1. Place her on her left side on the floor or firm surface. This helps keep her airway open and improves blood flow to the baby.
2. Keep her safe during any seizure: move hard objects away, cushion her head, loosen tight clothing.
3. Do not put anything in her mouth. Do not try to hold her tongue, restrain her, or give food, water, tablets, or herbal remedies.
4. If she is vomiting, keep her on her side and clear visible vomit from the mouth only if easily reachable.
5. Check breathing. If she is not breathing normally or has no pulse, start CPR if you are trained, and follow dispatcher instructions.
6. Note the time the seizure started and whether more seizures occur. If a seizure lasts 5 minutes or more, or repeats without her waking, tell emergency services immediately.
7. Do not transport her yourself unless an ambulance is impossible. She needs urgent hospital care, airway support, IV magnesium sulfate by clinicians, blood-pressure treatment, and obstetric assessment. Delivery may be needed after stabilization.

Emergency treatment plan for trained clinicians

1. Stabilize the mother first: ABC

• Call obstetric, anesthesia/critical-care, neonatal teams and arrange urgent transfer to a facility capable of emergency delivery.
• Left lateral position, protect from injury, suction secretions, high-flow oxygen.
• Assess airway and breathing. Intubate/ventilate if GCS remains low, aspiration risk is high, oxygenation is inadequate, or seizures recur.
• Two large-bore IV lines. Use cautious isotonic fluids only. Avoid fluid overload because pulmonary edema is a risk.
• Continuous BP, pulse oximetry, ECG; insert Foley catheter and record hourly urine output.

2. Stop and prevent seizures: magnesium sulfate

• Loading: magnesium sulfate 4-6 g IV over 15-20 minutes
• Maintenance: 1-2 g/hour IV infusion

• Give an additional 2 g IV slowly over 5-10 minutes.
• Check airway, oxygenation, glucose, magnesium dosing, and consider intubation if seizures persist.

• 4 g IV slowly plus 10 g IM, 5 g in each buttock, then
• 5 g IM every 4 hours, alternating sides, only if monitoring criteria are met.

• Respiratory rate at least 12/min
• Patellar reflex present
• Urine output at least 25-30 mL/hour

3. Treat severe hypertension urgently

• Labetalol: 20 mg IV over 2 minutes, then 40 mg after 10 minutes, then 80 mg every 10 minutes as needed, maximum 220 mg.
• Hydralazine: 5-10 mg IV slowly, repeat after about 20 minutes if needed.
• Nifedipine immediate-release oral is an option only if the patient can safely swallow. It is not appropriate while unconscious.

4. Investigations and monitoring

• CBC and platelet count
• Liver enzymes, bilirubin, LDH
• Creatinine, electrolytes, urine protein if feasible
• Coagulation tests if thrombocytopenia, bleeding, suspected placental abruption, or HELLP syndrome
• Bedside glucose
• Strict fluid balance and assessment for pulmonary edema
• Continuous fetal monitoring after maternal stabilization

5. Delivery

• Expedite delivery in a facility with neonatal support.
• Mode of delivery depends on fetal condition, cervical status, labor progress, and urgency. Eclampsia alone is not an automatic indication for cesarean delivery.
• If immediate preterm delivery is anticipated and time permits, give antenatal corticosteroids for fetal lung maturation, but never delay life-saving maternal care or delivery for steroids.

6. Consider other causes if atypical