partner Support

Support from partners, family, and community reduces stress for the mother and encourages ANC attendance. Community health workers also help with follow-ups, education, and referrals.

7. Complications of Eclampsia

Eclampsia is a life-threatening condition that can affect multiple organs in the mother and harm the unborn baby. Complications may occur before delivery, during labour, or after childbirth. Early treatment greatly reduces these risks.

7.1 Complications for the Mother

Without timely treatment, eclampsia can lead to serious short-term and long-term health problems. Some of the major maternal complications include:

• Brain Damage / Stroke: Severe high blood pressure can cause bleeding in the brain (intracranial hemorrhage), leading to seizures, paralysis, or death.
• Kidney Failure: Reduced blood flow to the kidneys can lead to acute kidney injury requiring dialysis.
• Liver Damage / HELLP Syndrome: A severe form of preeclampsia causing liver breakdown and low platelets.
• Placental Abruption: The placenta separates from the uterus prematurely, causing heavy bleeding and fetal distress.
• Respiratory Complications: Fluid accumulation in the lungs (pulmonary edema) can cause severe breathing problems.
• Blood Clotting Disorders: Risk of disseminated intravascular coagulation (DIC), leading to excessive bleeding.
• Vision Problems: Temporary blindness or visual disturbances may occur due to swelling in the brain or retina.
• Coma or Death: In severe cases, repeated seizures or organ failure can be fatal.

7.2 Complications for the Baby

Eclampsia affects the baby primarily by reducing blood flow to the placenta, limiting oxygen and nutrients needed for growth.

• Premature Birth: Early delivery may be required to save the mother or baby.
• Low Birth Weight: Poor blood circulation to the placenta causes restricted fetal growth.
• Breathing Problems After Birth: Premature babies may need special care in the newborn unit (NICU).
• Stillbirth: Placental abruption or severe oxygen deprivation may lead to loss of the baby.
• Developmental Delays: Babies born prematurely or with low oxygen at birth may face long-term developmental challenges.

7.3 Long-Term Health Risks for the Mother

Women who experience eclampsia are at higher risk of health problems later in life. These include:

• Chronic (long-term) high blood pressure
• Heart disease and stroke later in life
• Kidney disease
• Recurrent preeclampsia in future pregnancies
• Higher risk of diabetes and metabolic syndrome

7.4 Emotional and Psychological Effects

Beyond physical health, eclampsia can leave emotional and mental trauma for the mother and family. Common issues include:

• Postpartum depression
• Anxiety or fear of future pregnancies
• Post-traumatic stress, especially if ICU care was required

7.5 Prognosis (Chances of Recovery)

With proper treatment, most mothers recover fully from eclampsia, especially when diagnosed early and managed in a well-equipped facility. Prognosis depends on:

• How early treatment was started
• Number of seizures experienced
• Any organ damage that occurred
• Quality of medical care available

Babies born to mothers with eclampsia also recover well when cared for in a facility with specialist newborn care. Follow-up for both mother and baby is essential.

8. Frequently Asked Questions, Myths & Summary

8.1 Frequently Asked Questions (FAQs)

1. Can eclampsia occur without high blood pressure?

Yes. Although uncommon, some women develop seizures without obvious high blood pressure or urine protein. This is known as atypical eclampsia.

2. Can eclampsia happen after giving birth?

Yes. Postpartum eclampsia can occur days or even weeks after delivery. Any severe headache, vision changes, or seizures after childbirth requires urgent medical care.

3. Is eclampsia hereditary?

There is no direct inheritance, but a family history of preeclampsia or hypertension increases the risk in pregnancy.

4. Can a woman have a normal delivery after eclampsia?

Yes, many women deliver vaginally if they are stable. Caesarean section is only recommended when medically necessary.

5. Will eclampsia occur again in future pregnancies?

The risk of recurrence exists, especially if the mother had severe disease, early onset, or HELLP syndrome. Preconception counselling and early ANC are essential.

6. Is eclampsia preventable?

It cannot always be prevented, but early ANC, monitoring, aspirin for high-risk women, calcium supplementation, and healthy lifestyle greatly reduce the chances.

7. Can traditional herbs treat or prevent eclampsia?

No. There is no scientific evidence that herbs or traditional remedies treat or prevent eclampsia. It is a medical emergency requiring hospital treatment.

8. What is the difference between Preeclampsia and Eclampsia?

Preeclampsia = high blood pressure + signs of organ damage during pregnancy. Eclampsia = preeclampsia + seizures.

8.2 Myths vs Facts

Myth	Fact
“Eclampsia only happens to first-time mothers.”	It is more common in first pregnancies, but can affect any pregnancy.
“Seizures mean the mother was bewitched or cursed.”	Eclampsia is a medical condition caused by complications of high blood pressure in pregnancy, not witchcraft.
“If the mother looks healthy, she can’t have preeclampsia.”	Many mothers appear fine but still have dangerous internal complications.
“Traditional herbs can reduce pregnancy swelling.”	Some herbs increase blood pressure and delay treatment. Only medical care is safe.
“Once the baby is out, the mother is safe.”	Symptoms can continue or worsen after delivery; postpartum monitoring is crucial.

8.3 Key Takeaways

• Eclampsia is a life-threatening emergency caused by complications of preeclampsia.
• It causes seizures, high blood pressure, and organ damage for the mother and baby.
• Immediate treatment with Magnesium Sulphate saves lives.
• Early ANC, lifestyle care, aspirin for high-risk mothers, and calcium help reduce risk.
• Mothers require close follow-up during pregnancy and after delivery.

8.4 Helpful Resources

• World Health Organization – Maternal Health
• FIGO – Hypertension in Pregnancy Guidelines
• UNICEF & Ministry of Health – Maternal and Newborn Care Manuals

Part 9 — Nursing Care Plan (Professional) & Health Education for Eclampsia

This section provides a full, professional nursing care plan (NCP) for patients with preeclampsia/eclampsia and a companion health-education package for mothers and families. The NCP follows a structured format: Assessment → Nursing diagnoses → Goals (SMART) → Interventions with rationales → Evaluation. Important clinical recommendations (including magnesium sulfate as the first-line anticonvulsant) are supported by leading sources.

Quick clinical highlights (evidence-based)

• Magnesium sulfate (MgSO₄) is the recommended medication to prevent and treat eclamptic seizures and reduces the risk of eclampsia significantly.
• Seizure control, blood pressure management, maternal organ support and timely delivery are the pillars of care.
• Continuous monitoring of vital signs, urine output, neurological status and fetal well-being is essential.

Full Professional Nursing Care Plan (Detailed)

Nursing Diagnosis 1

Risk for injury related to seizures (eclampsia) as evidenced by history of recent generalized convulsion / severe preeclampsia.

Assessment

• Record seizure activity (duration, onset, motor pattern, post-ictal state).
• Neurological status: level of consciousness, pupil response, reflexes.
• Airway patency and respiratory effort.
• Time since last MgSO₄ dose and infusion status (if on MgSO₄).

SMART Goal

Within 24 hours the patient will experience no further seizures and will maintain patent airway and adequate oxygenation (SpO₂ ≥ 94%) while under hospital monitoring.

Nursing Interventions & Rationale

1. Continuous monitoring: Maintain continuous observation during acute phase; monitor SpO₂, respiratory rate, LOC, and seizure activity every 5–15 minutes as needed. Rationale: Early detection of recurrent seizures or respiratory compromise enables rapid intervention and prevents hypoxia.
2. Airway management readiness: Keep airway equipment, suction, oxygen, and intubation kit available at bedside; position patient on left lateral position when not actively seizing. Rationale: Seizures can compromise airway and aspiration risk; left lateral position improves uteroplacental perfusion.
3. Administer/monitor MgSO₄ per protocol: Ensure loading/maintenance infusion is being given and monitor for signs of toxicity (respiratory depression, loss of deep tendon reflexes, oliguria). Rationale: MgSO₄ is the evidence-based anticonvulsant for eclampsia; monitoring prevents and detects toxicity early.
4. Document seizure details: Time seizure onset, duration, movements, and interventions performed. Rationale: Accurate documentation guides medical decisions and medicolegal records.
5. Provide a safe environment: Pad bedrails, remove sharp objects, maintain low bed height, and restrict unnecessary visitors during acute phase. Rationale: Reduces risk of trauma during recurrent seizures.

Evaluation Criteria

• No recurrent seizures within 24 hours after initiation of treatment.
• Airway maintained without aspiration; oxygen saturation ≥94% on room air or prescribed oxygen.
• No nursing-documented injuries related to seizures.

Nursing Diagnosis 2

Risk for ineffective cerebral tissue perfusion related to severe hypertension and vasospasm.

Assessment

• Frequent BP measurements (initially every 5–15 minutes while acute, then hourly/PRN as ordered).
• Assess neurological signs: headache severity, visual disturbances, confusion.
• Baseline ECG if arrhythmia suspected; monitor heart rate and rhythm.

SMART Goal

Maintain blood pressure within target range set by medical team (e.g., systolic <160 mmHg and diastolic <110 mmHg acute targets) within the first 2–4 hours of pharmacologic therapy.

Nursing Interventions & Rationale

1. Frequent BP monitoring: Use appropriately sized cuff and record readings; notify physician for readings above agreed thresholds (e.g., ≥160/110 mmHg). Rationale: Rapid control of severe hypertension reduces risk of stroke and organ damage.
2. Administer antihypertensives as ordered: IV hydralazine, IV labetalol, or oral nifedipine per protocol; monitor maternal response and fetal heart rate. Rationale: Lowering dangerously high BP decreases risk of cerebrovascular events and placental complications.
3. Neurological checks: Assess GCS, pupil size, and limb movement regularly; document any deterioration. Rationale: Detects evolving cerebral compromise early.
4. Prepare for urgent imaging or interventions: If focal neurological signs or persistent severe headache develop, notify team for CT/MRI or neurology consult as indicated. Rationale: Rule out intracranial hemorrhage or other causes of neurological decline.

Evaluation Criteria

• BP within defined target range and trending downward.
• No new focal neurological deficits.
• Fetal heart rate reassuring or appropriately managed by obstetric team.

Nursing Diagnosis 3

Deficient knowledge (patient/family) related to condition, treatment and warning signs.

Assessment

• Assess baseline understanding of preeclampsia/eclampsia, medications, and emergency actions.
• Identify language, literacy, cultural beliefs and preferred learning methods.

SMART Goal

By discharge the patient and her support person will demonstrate understanding of at least 5 key warning signs, when to seek help, and how to take prescribed medications (teach-back method).

Nursing Interventions & Rationale

1. Teach-back education: Use simple language and ask the mother/support person to repeat key points about warning signs, emergency contacts, and medication administration. Rationale: Teach-back improves comprehension and retention of critical information.
2. Provide written/visual materials: Offer a one-page discharge card with warning signs, BP targets, emergency numbers and follow-up appointment details (use local language). Rationale: Written reminders support memory and quick reference at home.
3. Medication counselling: Explain purpose, side effects, and safety of MgSO₄ (if continuing) and antihypertensives; instruct on adherence and what to report. Rationale: Improves adherence and early recognition of adverse effects (e.g., signs of MgSO₄ toxicity such as breathing difficulty or absent reflexes).
4. Plan follow-up: Schedule early postpartum review (within 1–2 weeks) and primary care follow-up for BP monitoring. Rationale: Many complications can occur postpartum; early review reduces risk of missed deterioration.

Evaluation Criteria

• Patient/support person correctly names warning signs and the emergency plan (teach-back success).
• Discharge card provided and follow-up appointment scheduled.

Nursing Diagnosis 4

Fluid volume excess / risk for decreased renal perfusion related to hypertensive vasospasm and capillary leak.

Assessment

• Monitor intake & output hourly (urine output target ≥ 30 mL/hr unless otherwise ordered).
• Daily weight and peripheral edema assessment.
• Assess serum electrolytes, creatinine and urine protein results as available.

SMART Goal

Maintain urine output ≥30 mL/hr and stable renal function (no rising creatinine) during hospital stay.

Nursing Interventions & Rationale

1. Strict I&O: Record all fluids, IV fluids, and urine hourly. Notify provider if urine <30 mL/hr. Rationale: Early detection of oliguria informs decisions on fluid resuscitation or renal support.
2. Limit aggressive fluid boluses: Collaborate with medical team on fluids — avoid fluid overload which can precipitate pulmonary edema. Rationale: Women with preeclampsia/eclampsia are at increased risk of pulmonary edema; careful fluid management reduces this risk.
3. Monitor labs: Check renal and liver function, platelets, and electrolytes per orders and report abnormalities immediately. Rationale: Guides therapy (e.g., MgSO₄ dose adjustments in renal impairment).

Evaluation Criteria

• Urine output ≥30 mL/hr or as individualized by provider.
• No signs of fluid overload (no crackles, no worsening oxygenation).
• Stable or improving renal markers on labs.

MgSO₄ Safety Monitoring Checklist (Nursing)

While exact dosing protocols vary by institution, nurses must monitor for both therapeutic effect and toxicity. Common monitoring items include:

• Respiratory rate (record hourly or per protocol) — observe for respiratory depression.
• Deep tendon reflexes (knee jerk) — assess before each maintenance dose; absent reflexes can indicate toxicity.
• Urine output — ensure adequate renal clearance (≥30 mL/hr) as MgSO₄ is renally eliminated.
• Level of consciousness / sedation — monitor for increasing drowsiness or confusion.
• Continuous cardiorespiratory monitoring if available (SpO₂, heart rate, BP).
• Have calcium gluconate readily available as the antidote for MgSO₄ toxicity.

Health Education: What to Teach the Mother & Family

Use simple language, visual aids and teach-back. Provide this information in print and verbally before discharge.

Core Education Points (discharge checklist)

1. Warning signs to seek immediate care: severe headache, visual changes, sudden swelling, difficulty breathing, severe upper abdominal pain, decreased baby movements, or any seizure activity.
2. Blood pressure monitoring: If given a BP machine at home, teach how to measure BP and what numbers to report (>140/90 mmHg initially or per local protocol).
3. Medications: Explain purpose, common side effects, and when to contact the provider (e.g., excessive sleepiness, breathing difficulty, or absent reflexes if on MgSO₄).
4. Follow-up plan: Early postpartum clinic visit (within 1–2 weeks), and primary care for long-term BP follow-up.
5. Rest & activity: Encourage gradual return to activity, avoid heavy lifting, and prioritize rest and hydration.
6. Emotional support: Discuss possible anxiety or mood changes and provide referral information for counseling or support groups.
7. Family role: Designate a support person to help monitor symptoms, transport in emergencies, and assist with newborn care while mother recovers.

Printable resources to give the mother

• One-page warning signs card (pocket size)
• Medication card (names, purpose, contact numbers)
• Follow-up appointment slip with date/time and location

Documentation & Safe Handoff

Accurate documentation and clear handoff between teams reduces errors. Include in the chart and handoff:

• Seizure details (time, duration, interventions)
• Current medications and infusion details (MgSO₄ start time, rate, last dose)
• Latest vital signs and neurological checks
• Recent lab results and trending values
• Fetal heart rate status and plans for delivery
• Discharge education given and teach-back confirmation

Special Considerations & Referral

In resource-limited settings, follow local protocols and consult higher-level facilities early for:

• Recurrent or refractory seizures despite MgSO₄
• Organ failure (renal, hepatic), DIC, or severe pulmonary edema
• Need for neonatal intensive care due to prematurity

References & Further Reading

1. World Health Organization — Pre-eclampsia factsheet and recommendations.
2. ACOG Practice Bulletin — Gestational Hypertension and Preeclampsia (clinical guidance).
3. MSD Manual — Preeclampsia and eclampsia: management overview (magnesium sulfate monitoring).
4. Lu JF. Magnesium sulfate in eclampsia and pre-eclampsia (classic review).
5. Comprehensive review on preeclampsia management and MgSO₄ monitoring.

Note: This nursing care plan is designed for professional use and should be adapted to your facility’s protocols, local drug formularies, and physician orders. Always follow your hospital’s policies and national guidelines for drug dosing and emergency management.

Final Words

Eclampsia remains one of the leading causes of maternal and newborn deaths globally — yet many cases are preventable. Awareness, early detection, and emergency care can save lives. Share this knowledge to help protect mothers, babies, and families.

If you found this guide helpful:

• Share it with pregnant women, partners, and caregivers.
• Encourage expecting mothers to start antenatal care (ANC) early and attend all visits.
• Follow our blog for more maternal health education.

Prepared by VitalWell Hub — empowering mothers with clear, trustworthy maternal health information.