A 28-year-old woman at 32 weeks develops severe pre-eclampsia with BP 168/112 mmHg. After initial stabilization with intravenous labetalol, which drug is the FIRST-LINE anticonvulsant for prophylaxis and treatment of eclamptic seizures in this patient?
- A Phenytoin sodium 15 mg/kg IV loading dose
- B Diazepam 10 mg IV bolus
- C Magnesium sulfate 4–6 g IV loading dose followed by 1–2 g/hour maintenance ✓
- D Levetiracetam 500 mg IV
Correct answer: C. Magnesium sulfate 4–6 g IV loading dose followed by 1–2 g/hour maintenance
Explanation
Magnesium sulfate is the drug of choice for both prophylaxis and treatment of eclamptic seizures, superior to phenytoin and diazepam as demonstrated in the Magpie Trial. The standard protocol is a 4–6 g IV loading dose over 15–20 minutes followed by 1–2 g/hour maintenance infusion. Phenytoin is less effective and not recommended for eclampsia; diazepam has higher neonatal respiratory depression risk.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.