60 Access to magnesium sulfate for eclampsia and severe pre-eclampsia in the public health system in Brazil: Situational analysis

Abstract

Background Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive syndrome, including timely access to magnesium sulfate. Objective To identify the potential causes of improper magnesium sulfate use. Method A situational analysis was conducted with a survey on information available at the official websites on the policy, regulation and availability of the medication, field analysis and interviews with local managers of public obstetric health services in Campinas, a city in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations. Results There was no access to magnesium sulfate in primary care facilities, urgent obstetric care was excluded from urgency care services and clinical protocols for professional guidance on the proper use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals (Table). Conclusion The lack of processes that promote the integration between urgency/emergency care and specialized obstetric care favors the improper use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates. Download : Download high-res image (873KB) Download : Download full-size image