Magnesium Sulphate In Eclampsia Research Articles

A Comparative Study of Intravenous and Intramuscular Administration of Magnesium Sulfate in Eclampsia

A Comparative Study of Intravenous and Intramuscular Administration of Magnesium Sulfate in Eclampsia

A Study to Assess the Knowledge Regarding Factor Influencing the Use of Magnesium Sulphate in Eclampsia and Preeclampsia among Staff Nurses at Smvmch, Puducherry

A Study to Assess the Knowledge Regarding Factor Influencing the Use of Magnesium Sulphate in Eclampsia and Preeclampsia among Staff Nurses at Smvmch, Puducherry

Low dose Magnesium Sulfate in Eclampsia in a tertiary care hospital

Low dose Magnesium Sulfate in Eclampsia in a tertiary care hospital

Adverse Maternal and Fetal Outcome in Patients with Eclampsia

Eclampsia is a multisystem disorder that may lead to deterioration of maternal condition, hypoxia and acidosis of fetus. Objective was to evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia. All patients with eclampsia were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to the patients and attendants about antenatal visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate, then the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition and mortality were then noted. Fifty-two patients with eclampsia were admitted in the study period. Thirty-one patients required mechanical ventilator support. Twenty-five (48.07%) patients were delivered by emergency cesarean section and 30(57.6%) babies were low birth weight and there were 11(21.1%) stillbirths. There was one maternal mortality and 45(86.5%) patients were discharged with improvement but 6(11.5%) patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. Early detection of hypertension and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes.

Factors Associated with Maternal Deaths in District and Upazila Hospitals of Bangladesh

Objective(s): Aim of the study was to use death review to explore medical causes and three delay causal factors responsible for maternal deaths in district or below level health facilities of Bangladesh.Methods: Government health workers conducted facility based death review in 56 maternal deaths occurred during 2010-2012 in four district and five upazila (EmONC) health facilities of Bangladesh. The data was analyzed to assess the causal relationship between the medical causes and the ‘three delays’ factors in maternal mortality.Results: Majority of the mothers died was young (89.3%; below age 30 years) and died during first pregnancy (78.6%) and postpartum period (71.4%). Postpartum hemorrhage and preeclampsia-eclampsia were the foremost causes of maternal deaths at district level facilities of Bangladesh. Seventy two percent of them arrived the hospitals in a travel time <2 hour from home or first care-centre when 88% of cases had an unstable general condition. 72% of them received treatment within one hour of admission in the hospital. The patients’ records reflected that only a few patients received life-saving interventions like blood transfusion, fundal message, and/or oxytocic in postpartum haemorrhage or magnesium sulphate in eclampsia. The study also observed a poor documentation in all the facilities, which was a challenge for death review.Conclusions: The study suggested improving quality of care and increasing availability of skills to manage the complicated cases in district and below level EmONC hospitals with focused interventions for postpartum haemorrhage and preeclampsia-eclampsia. The ‘facility death review’ will be useful in identifying causal factors, the third delay factors and service gaps and to respond accordingly to avert similar deaths.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 16-22

Prophylactic magnesium sulphate in prevention of eclampsia in women with severe preeclampsia: randomised controlled trial (PIPES trial)

Optimum dose, route and duration of use of prophylactic magnesium sulphate in women with severe pre-eclampsia is still controversial. We compared the efficacy and safety of ‘low-dose Dhaka’ regime with ‘Loading dose only’ regime for seizure prophylaxis in severe preeclampsia using a randomised controlled trial in 402 women. The incidence of eclampsia in the ‘low-dose Dhaka’ regime group was 1.49% and that in the ‘Loading dose only regime’ was 2.98% (p = .321). In the low-dose Dhaka regime, injection site abscess and respiratory depression occurred in one woman each. Neonatal outcomes such as Apgar score at 5 minutes (5.0% vs. 8.05% p = .251) and perinatal mortality (20.4% vs. 21.9%, p = .724) were similar in both groups. Loading dose only regime may be considered an effective alternative regime for the prevention of eclampsia in women with severe preeclampsia.Impact statementWhat is already known on this subject: Efficacy of therapeutic short regime magnesium sulphate in eclampsia has already been reported. Data regarding prophylactic short regime in women with preeclampsia is sparse.What the results of this study add: We have shown that short regime of magnesium sulphate using only the loading dose in the prevention of seizure in preeclampsia is an effective alternative to the low-dose Dhaka regime.What the implications are of these findings for clinical practice and/or further research: The short regime is less resource-intensive. Further larger studies are needed to confirm the efficacy of this short regime and to establish its cost-effectiveness.

English

OBJECTIVES: The aim of the study is to compare the Low dose magnesium sulphate regime Vs standard dose with regard to the efficacy, maternal outcome and fetal - neonatal outcome. MATERIALS & METHODS: The study was conducted at Govt. General Hospital Kakinada from June 2009 to September 2010. A Total of 100eclampsia patients were studied with50 cases in each group. In Low dose regime, a loading dose of 4gm Magnesium Sulphate (20ml of 20% solution) given slow IV over 20 minutes. This is compared to standard Pritchard regimen and a maintenance dose of 2gm deep IM 4 th hourly up to 24hrs after delivery/ last convulsion whichever is later. RESULTS: Low dose magnesium sulphate regimen is as effective as Pritchard standard regimen in controlling eclamptic convulsions. No increase in maternal morbidity, mortality and no increase in perinatal morbidity, mortality were noted in the study group. CONCLUSION: A lower dose of magnesium sulphate is suitable and equally effective in Indian women who on an average weigh much less than the western counterparts to control convulsions in eclampsia with no increase in maternal mortality & morbidity (or) perinatal mortality & morbidity with the added benefit of reducing the side effects. The results obtained with this low dose regime bring out the focus for the need to review the correct dose of magnesium sulphate in Eclampsia in Indian scenario.

Challenges to the Provision of Emergency Obstetric Care in Iraq

To assess the availability of, and challenges to the provision of emergency obstetric care in order to raise awareness and assist policy-makers and development partners in making appropriate decisions to help pregnant women in Iraq. Descriptive and exploratory study based on self-administered questionnaires, an in-depth interview and a Focus Group Discussion. The setting was 19 major hospitals in 8 out of the 18 Governorates and the participants were 31 Iraqi doctors and 1 midwife. The outcome measures were availability of emergency obstetric care (EOC) in hospitals and challenges to the provision of EOC. Only 26.3% (5/19) of hospitals had been able to provide all the 8 signal functions of comprehensive emergency obstetric care in the previous 3 months. All the 19 hospitals provided parenteral antibiotics and uterine evacuation, 94.7% (18/19) were able to provide parenteral oxytocics and perform manual removal of retained placenta, magnesium sulphate for eclampsia was available in 47.4% (9/19) of hospitals, 42.1% (8/19) provided assisted vaginal delivery, 26.5% (5/19) provided blood transfusion and 89.5% (17/19) offered Caesarean section. The identified challenges for health care providers include difficulties travelling to work due to frequent checkpoints and insecurity, high level of insecurity for patients referred or admitted to hospitals, inadequate staffing due mainly to external migration and premature deaths as a result of the war, lack of drugs, supplies and equipment (including blood for transfusion), and falling standards of training and regulation. Most women and their families do not currently have access to comprehensive emergency obstetric care. Health care providers recommend reconstruction and strengthening of all components of the Iraqi health system which may only be achieved if security returns to the country.

Magnesium sulphate for eclampsia: putting the evidence into clinical practice.

Eclampsia is the third commonest cause of maternal mortality after haemorrhage and infection. The morbidity and mortality in eclampsia is related to the number of convulsions. The control of convulsions is, therefore, important in reducing maternal morbidity and mortality. Teaching hospitals in Southern Africa contributed to the multicentre Collaborative Eclampsia Trial, which provided the overwhelming evidence for the superiority of magnesium sulphate as the drug of choice for eclampsia. While other parts of the world have put this evidence into practice, this trend has not yet become uniform in Africa. This paper seeks to encourage African governments, teaching hospitals, the pharmaceutical industry and the regional Cochrane Collaboration Centre in South Africa to co-operate in order to facilitate the practice of evidence-based medicine in this aspect of maternal health in the region.

Magnesium sulfate in eclampsia and pre-eclampsia: pharmacokinetic principles.

Magnesium sulfate (MgSO4) is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre-eclampsia. It is usually given by either the intramuscular or intravenous routes. The intramuscular regimen is most commonly a 4 g intravenous loading dose, immediately followed by 10 g intramuscularly and then by 5 g intramuscularly every 4 hours in alternating buttocks. The intravenous regimen is given as a 4 g dose, followed by a maintenance infusion of 1 to 2 g/h by controlled infusion pump. After administration, about 40% of plasma magnesium is protein bound. The unbound magnesium ion diffuses into the extravascular-extracellular space, into bone, and across the placenta and fetal membranes and into the fetus and amniotic fluid. In pregnant women, apparent volumes of distribution usually reach constant values between the third and fourth hours after administration, and range from 0.250 to 0.442 L/kg. Magnesium is almost exclusively excreted in the urine, with 90% of the dose excreted during the first 24 hours after an intravenous infusion of MgSO4. The pharmacokinetic profile of MgSO4 after intravenous administration can be described by a 2-compartment model with a rapid distribution (a) phase, followed by a relative slow beta phase of elimination. The clinical effect and toxicity of MgSO4 can be linked to its concentration in plasma. A concentration of 1.8 to 3.0 mmol/L has been suggested for treatment of eclamptic convulsions. The actual magnesium dose and concentration needed for prophylaxis has never been estimated. Maternal toxicity is rare when MgSO4 is carefully administered and monitored. The first warning of impending toxicity in the mother is loss of the patellar reflex at plasma concentrations between 3.5 and 5 mmol/L. Respiratory paralysis occurs at 5 to 6.5 mmol/L. Cardiac conduction is altered at greater than 7.5 mmol/L, and cardiac arrest can be expected when concentrations of magnesium exceed 12.5 mmol/L. Careful attention to the monitoring guidelines can prevent toxicity. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most commonly followed variables. In this review, we will outline the currently available knowledge of the pharmacokinetics of MgSO4 and its clinical usage for women with pre-eclampsia and eclampsia.

Recent developments for neonatal health in developing countries

Interventions to reduce neonatal mortality are at the cutting edge of child survival programmes. Neonatal deaths account for up to two-thirds of infant deaths in developing countries. The common causes of death are preterm birth, intrauterine growth retardation, perinatal infection, impaired metabolic adaptation, and asphyxia. Effective interventions before delivery include food and micronutrient supplementation, malaria protection, and immunization against tetanus and perhaps pneumococcal infection in future. Many cost-effective intrapartum interventions, such as partography and magnesium sulphate for eclampsia, are not routinely implemented. Likewise, resuscitation, prevention and treatment of hypothermia, promotion of early and exclusive breastfeeding, and rapid treatment of neonatal infection with injectable antibiotics given by primary care workers are cost-effective postnatal interventions. The challenge is to get these interventions into policy and practice. Going to scale must involve partnerships between government, international agencies and non-government organizations. Interventions to reduce neonatal mortality are at the cutting edge of child survival programmes. Neonatal deaths account for up to two-thirds of infant deaths in developing countries. The common causes of death are preterm birth, intrauterine growth retardation, perinatal infection, impaired metabolic adaptation, and asphyxia. Effective interventions before delivery include food and micronutrient supplementation, malaria protection, and immunization against tetanus and perhaps pneumococcal infection in future. Many cost-effective intrapartum interventions, such as partography and magnesium sulphate for eclampsia, are not routinely implemented. Likewise, resuscitation, prevention and treatment of hypothermia, promotion of early and exclusive breastfeeding, and rapid treatment of neonatal infection with injectable antibiotics given by primary care workers are cost-effective postnatal interventions. The challenge is to get these interventions into policy and practice. Going to scale must involve partnerships between government, international agencies and non-government organizations.

Hypertensive disorders in pregnancy

This article describes a pattern of management for women who are either at risk of, or suffering from, a hypertensive disorder during pregnancy. The reasons for concern about these conditions are described and the problems of predicting and preventing the serious hypertensive disorders discussed. The place of prophylactic agents, such as aspirin, is examined and their use evaluated. The management of mild to moderate problems is briefly discussed but the main focus is on serious problems. What can be learnt from the changes in incidence of the serious sequelae associated with these disorders will be specifically considered by examining changes in maternal mortality and eclampsia. The difficulties faced with timing of delivery are considered, together with important evidence concerning the benefits of magnesium sulphate in eclampsia. A way to improve the care of these seriously ill women in line with the Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1991–1993 (Department of Health, 1996) will be described.

The use of audit to improve clinical effectiveness in an infrequent obstetric therapy: magnesium sulphate in severe pre-eclampsia.

Magnesium sulphate has been established as the drug of choice in the management of eclampsia and even when used in cases of severe pre-eclampsia it is given infrequently. It is recognised to have potentially severe toxic effects but there is a need to achieve therapeutic levels quickly enough to prevent seizures. This paper reports an audit following the introduction of a protocol for the use of magnesium sulphate in eclampsia and severe pre-eclampsia at Ninewells hospital, Dundee. Problems were identified with both the time taken to reach therapeutic levels and clinical monitoring of magnesium levels despite the use of loading doses commonly recommended. Reaudit after changes to the protocol and the introduction of an administration/monitoring chart showed a significant improvement in both monitoring and the adequacy of prophylaxis. This demonstrates how audit of clinical practice has been used to improve clinical effectiveness in an area in which a potentially toxic drug is used infrequently but with potentially life saving benefits.

Drug management of hypertensive disorders of pregnancy

Drugs used in the acute and long-term management of hypertension in pregnancy and the pre-eclampsia-eclampsia syndrome have been reviewed and their therapeutic effects and maternal and fetal adverse effects have been considered. The review also focuses on recent developments in the areas of prevention and management of pre-eclampsia-eclampsia syndrome. Although a number of new drugs have emerged, as potentially useful in the management of hypertension in pregnancy and pre-eclampsia-eclampsia syndrome, some remain at the cornerstone of therapy; for example, methyldopa for long-term treatment of chronic hypertension, hydralazine or nifedipine for rapid reduction of severely elevated blood pressure, and magnesium sulphate for eclampsia. Some of these agents, especially the calcium antagonists, show promise in that their use is associated with fewer side effects. Safety for the fetus, however, has not been adequately evaluated yet. Neither aspirin nor calcium supplements appear to improve the outcome in pregnancy. Currently, the dilemma whether to treat hypertension in pregnancy and pre-eclampsia-eclampsia syndrome with old, established, cost-effective drugs or the promising newer drugs provides an interesting academic challenge.

Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: an overview of the evidence from randomised trials.

To evaluate the effectiveness of magnesium sulphate in the treatment of eclampsia and pre-eclampsia by a systematic quantitative overview of controlled clinical trials. Online searching of the MEDLINE database between 1966 and 1995, and scanning of the bibliography of known primary studies and review articles on the use of magnesium sulphate in eclampsia and pre-eclampsia. Study-selection, study quality assessment and data extraction were performed independently by two reviewers under masked conditions. Where possible outcome data from trials were pooled and summarised using the Mantel-Haenszel method. One thousand seven hundred and forty-three women with eclampsia and 2390 with pre-eclampsia included in nine randomised trials that evaluated the effects of magnesium sulphate. Seizure activity and maternal death. In eclampsia, recurrence of seizures was less common with magnesium sulphate therapy compared with phenytoin (odds ratio [OR] 0.27, 95% CI 0.17-0.45, P = 0.00) and diazepam (OR 0.41, 95% CI 0.30-0.57, P = 0.00). As indicated by the point estimate, there was a trend towards a reduction in maternal mortality with magnesium sulphate in eclampsia (OR 0.51, 95% CI 0.24-1.07, P = 0.10 versus phenytoin; OR 0.78, 95% CI 0.41-1.45, P = 0.52 versus diazepam). When used for seizure prophylaxis in pre-eclampsia, magnesium sulphate was found to be more effective than phenytoin (OR 0.15, 95% CI 0.03-0.72, P = 0.01). Magnesium sulphate is a superior drug in preventing the recurrence of seizures in eclampsia and in seizure prophylaxis in pre-eclampsia.

Paper to change practice: Magnesium sulphate for eclampsia

Paper to change practice: Magnesium sulphate for eclampsia

No doubt about magnesium sulfate in eclampsia

No doubt about magnesium sulfate in eclampsia

MAGNESIUM SULPHATE IN ECLAMPSIA

To the Editor: —InThe Journal, October 9, a correspondent's inquiry as to the intravenous use of magnesium sulphate in eclampsia is answered, in part, as follows: It is always advisable to have 5 cc. of a 10 per cent solution of calcium chloride available for intravenous injection should magnesium sulphate be given intravenously, as the effective dose of magnesium sulphate closly approaches the fatal dose. While this may be true where the magnesium sulphate is used to produce anesthesia, it is certainly not so in the dosage which I have been using for eclampsia; namely, from 20 to 30 cc. of a 10 per cent solution. While a solution of calcium chloride has been available to combat a possible respiratory paralysis, occasion has not arisen for its use. In our last report (Lazard, Irwin and Vruwink: Am. J. Obst. & Gynec. 12 :104 [July] 1924) we analyzed the results