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Postpartum eclampsia — MRCEM SBA MCQ

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HardObstetric and gynaecological emergenciesPostpartum eclampsiaMRCEM SBA

A 32-year-old woman attends the emergency department four days after an uncomplicated delivery. She had normal blood pressure throughout pregnancy but has developed a severe headache and flashing lights in her vision. While being assessed, she has a generalised tonic–clonic seizure lasting 90 seconds. She is now breathing normally and regaining consciousness; capillary glucose is 5.4 mmol/L and there is no focal neurological deficit. Blood pressure is 174/112 mmHg and remains 170/110 mmHg ten minutes later. Urine dipstick shows 3+ protein. Intravenous access is established and the obstetric and anaesthetic teams have been called. What is the most appropriate immediate treatment and disposition?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start intravenous magnesium sulfate loading and maintenance doses, give intravenous labetalol immediately, and arrange level 2 care.

The combination of recent delivery, headache, visual symptoms, proteinuria, severe hypertension and a generalised seizure indicates **postpartum eclampsia**. Normal antenatal blood pressure does not exclude pre-eclampsia developing after birth. The seizure has stopped, but she still needs intravenous magnesium sulfate to prevent recurrence. NICE specifies a 4 g loading dose over 5–15 minutes followed by 1 g/hour, continued for 24 hours after the last fit. Her persistently severe blood pressure also requires immediate treatment; intravenous labetalol is a recommended option. Eclampsia and intravenous antihypertensive treatment warrant level 2 critical care. ([nhs.uk](https://www.nhs.uk/conditions/pre-eclampsia/?src=conditionswidget)) **A** delays treatment of severe hypertension for imaging; imaging can be considered after initial stabilisation if clinically indicated. **C** selects level 1 care despite eclampsia and the need for intravenous antihypertensive treatment. **D** substitutes levetiracetam for magnesium sulfate, contrary to NICE guidance for eclampsia. **E** omits the maintenance infusion, leaving the recommended post-fit course incomplete. ([nice.org.uk](https://www.nice.org.uk/guidance/ng133/chapter/recommendations))

Reference: NICE NG133: Hypertension in pregnancy—recommendations 1.8.1 and 1.8.4–1.8.5 (Updated 17 April 2023) — https://www.nice.org.uk/guidance/ng133/chapter/recommendations NICE NG133: Hypertension in pregnancy—recommendation 1.8.6 (Updated 17 April 2023) — https://www.nice.org.uk/guidance/ng133/chapter/recommendations NICE NG133: Hypertension in pregnancy—recommendation 1.8.14 and table 4 (Updated 17 April 2023) — https://www.nice.org.uk/guidance/ng133/chapter/recommendations