= Solution
\b[Treat new convulsions during labour as possible <eclampsia>: protect breathing, terminate and prevent seizures, control severe <hypertension>, and plan birth after stabilisation.] Previous good health does not exclude <pre-eclampsia> or <eclampsia>. Also consider <epilepsy>, <hypoglycaemia>, intracranial disease and other causes if the clinical findings suggest them; neither an invented history nor a fabricated <urine> result is needed to recognise the emergency.
Summon obstetric, anaesthetic and neonatal assistance. Protect the woman from injury, position her safely on her side when feasible, maintain the <airway>, and assess breathing and <oxygen saturation>. Do not force an object into her mouth or attempt to suppress a fit by forcefully holding down her limbs. Obtain <intravenous access>, check <blood glucose>, and measure <blood pressure>; assess <platelets>, <renal function>, liver tests and <proteinuria> without delaying essential treatment. Review the fetal condition once maternal resuscitation is under way.
Current first-line anticonvulsant treatment is <magnesium sulfate>. NICE describes an intravenous loading dose of 4 g over 5–15 minutes, followed by 1 g per hour, with continued treatment for 24 hours after the last fit. Recurrent fits require additional treatment under the emergency protocol. Monitor breathing, tendon reflexes and <urine> output because impaired <renal function> increases the risk of <magnesium> accumulation. A <benzodiazepine> is not an interchangeable routine substitute for <magnesium sulfate> in this setting. Severe <hypertension> requires prompt suitable treatment, for example <labetalol>, <nifedipine> or <hydralazine>, with continuing reassessment.<Hypertension in pregnancy by NICE>[NG133, §§1.8.1–1.8.6: anticonvulsants and immediate treatment of severe hypertension]{ref}
Once stabilised, the woman needs a plan for birth. Cervical findings, progress of labour, gestation and maternal and fetal condition determine whether vaginal birth or <Caesarean section> is appropriate. Performing an immediate instrumental delivery during an uncontrolled fit is not a general rule, nor does the occurrence of one fit automatically establish the route of birth. Observation and treatment continue after delivery because further fits in <eclampsia> can occur.<Hypertension in pregnancy by NICE>[§1.8.13: mode of birth according to clinical circumstances; §1.8.4: magnesium regimen after a fit]{ref}
Historically, <bloodletting>, purgation, <chloroform> and expedited delivery were advocated in different combinations. An actual 1864 case report records such treatment and continuing convulsions despite delivery. It illustrates the historical problem, not proof that removal of blood or pressure on pelvic <nerves> explains or cures <eclampsia>.<Report of a Case of Puerperal Convulsions (1864)>[pp. 411–413: bloodletting, chloroform, delivery and subsequent course]{ref} Modern <eclampsia> care replaces those obsolete theories with specific seizure treatment, blood-pressure control and maternal resuscitation.
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