A seizure in a pregnant or recently delivered woman is an emergency; call for help and notify the provider at once.
Before you read
Test yourself first: 1 question
Question 1 of 1
A client receiving IV magnesium sulfate for preeclampsia has absent deep tendon reflexes, a respiratory rate of 10, and decreased urine output. What is the nurse's FIRST action?
Answer: B. These findings indicate magnesium sulfate toxicity. The nurse should first stop the infusion to prevent further accumulation, then notify the provider and prepare to administer calcium gluconate, the antidote that antagonizes magnesium's effects. Continuing the infusion would worsen the respiratory depression.
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What is eclampsia?
It results from severe cerebral vasospasm, edema, and hypertension. It is an obstetric emergency that threatens both maternal airway/oxygenation and fetal oxygenation. The priority during a seizure is patient safety and airway, not stopping the seizure with force.
Key points to remember
- Seizures are typically generalized tonic-clonic and may be preceded by a severe headache, visual changes, and hyperreflexia with clonus.
- Cerebral vasospasm and edema cause the seizure activity.
- During the seizure the mother becomes apneic, risking maternal and fetal hypoxia.
- A transient fetal bradycardia commonly follows the maternal seizure as placental perfusion drops.
- Seizures can occur before, during, or up to 48-72 hours after delivery (postpartum eclampsia).
Nursing priorities
- Protect the airway: turn the patient to the side, do not restrain, and do not insert objects into the mouth.
- Apply oxygen by face mask and have suction ready for secretions after the seizure ends.
- Administer or continue magnesium sulfate as the first-line drug to control and prevent further seizures.
- After the seizure, assess fetal heart rate and uterine activity and notify the provider immediately.
- Keep the room quiet and dim and pad the side rails to reduce stimulation and injury risk.
Labs & values
Patient teaching
- Postpartum patients should report headaches, visual changes, or feeling like they may pass out, since seizures can occur after delivery.
- Have a support person stay with the patient during the high-risk period.
Red flags: report now
- A seizure in a pregnant or recently delivered woman is an emergency; call for help and notify the provider at once.
- Report persistent fetal bradycardia or late decelerations after the seizure, which signal fetal compromise.
- Watch for signs of magnesium toxicity (absent reflexes, respirations under 12, low urine output) and have calcium gluconate available as the antidote.
- Never leave the patient unattended during or immediately after a seizure.
References
Clinical references for this topic
