Eclampsia — MSF Essential obstetric and newborn care — Médecins Sans Frontières 2026

MSFClinical guideline (chapter)Current edition

From Essential obstetric and newborn care › Chapter 4: Pathologies during pregnancy and pregnancy-related disorders · Médecins Sans Frontières, Current online edition, 2026

Clinical management of eclamptic seizures in pregnancy and postpartum for frontline obstetric care.

In one sentenceEclampsia (convulsions in pregnancy/postpartum) requires magnesium sulfate for 24 hours after delivery/last seizure, oxygen 4–6 L/min, antihypertensives if BP ≥160/110 mmHg, and delivery within 24 hours.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Obstetricians, midwives, emergency physicians, and frontline maternal health providers
Evidence: Expert consensus based on MSF field experience
Reviewed: 23 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 23 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This MSF clinical guideline addresses the diagnosis and emergency management of eclampsia, defined as convulsions during the third trimester of pregnancy (most commonly in the context of pre-eclampsia) or within 48 hours after delivery (and up to 6 weeks postpartum). The guideline emphasises the importance of excluding other causes of convulsions such as meningitis and severe malaria, whose incidence is increased in pregnant women.

Management focuses on immediate protection from injury, airway maintenance, magnesium sulfate as first-line anticonvulsant therapy (using the same protocol as for severe pre-eclampsia), oxygen therapy, antihypertensive treatment when blood pressure thresholds are exceeded (SBP ≥ 160 mmHg or DBP ≥ 110 mmHg), and delivery within 24 hours. Treatment with magnesium sulfate should continue for 24 hours after delivery or 24 hours after the last seizure, whichever is more recent.

The guideline provides an alternative anticonvulsant regimen (diazepam) when magnesium sulfate is unavailable, and recommends secondary prophylaxis with acetylsalicylic acid as per the pre-eclampsia protocol.

Key points

For clinicians — doses and thresholds as stated in the guideline

Eclampsia is diagnosed by convulsions during the third trimester of pregnancy (typically in pre-eclampsia context) or within 48 hours after delivery (up to 6 weeks postpartum)
Magnesium sulfate is first-line anticonvulsant therapy, using the same protocol as for severe pre-eclampsia; continue for 24 hours after delivery or 24 hours after the last seizure, whichever is more recent
If magnesium sulfate unavailable: diazepam 10 mg slow IV (or rectal), then 40 mg in 500 ml of 5% glucose over 24 hours (ventilation equipment must be immediately available)
Administer oxygen at 4 to 6 litres/minute
Antihypertensive treatment indicated if SBP ≥ 160 mmHg or DBP ≥ 110 mmHg, using protocols for severe pre-eclampsia
Deliver within 24 hours (vaginally or by caesarean section, depending on cervical state, gestational age and foetal condition)
Consider and exclude other causes of convulsions: meningitis and severe malaria (incidence increased in pregnant women)
Administer secondary prophylaxis with acetylsalicylic acid as per pre-eclampsia protocol

From the guideline

Verbatim

“Continue treatment for 24 hours after delivery or 24 hours after the last seizure, whichever was more recent.”

— Médecins Sans Frontières, Eclampsia — MSF Essential obstetric and newborn care, Section 4.6.2 (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute of Georgia, I recognise that eclampsia management remains a critical gap in maternal mortality reduction across our region. This MSF guideline provides clear, actionable protocols that align with international standards whilst acknowledging resource constraints through the diazepam alternative regimen. Georgian obstetricians should particularly note the specific blood pressure thresholds (160/110 mmHg) for antihypertensive intervention and the precise duration of magnesium sulfate therapy—24 hours after delivery or last seizure, whichever is later. The main implementation challenge for Georgia will be ensuring magnesium sulfate availability and staff competency at all levels of the maternity care system, from rural birthing centres to tertiary facilities, alongside functional referral networks for timely delivery within the recommended 24-hour window.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026

Applicability

Georgia and the South Caucasus

Eclampsia remains a significant cause of maternal mortality in Georgia and the South Caucasus region, where access to magnesium sulfate and emergency obstetric care varies between urban centres and rural settings. National maternal health programmes should ensure magnesium sulfate availability at all delivery facilities, establish clear referral pathways for eclamptic emergencies, train midwives and physicians in seizure management and airway protection, and maintain functional blood pressure monitoring equipment. The guideline’s provision of an alternative diazepam regimen addresses resource-limited contexts, though Georgia’s maternal health infrastructure should prioritise magnesium sulfate as the evidence-based standard. Timely delivery within 24 hours requires functional operating theatre capacity and anaesthetic services at district hospital level.

Questions this guideline answers

Quick answers

How long should magnesium sulfate be continued after an eclamptic seizure?

Continue magnesium sulfate for 24 hours after delivery or 24 hours after the last seizure, whichever was more recent.

What is the alternative if magnesium sulfate is not available?

Use diazepam: 10 mg slow IV (or by rectal route), then 40 mg in 500 ml of 5% glucose administered over 24 hours. Ventilation equipment must be immediately available.

What blood pressure thresholds require antihypertensive treatment in eclampsia?

Antihypertensive treatment is indicated if systolic blood pressure is ≥ 160 mmHg or diastolic blood pressure is ≥ 110 mmHg, following the same protocols as for severe pre-eclampsia.

When can eclampsia occur in relation to delivery?

Eclampsia most commonly occurs during the third trimester of pregnancy but can also occur within 48 hours after delivery and up to 6 weeks postpartum. Other causes of convulsions such as meningitis and severe malaria should be considered and excluded.

Related on GMJ

Interconnected resources

Dictionary of Public Health

Drugs A–Z

Diazepam

GMJ News coverage

Quality & accreditation

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Hypertensive disorders in pregnancy — MSF Essential obstetric and newborn careChapter 4: Pathologies during pregnancy and pregnancy-related disorders
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Parasitic infections in pregnancy: malaria, hookworms and ascariasis — MSF Essential obstetric and newborn careChapter 4: Pathologies during pregnancy and pregnancy-related disorders
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Eclampsia — MSF Essential obstetric and newborn care

What this guideline says

Key points

From the guideline