A 32-year-old woman delivered at 34 weeks for severe pre-eclampsia. On postpartum day 2, she develops a generalized tonic-clonic seizure. Her blood pressure is 150/100 mmHg. What is the most appropriate management?

• A IV phenytoin loading dose followed by maintenance therapy
• B Immediate CT head to rule out intracranial hemorrhage before treatment
• C IV diazepam bolus and repeat if seizures recur
• D IV magnesium sulfate regimen as per Zuspan or Pritchard protocol ✓

Explanation

Eclampsia can occur up to 4 weeks postpartum, and late postpartum eclampsia is well described. Magnesium sulfate remains the anticonvulsant of choice for eclampsia regardless of timing (antepartum, intrapartum, or postpartum), as established by the MAGPIE and Collaborative Eclampsia trials. Phenytoin and diazepam are second-line agents. While neuroimaging may be considered, treatment should not be delayed for imaging.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.