MAGNESIUM SULPHATE IN THE PROPHYLAXIS AND TREATMENT OF ECLAMPSIA
AbstractBackground: Magnesium Sulphate is considered to be the agent of choice for the control of eclamptic seizures in pregnant women. Our objectives were to determine frequency of eclampsia and pre-eclampsia in our unit and to determine the effect of initial loading dose of magnesium sulphate on maternal and fetal outcome. Methods: This study was carried out in Department of Gynaecology at Lady Reading Hospital, Peshawar. In the year 2000 only 133 patients received magnesium sulphate out of 228 cases of eclampsia and pre eclampsia due to the problems with the continuous supply of the drug. This included 53 cases of eclampsia and 80 cases of pre-eclampsia. Information regarding the dosage of magnesium sulphate labor out come, maternal and fetal outcome, side effects and complications of therapy were evaluated from hospital case records. The magnesium sulphate regimen consisted of 4 gm loading dose as 20% solution intravenously over 10-15 minutes followed immediately by 5 gm into each buttock. Dose of 5gm intramuscularly was repeated only if the patient developed convulsions. Results: Eclampsia and pre-eclampsia occurred in 1 in 25.5 and 1 in 34.4 deliveries respectively. Majority of patients received the initial loading dose of magnesium sulphate, but in 2 patients dose had to be repeated. In two patients of pregnancy induced hypertension convulsions occurred soon after delivery unheralded by any signs and symptoms of impending eclampsia. Perinatal mortality was 19 (35.8%) and 16 (20%) in eclampsia and pre-eclampsia respectively. High perinatal mortality was attributed to prematurity as only 16.98% of eclampsia and 57.5% of Pre eclampsia were more than 37 weeks. One patient of sever pre-eclampsia developed postpartum hemorrhage and acute renal failure, but she recovered while another one developed sudden postpartum collapse immediately after delivery and died due to cerebrovascular accident. 8 patients of eclampsia died despite intensive management. All of them were referred from periphery with history of multiple fits and were brought in a serious state. Conclusion: Frequency of eclampsia and pre-eclampsia is high in this region with high perinatal and maternal morbidity and mortality. Magnesium sulphate is an effective drug to prevent and control seizures. It is easy to administer and subsequent nursing is easy. Seizures usually terminate after the initial loading dose of magnesium sulphate.
Chien PF, Khan KS, Arnott N. Magnesium sulphate in the treatment of eclampsia and pre eclampsia: an overview of the of the evidence from randomized trials. Br J Obs gynecol 1996; 103:1085-91.
Anthony J, Johanson RB, Duley L. Role of magnesium sulphate in seizure prevention in patients with eclampsia and pre eclampsia. Drug saf 1996;15(3):188-99.
Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia (Cochrane review). In the Cochrane library, issue 3, 2003 Oxford.
Sibai BM. Magnesium sulphate is the ideal anticonvulsant in pre eclampsia-eclampsia. Am J Obst Gynecol 1990;162:1141-5.
Belfort MA, Moise KJ. Effect of Magnesium sulphate on maternal brain blood flow in pre eclampsia. A randomized Placebo controlled study. Am J Obst Gynecol 1992;167:661-6.
Burrows RF, Burrows EA. The feasibility of a control population for a randomized control trial of seizure prophylaxis in the hypertensive disorders of pregnancy. Am J Obst Gynecol 1995;173:929-35.
Duley L. Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial. The Lancet. 1995; 345:1455-63.
Duley L. Do women with pre-eclampsia and their babies benefit from Magnesium sulphate? The MagPie Trial: a randomized placebo-controlled trial. Lancet 2002;359:(9321):1877-90
Katz VL, Farmer R, Kuller JA. Pre eclampsia into eclampsia. Towards a new paradigm. Am J Obst Gynecol 2000;182:1389-96.
Pritchard JA, Cunnigham FG, Pritchard SA. Parkland Memorial Hospital Protocol for treatment of Eclampsia.Evaluation of 245 cases. Am J Obst Gynecol 1984;148:951-63.
Fugate SR, Chow GE. Eclampsia. Retracted from e-Medicine. May 13, 2003.
Mattar F, Sibai BM. Risk factors for maternal morbidity. Am J Obst Gynecol 2000; 182:307-12.
Appleton MP, Kuchl TJ, Rebel MA, Adams HR, Knight AB, Gold WR. Magnesium sulphate versus Phenytoin for Seizure Prophylaxis in pregnancy induced hypertension. Am J Obst Gynecol 1991;165:907-13.
Douglas KA, Redman CWG. Eclampsia in the United Kingdom. BMJ 1994; 309:1395-1400.
Steer PJ. The definition of pre eclampsia. Commentary. Br J Obstet Gynecol 1999;106:753-5.
Schendel DE, Berg CJ, Allsopp MY, Boyle CA, Decoufle P. Prenatal Magnesium Sulphate Exposure and the risk for Cerebral Palsy or Mental Retardation among very Low birth weight Children aged 3 to 5 years. JAMA 1996;276:1805-10.
Nelson Kb, Grether JK. Can Magnesium sulphate reduce the risk of cerebral palsy in very Low birth weight infants? Pediatrics 1995;95:263-9.
Duley L. Magnesium sulphate regimen for women with eclampsia. Messages from the collaborative Eclampsia trial. Br J Obstet Gynecol 1996;103:103-5.