Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting pre-eclampsia, intrauterine growth retardation and perinatal death.

Objective To evaluate the effectiveness of magnesium sulphate in the treatment of eclampsia and pre‐eclampsia by a systematic quantitative overview of controlled clinical trials. Design 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. Participants 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. Main outcome measures Seizure activity and maternal death. Results 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= 0.10versus phenytoin; OR 0.78, 95% CI 0.41–1.45, P= 0.52versus 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). Conclusion Magnesium sulphate is a superior drug in preventing the recurrence of seizures in eclampsia and in seizure prophylaxis in pre‐eclampsia.

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Oxytocin (Syntocinon, Sandoz Pharmaceuticals) is a commonly used drug in the modern management of labour. A recently published British survey found that 38% of low risk primigravid labours were augmented, most commonly by intravenous syntocinon. Unfortunately the misuse of syntocinon can lead to potentially serious problems for the fetus and mother. Despite the frequency of usage there appears to be no consensus as to the optimal dose and mode of administration. This paper explores the extent of this variation among Scottish obstetric units, the reasons for any variation in its use and makes some suggestions as to the way forward based on the current literature.