Single Loading Dose of Magnesium Sulphate in Severe Preeclampsia and Eclampsia-Is it Effective? A Randomized Prospective Study

Abstract

Introduction: Magnesium sulphate (MgSO4) is the most effective anticonvulsant in preventing and controlling convulsion in severe preeclampsia and eclampsia. We tried to compare the efficacy of single dose of MgSO4 with standard Pritchard regime. Objectives: To compare between single loading dose of MgSO4 and standard Pritchard regime in terms of efficacy and outcomes. Methods: In a comparative, prospective, randomized study carried out from July 2010 to December 2012 in the Department of Obstetrics and Gynecology, Medical College, Kolkata, we included antenatal women with severe pre-eclampsia and eclampsia after 34 weeks of gestation, who were randomized in two groups. The study group (A) received single loading dose of MgSO4 and the control group (B) received the standard Pritchard regime. The results were analyzed by standard statistical methods. Results: Total 500 women were included, of which 150 belonged to group A (50 severe preeclampsia, 100 eclampsia) and 350 to group B (150 severe preeclampsia, 200 eclampsia). The incidence of appearance or recurrence of convulsions, pulmonary edema, maternal mortality, Caesarean section and post-partum hemorrhage did not vary significantly in between two groups. However, in group A, the incidence of magnesium toxicity was significantly lower (p-value <0.005) than group B. The mothers in group A took significantly less time to return to post natal wards and also to return home with involvement of significantly less number of health care staffs in their care (p value <0.0001). The perinatal outcomes were similar in between two groups. Discussion: Women receiving single dose MgSO4 had similar clinical course to those receiving standard regime, while having significantly less incidence of magnesium toxicity. It was associated with fewer burdens on health care delivery system. Conclusion: Single loading dose MgSO4 is a cost-effective and safe therapy in developing countries with low average body-weight and limited resources.