{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T19:04:40Z","timestamp":1776884680041,"version":"3.51.2"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"880","license":[{"start":{"date-parts":[[1999,2,1]],"date-time":"1999-02-01T00:00:00Z","timestamp":917827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[1999,2,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Eclampsia, the occurrence of a seizure in association with pre-eclampsia, remains an important cause of maternal mortality and morbidity. Despite being recognised since antiquity, consistent management practices are still lacking. Given that the aim of good care is to prevent seizures, it is disappointing that in the majority of cases the first eclamptic convulsion occurs after admission to hospital. This indicates that either the women who are likely to have a convulsion were not identified accurately, or the treatment given was ineffective. The answer to poor management of eclampsia lies in better education and training of all obstetricians, anaesthetists, midwives, and general practitioners in the diagnosis and treatment of severe pre-eclampsia and eclampsia. Protocols for the management of fluid balance, antihypertensive and anticonvulsant therapies should be available and reviewed regularly. The universal adoption of such guidelines in all obstetric units would substantially reduce elements of substandard care which have repeatedly been identified in the triennial reports of the confidential enquiries into maternal deaths in the UK.<\/jats:p>","DOI":"10.1136\/pgmj.75.880.78","type":"journal-article","created":{"date-parts":[[2015,2,18]],"date-time":"2015-02-18T00:04:10Z","timestamp":1424217850000},"page":"78-82","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Modern management of eclampsia"],"prefix":"10.1093","volume":"75","author":[{"given":"Osama","family":"Salha","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, St James's University Hospital , Leeds LS9 7TF, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James J","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, St James's University Hospital , Leeds LS9 7TF, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1999,2,1]]},"reference":[{"key":"2023042616102076400_B1","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1136\/bmj.309.6966.1395","article-title":"Eclampsia in the United Kingdom","volume":"309","author":"Douglas","year":"1994","journal-title":"BMJ"},{"key":"2023042616102076400_B2","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/0002-9378(88)90782-X","article-title":"Geographic variation in the incidence of hypertension in pregnancy","volume":"158","author":"World Health Organisation International Collaborative Study of Hypertensive Disorders of pregnancy","year":"1988","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B3","first-page":"927","article-title":"Eclampsia at Harare Maternity Hospital. An epidemiological study","volume":"68","author":"Crowther","year":"1985","journal-title":"S Afr Med J"},{"key":"2023042616102076400_B4","first-page":"153","article-title":"Seasonal incidence of eclampsia and its relationship to meteorological data in Mozambique","volume":"20","author":"Bergst\u00f6m","year":"1992","journal-title":"J Perinat Med"},{"key":"2023042616102076400_B5","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/S0140-6736(87)90423-5","article-title":"The safe motherhood initiative: a call to action","volume":"1","author":"Mahler","year":"1987","journal-title":"Lancet"},{"key":"2023042616102076400_B6","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0140-6736(85)90188-6","article-title":"Maternal mortality - a neglected tragedy. Where is the M in MCH?","volume":"2","author":"Rosenfield","year":"1985","journal-title":"Lancet"},{"key":"2023042616102076400_B7","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1111\/j.1471-0528.1992.tb13818.x","article-title":"Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean","volume":"99","author":"Duley","year":"1992","journal-title":"Br J Obstet Gynaecol"},{"key":"2023042616102076400_B8","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780198229971.001.0001","volume-title":"Death in childbirth: an international study of maternal care and maternal mortality 1800\u20131950","author":"Loudon","year":"1992"},{"key":"2023042616102076400_B9"},{"key":"2023042616102076400_B10","volume-title":"Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1990\u20131992","author":"Department of Health, Welsh Office, Scottish Home and Health Department, Department of Health and Social Security, Northern Ireland","year":"1996"},{"key":"2023042616102076400_B11","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/0002-9378(90)91123-T","article-title":"Eclampsia: VI. Maternal-perinatal outcome in 254 consecutive cases","volume":"163","author":"Sibai","year":"1990","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B12","first-page":"328","article-title":"Postpartum eclampsia: a recurring perinatal dilemma","volume":"76","author":"Miles","year":"1990","journal-title":"Obstet Gynecol"},{"key":"2023042616102076400_B13","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1111\/j.1471-0528.1992.tb13819.x","article-title":"Management of pre-eclampsia and eclampsia by UK consultants","volume":"99","author":"Hutton","year":"1992","journal-title":"Br J Obstet Gynaecol"},{"key":"2023042616102076400_B14","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/j.1471-0528.1993.tb14227.x","article-title":"Phenytoin prophylaxis in severe pre-eclampsia and eclampsia","volume":"100","author":"Robson","year":"1993","journal-title":"Br J Obstet Gynaecol"},{"key":"2023042616102076400_B15","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/0140-6736(91)92227-S","article-title":"Are prophylactic anticonvulsants required in severe pre-eclampsia?","volume":"337","author":"Chua","year":"1991","journal-title":"Lancet"},{"key":"2023042616102076400_B16","first-page":"148","article-title":"The death of eclampsia","volume":"51","author":"Walker","year":"1994","journal-title":"Br J Hosp Med"},{"key":"2023042616102076400_B17","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/0002-9378(95)90368-2","article-title":"The feasibility of a control population for a randomised controlled trial of seizure prophylaxis in the hypertensive disorders of pregnancy","volume":"173","author":"Burrows","year":"1995","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B18","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/0959-289X(92)90024-X","article-title":"The case for magnesium sulphate in pre-eclampsia","volume":"1","author":"Sibai","year":"1992","journal-title":"Int J Obstet Anesth"},{"key":"2023042616102076400_B19","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S0095-5108(18)30499-8","article-title":"Hypertensive drugs in pregnancy: antihypertensive therapy in pregnancy, pre-eclampsia, eclampsia","volume":"18","author":"Walker","year":"1991","journal-title":"Clin Perinatol"},{"key":"2023042616102076400_B20","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1016\/S0140-6736(95)91034-4","article-title":"Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trail","volume":"345","author":"The Eclampsia Trail Collaborative Group","year":"1995","journal-title":"Lancet"},{"key":"2023042616102076400_B21","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1016\/0002-9378(91)90711-Y","article-title":"Magnesium sulphate-induced relaxation of uterine arteries from pregnant and non-pregnant patients","volume":"164","author":"Nelson","year":"1991","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B22","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0002-9378(11)91567-1","article-title":"Effect of magnesium sulphate on brain blood flow in pre-eclampsia: A randomised placebo-controlled study","volume":"167","author":"Belfort","year":"1992","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B23","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/0002-9378(90)90714-I","article-title":"Effects of magnesium and isradipine on contractile activation induced by the thromboxane A2 analogue U46619 in human uteroplacental arteries in term pregnancy","volume":"163","author":"Skajja","year":"1990","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B24","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1056\/NEJM198811033191813","article-title":"Therapeutic use of magnesium sulphate in selected cases of cerebral ischaemia and seizure","volume":"319","author":"Goldman","year":"1988","journal-title":"N Engl J Med"},{"key":"2023042616102076400_B25","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S0002-9378(11)90599-7","article-title":"Anticonvulsant effects of magnesium sulphate on hippocampal seizures: Therapeutic implications in pre-eclampsia\/eclampsia","volume":"166","author":"Cotton","year":"1992","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B26","volume-title":"Management of eclampsia","author":"Royal College of Obstetricians and Gynaecologists (RCOG) Guidelines No 10","year":"1996"},{"key":"2023042616102076400_B27","first-page":"1689","article-title":"National High Blood Pressure Education Program Working Group report on high blood pressure in pregnancy","volume":"163","author":"Gifford","year":"1990","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B28","first-page":"845","article-title":"Hypertension in pregnancy; whom and how to treat","volume":"18","author":"Lubbe","year":"1987","journal-title":"Clin Perinatol"},{"key":"2023042616102076400_B29","first-page":"763","volume-title":"Williams Obstetrics","author":"Grant","year":"1993","edition":"19th edn."},{"key":"2023042616102076400_B30","first-page":"626","article-title":"Conservative management of severe pre-eclampsia remote from term","volume":"84","author":"Schiff","year":"1994","journal-title":"Obstet Gynecol"},{"key":"2023042616102076400_B31","first-page":"331","article-title":"Nifedipine in the treatment of severe pre-eclampsia","volume":"77","author":"Fenakel","year":"1991","journal-title":"Obstet Gynecol"},{"key":"2023042616102076400_B32","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1111\/j.1471-0528.1994.tb11913.x","article-title":"Hydralazine boluses for the treatment of severe hypertension in pre-eclampsia","volume":"101","author":"Paterson-Brown","year":"1994","journal-title":"Br J Obstet Gynaecol"},{"key":"2023042616102076400_B33","first-page":"328","article-title":"A comparative trail of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy","volume":"70","author":"Mabie","year":"1987","journal-title":"Obstet Gynecol"},{"key":"2023042616102076400_B34","first-page":"371","article-title":"Intravenous labetalol and intravenous hydralazine in severe hypertension in pregnancy","volume":"1","author":"Garden","year":"1982","journal-title":"Clin Exp Hypertens"},{"key":"2023042616102076400_B35","first-page":"354","article-title":"Comparison of labetalol and dihydralazine in hypertensive emergencies of pregnancy","volume":"71","author":"Ashe","year":"1987","journal-title":"S Afr Med J"},{"key":"2023042616102076400_B36","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/j.1471-0528.1992.tb13872.x","article-title":"A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy","volume":"99","author":"Moodley","year":"1992","journal-title":"Br J Obstet Gynaecol"},{"key":"2023042616102076400_B37","first-page":"525","article-title":"Ketanserine and hydralazine in hypertension in pregnancy - a randomised double-blind trail","volume":"85","author":"Rossouw","year":"1995","journal-title":"S Afr Med J"},{"key":"2023042616102076400_B38","first-page":"248","article-title":"Nifedipine in acute hypertensive emergencies in pregnancy","volume":"76","author":"Seabe","year":"1989","journal-title":"S Afr Med J"},{"key":"2023042616102076400_B39","first-page":"25","article-title":"Randomised, controlled trail of hydralazine versus nifedepine in pre-eclamptic women with acute hypertension","volume":"11","author":"Martins-Costa","year":"1992","journal-title":"Clin Exp Hypertens"},{"key":"2023042616102076400_B40","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/S0002-9378(88)80072-3","article-title":"Magnesium plus nifedipine: potentiation of the hypertensive effect in pre-eclampsia?","volume":"159","author":"Waisman","year":"1988","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B41","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1042\/cs0770599","article-title":"Capillary permeability and extracellular fluid volumes in pregnancy-induced hypertension","volume":"63","author":"Brown","year":"1989","journal-title":"Clin Sci"},{"key":"2023042616102076400_B42","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/S0002-9378(12)80015-9","article-title":"Cerebral imaging in eclampsia: magnetic resonance imaging versus computed tomography","volume":"167","author":"Dahmus","year":"1992","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B43","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/bja\/49.1.3","article-title":"The management of severe pre-eclampsia and eclampsia","volume":"49","author":"Hibbard LT","year":"1977","journal-title":"Br J Anaesth"},{"key":"2023042616102076400_B44","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/S0002-9378(85)80149-6","article-title":"Evaluation of the use of continuous lumbar epidural anaesthesia for hypertensive pregnant women in labour","volume":"152","author":"Moore","year":"1985","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B45","first-page":"31","article-title":"Severe pre-eclampsia: haemodynamic effects of lumbar epidural anaesthesia","volume":"65","author":"Newsome","year":"1986","journal-title":"Anesth Analg"},{"key":"2023042616102076400_B46","first-page":"158","article-title":"Lumbar epidural analgesia to improve intervillous blood flow during labour in severe pre-eclampsia","volume":"59","author":"Jouppila","year":"1982","journal-title":"Obstet Gynecol"},{"key":"2023042616102076400_B47","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/j.1365-2044.1980.tb03886.x","article-title":"Epidural analgesia and cardiac output in severe pre-eclampsia","volume":"35","author":"Graham","year":"1980","journal-title":"Anaesthesia"},{"key":"2023042616102076400_B48","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1399-6576.1980.tb01514.x","article-title":"Laryngeal oedema as an obstetric anaesthesia complication: case reports","volume":"24","author":"Jouppila","year":"1980","journal-title":"Acta Anaesthesiol Scand"},{"key":"2023042616102076400_B49","first-page":"523","article-title":"Pharolaryngeal oedema as a presenting symptom in pre-eclampsia","volume":"62","author":"Heller","year":"1983","journal-title":"Obstet Gynecol"},{"key":"2023042616102076400_B50","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/BF03007461","article-title":"Systemic and pulmonary blood pressure during caesarean section in parturients with gestational hypertension","volume":"27","author":"Hodgkinson","year":"1980","journal-title":"Can Anaesth Soc J"},{"key":"2023042616102076400_B51","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/S0002-9378(88)80027-9","article-title":"The use of labetalol for attenuation of the hypertensive response to endotracheal intubation in pre-eclampsia","volume":"159","author":"Ramanathan","year":"1988","journal-title":"Am J Obstet Gynecol"},{"key":"2023042616102076400_B52","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/00000542-197712000-00013","article-title":"Complications related to the pressor response","volume":"47","author":"Fox","year":"1977","journal-title":"Anesthesiology"},{"key":"2023042616102076400_B53","first-page":"175","volume-title":"Whitfield C Dewhurst's Textbook of obstetrics and gynaecology for postgraduates","author":"Davey","year":"1989","edition":"5th edn."},{"key":"2023042616102076400_B54","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/0028-2243(95)02318-M","article-title":"Care of the patient with severe pregnancy induced hypertension","volume":"65","author":"Walker","year":"1996","journal-title":"Eur J Obstet Gynaecol Reprod Biol"},{"key":"2023042616102076400_B55","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1471-0528.1996.tb09657.x","article-title":"Magnesium sulphate regimens for women with eclampsia: messages from the Collaborative Eclampsia Trial","volume":"103","author":"Duley","year":"1996","journal-title":"Br J Obstet Gynaecol"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/75\/880\/78\/50046630\/postgradmedj-75-78.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/75\/880\/78\/50046630\/postgradmedj-75-78.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T16:19:08Z","timestamp":1682525948000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/75\/880\/78\/7044914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,2,1]]},"references-count":55,"journal-issue":{"issue":"880","published-online":{"date-parts":[[1999,2,1]]},"published-print":{"date-parts":[[1999,2,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.75.880.78","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1999,2]]},"published":{"date-parts":[[1999,2,1]]}}}