Modern management of eclampsia

Eclampsia, the occurrence of a seizure in association with preeclampsia, re mains an important cause of maternal mortality and morbidity. Despite being recognised since antiquity, consistent management practices are still lack ing. Given that the aim of good care is to prevent seizures, it is disappoi nting that in the majority of cases the first eclamptic convulsion occurs a fter admission to hospital. This indicates that either the women who are li kely to have a convulsion were not identified accurately, or the treatment given was ineffective. The answer to poor management of eclampsia lies in b etter education and training of all obstetricians, anaesthetists, midwives, and general practitioners in the diagnosis and treatment of severe pre-ecl ampsia and eclampsia. Protocols for the management of fluid balance, antihy pertensive and anticonvulsant therapies should be available and reviewed re gularly. The universal adoption of such guidelines in all obstetric units w ould substantially reduce elements of substandard care which have repeatedl y been identified in the triennial reports of the confidential enquiries in to maternal deaths in the UK.