Hypertension, or high blood pressure, affects 5 to 10% of all pregnancies. There is a spectrum of hypertensive disorders of pregnancy that includes the following situations: chronic hypertension (which is high blood pressure diagnosed in a person before pregnancy), gestational hypertension (which is high blood pressures seen only in the setting of pregnancy and noted after 20 weeks gestation), preeclampsia (which involves both elevated blood pressure and spillage of protein in the urine), HELLP (which is a variant of preeclampsia involving significant lab abnormalities and physical findings), and ecclampsia (which is seizure in the setting of preeclampsia). Ecclampsia occurs in 1% of patients with preeclampsia and is an obstetric emergency. The diagnosis is made when a patient experiences a seizure in the setting of a diagnosis of preeclampsia, although it should be suspected in any pregnant patient with a seizure even if the blood pressure is normal and there is no proteinuria. It can occur before labor, during labor, or in the postpartum period. Management involves IV magnesium sulfate and possibly antiseizure medications. If the blood pressures are high, medications are used to control the hypertension. It is important to first stabilize the patient, but preparation for emergency delivery may be necessary.