832: Comparison of magnesium sulfate regimens for prevention of eclampsia: A network meta-analysis

Abstract

To compare the efficacy and safety profile of different magnesium sulfate regimens administered to patients with preeclampsia with severe features for eclampsia prophylaxis A search was conducted on PubMed, Scopus, Web of Science and the Cochrane Library databases from database inception through February 1st, 2019. Search includes clinical trials, comparative prospective and retrospective studies comparing 2 or more magnesium sulfate regimens administered for eclampsia prophylaxis. Primary outcome was treatment efficacy in preventing eclampsia. Secondary outcomes were maternal complications and side effects. Fixed effects models were used to pool odds ratios (OR) and 95% confidence interval (CI) Out of 5414 articles retrieved on initial search, 20 studies were eligible for network meta-analysis and met our inclusion criteria. Comparing Pritchard regimen to Dhaka, low dose, Pritchard with shortened maintenance, standard dose (25 g), Zuspan, and loading dose only regimens, there were no significant differences in the risk of seizures. Similarly, the risk of maternal and neonatal mortality was not significantly different among these regimens. Although loading dose only (OR 0.01, 95% CI 0.00; 0.26), and low dose regimens (OR 0.14, 95% CI 0.06; 0.38) were associated with lower risk of loss of tendon reflexes compared to Pritchard regimen, the risk of respiratory depression with Pritchard regimen was comparable to low dose, Dhaka and Zuspan regimens. Loading dose only and low dose regimens were associated with lower APGAR scores at 5 minutes but there was no significant difference in the incidence of APGAR scores < 7. Cesarean delivery rates associated with Pritchard, low dose, standard dose, loading dose only regimen and Pritchard with shortened maintenance were not significantly different. Dhaka regimen is associated with shorter hospital stay compared to Pritchard regimen (MD −0.92, 95% CI −1.24; −0.60) Efficacy and safety profile of Pritchard, Dhaka, low dose, Pritchard with shortened maintenance, standard dose, Zuspan, and loading dose only regimens are comparableView Large Image Figure ViewerDownload Hi-res image Download (PPT)