Q. When do I give magnesium to a pregnant woman who is fitting and eclampsia is suspected, and when would I use diazepam?
A. Most eclamptic grand mal fits are self-limiting
The best approach is not to give any medication for a first fit in the first 5 minutes, but to give supportive measures including left lateral (recovery) position and rapid transfer to an obstetric unit.
However, for a second eclamptic fit or a prolonged first fit longer than 5 minutes, give 4g slow IV magnesium (if available) as a loading dose and rapid conveyance.
If magnesium is not available and the woman has a prolonged or second fit, give diazepam and rapid conveyance.
If magnesium is not available, a pre alert to the hospital should be given and it is likely that magnesium would be administered on arrival by the receiving team.