A woman with pre-eclampsia at 36 weeks has a seizure despite adequate magnesium sulfate. The next appropriate step is:
- A Switch to phenytoin 15 mg/kg IV loading dose
- B Start levetiracetam IV and continue magnesium
- C Give an additional 2 g MgSO4 IV over 3–5 minutes ✓
- D Perform emergency cesarean delivery before any further anticonvulsant
Correct answer: C. Give an additional 2 g MgSO4 IV over 3–5 minutes
Explanation
A breakthrough seizure on therapeutic magnesium is managed by giving an additional 2 g MgSO4 IV bolus over 3–5 minutes; this saturates the gap created by seizure-related redistribution. Phenytoin is no longer recommended for eclampsia management (inferior to magnesium per Magpie trial). Levetiracetam lacks RCT data for eclampsia. Delivery is necessary but anticonvulsant stabilization comes first to allow safe anesthesia.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.