Nursing care
Eclampsia nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 6 min read · Updated September 2026
Short answer
Eclampsia is a generalised tonic-clonic seizure in a woman with preeclampsia, and the immediate response is to protect the airway, turn her onto her side, and never restrain the convulsion. Magnesium sulfate is the drug of choice to stop the seizure and prevent recurrence, given alongside continuous maternal and fetal monitoring.
What it is and why it happens
Eclampsia is the onset of new generalised tonic-clonic seizures, or coma, in a woman with preeclampsia, in the absence of any other cause such as epilepsy. It can occur antepartum, intrapartum, or postpartum, and postpartum eclampsia most often develops within 48 hours of delivery, though later cases are recognised.
The mechanism follows directly from preeclampsia's underlying vasospasm and endothelial dysfunction. Cerebral vasospasm, loss of normal cerebral autoregulation, and localised oedema, often posterior and occipital in distribution, produce the cortical irritability that culminates in seizure. This is why the warning signs of eclampsia, severe headache, visual disturbance, and hyperreflexia with clonus, are neurological rather than cardiovascular: the seizure is a brain event triggered by a systemic disease.
Risk rises sharply once severe features are present, but eclampsia can occur in women whose blood pressure readings had looked only mildly elevated, which is why symptom reporting matters as much as the numbers on the monitor.
How it presents — what you will actually see
The seizure itself is generalised tonic-clonic: a brief tonic phase of muscle rigidity, followed by clonic jerking of the limbs, typically lasting one to two minutes, then a postictal period of confusion or drowsiness. Before the seizure, most women have had premonitory signs, severe or persistent headache, visual disturbances such as blurring or scotomata, epigastric or right upper quadrant pain, or altered mental status, though a seizure can occur without clear warning.
During the event, breathing may stop briefly during the tonic phase, and cyanosis can appear before respiration resumes as the clonic phase ends. Fetal heart rate commonly shows late decelerations or bradycardia during and immediately after the seizure due to transient maternal hypoxia and reduced placental perfusion, and this typically resolves once the mother is stabilised and repositioned.
Postictally, expect a period of unresponsiveness or confusion lasting minutes to longer, and some women have no memory of the event at all.
Nursing assessment priorities
The priority during an active seizure is not assessment but protection: airway, breathing, and safety come first, and formal assessment resumes once the convulsion ends. Once the seizure has stopped, assess airway patency and breathing immediately, then oxygen saturation, and initiate continuous fetal monitoring as soon as it is safe to do so.
Check maternal vital signs, with particular attention to blood pressure, which is frequently elevated further immediately post-seizure, and level of consciousness as she moves through the postictal period. Reassess deep tendon reflexes and clonus once she is responsive, and ask, as soon as she can answer, whether the premonitory symptoms, headache or visual change, were present beforehand, since this informs ongoing risk.
Review the timing and duration of the seizure and document it precisely, as prolonged or repeated seizures change the management plan and raise concern for status eclampticus.
Interventions and what to do first
The first action when a preeclamptic patient begins to seize is to protect the airway and turn her onto her side, left lateral position where possible, to reduce aspiration risk and improve venous return and placental perfusion. Do not restrain the convulsing limbs and do not attempt to place anything in the mouth; padding the side rails and clearing the immediate area from hard objects is the correct protective action.
Call for help immediately and prepare for magnesium sulfate, which is the first-line drug both to treat the active or recent seizure and to prevent recurrence, typically a 4-6 g loading dose over 15-20 minutes followed by a maintenance infusion. Have suction and oxygen ready at the bedside, apply supplemental oxygen once the seizure ends, and continue continuous fetal and maternal monitoring throughout.
If seizures recur despite magnesium sulfate, additional anticonvulsant therapy may be used per provider order, and the team moves toward stabilising the mother before considering delivery, since delivery is the definitive treatment for eclampsia but is not undertaken until the mother is stable.
Complications to watch for
Aspiration is the immediate risk during and just after the seizure, which is why side-lying positioning and suction availability matter more than any single drug. Magnesium toxicity is the ongoing risk during treatment: absent deep tendon reflexes, respiratory depression below 12 breaths per minute, and decreasing urine output form the sequence to monitor, with calcium gluconate kept at the bedside as the antidote.
Placental abruption can follow the vasospasm and hypertension surge associated with a seizure, so watch for vaginal bleeding, abdominal pain, or a rigid, tender uterus. HELLP syndrome can develop concurrently, so trend platelets and liver enzymes, and pulmonary oedema is a risk during aggressive fluid and magnesium administration, so monitor respiratory status and fluid balance closely.
Postpartum, the risk of eclampsia does not disappear at delivery. Continue seizure precautions and magnesium therapy for the period specified by the provider, commonly 24 hours postpartum, since a meaningful share of eclamptic seizures occur after birth.
Patient teaching before discharge
Explain that magnesium sulfate will usually continue for a set period after delivery, often 24 hours, because the risk of seizure does not end when the baby is born. Tell her plainly which symptoms to report immediately after discharge: severe headache, visual changes, or epigastric pain, since postpartum eclampsia can occur days after she leaves the hospital.
Cover home blood pressure monitoring if it has been arranged, and make sure she knows the follow-up appointment schedule and who to contact if a warning sign appears rather than waiting for the next visit. Address her memory of the seizure itself; many women recall nothing and benefit from a clear, calm explanation of what happened and why.
Discuss future pregnancy risk in plain language: a history of eclampsia raises the risk of preeclampsia and eclampsia recurring, and early, consistent prenatal care with prompt reporting of symptoms is the main way that risk is managed going forward.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our maternity and newborn practice questions are the closest set to what this page covers.
Common questions
What is the first nursing action when a preeclamptic patient starts seizing?
Protect the airway and turn the patient onto her side, left lateral if possible, and do not restrain the convulsing limbs or place anything in the mouth. Call for help and prepare magnesium sulfate, since it is the first-line treatment to stop and prevent further seizures.
Why is magnesium sulfate used in eclampsia rather than a standard anticonvulsant?
Magnesium sulfate specifically addresses the cerebral vasospasm underlying eclamptic seizures and has the strongest evidence for both treating the seizure and preventing recurrence in this population. Standard anticonvulsants are reserved for seizures that continue despite adequate magnesium therapy.
How long after delivery can eclampsia still occur?
Eclampsia can occur postpartum, most commonly within the first 48 hours after delivery, though later cases happen. Magnesium sulfate and seizure precautions are typically continued for around 24 hours postpartum for this reason.
What are the signs of magnesium sulfate toxicity to monitor?
Watch for loss of deep tendon reflexes, respiratory rate falling below 12 breaths per minute, and decreasing urine output, which tend to appear in that order. Calcium gluconate should be available at the bedside as the antidote.
Does the fetal heart rate change during an eclamptic seizure?
Yes, late decelerations or bradycardia are common during and immediately after the seizure due to transient maternal hypoxia and reduced placental blood flow. This usually resolves once the mother is repositioned and stabilised, and continuous monitoring should resume as soon as it is safe.