Magnesium Sulphate Therapy in Women with Pre-Eclampsia and Eclampsia in Kuwait

Abstract

Objective: To evaluate the outcome of the use of MgSO₄ therapy in women with severe pre-eclampsia in Kuwait from January 2002 to December 2004. Subjects and Methods: The study involved 450 women managed at the Maternity Hospital in Kuwait with a blood pressure of 160/110 mm Hg and proteinuria of >0.3–5 g/24 h. A loading dose of 4 g MgSO₄ was administered intravenously over 20 min and then the maintenance dose continued at 1 g/h for 24 h postpartum. Magnesium sulphate toxicity was monitored by urine output, deep tendon reflexes and serum magnesium levels and managed with an infusion of 10 ml of 10% calcium gluconate and cessation of magnesium infusion. Adjunct therapy included intravenous hydralazine 10 mg and labetalol 100 mg. The mode of delivery was determined after stabilizing the patient. Results: The women included Kuwaitis (n = 200, 44.4%), Asians (n = 129, 28.7%) and other Arabs (n = 116, 25.8%) with a mean age of 29.7 ± 6.7 years (primigravida: n = 233, 51.8%; other parities: n = 217, 48.2%). Antenatal complications included intra-uterine growth restriction (n = 136, 30.2%), oliguria (n = 39, 8.7%), haemolysis, elevated liver enzymes and low platelet count syndrome (n = 30, 6.6%), abruptio placentae (n = 20, 4.4%), eclampsia (n = 15, 3.3%), and preterm birth (n = 253, 55.2%). Caesarean section (n = 241, 53.6%) was the main mode of delivery. The perinatal mortality rate was 27 per 1,000. Magnesium sulphate toxicity observed as reduced tendon reflexes occurred in 14 (3.1%) patients and flushing, nausea and vomiting and blocked nostrils in 86 (19.1%). There was no association between adverse outcomes and maternal serum magnesium concentrations and no maternal mortality occurred. Conclusion: Magnesium sulphate was effective in preventing recurrence of eclamptic fits and safe for both mother and fetus.

Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: Insights from an intervention with magnesium sulphate in a primary care setting in northern Nigeria

“…This is not unexpected since this study utilized 10 grams intra-muscular loading dose of MgSo 4 and no further dose was given before referral. Previous studies in which low doses of MgSo 4 were used showed that toxic effects are not as common as frequently feared [17,18]. In addition, the CHEWs and CHOs in this study did not report any difficulty with the administration of MgSo 4 both in terms of competence or the fear of side effects.…”

Magnesium sulfate therapy of preeclampsia: an old tool with new mechanism of action and prospect in management and prophylaxis

“…17,33 Similarly, MgSO 4 inhibits cerebral vasospasms and prevents seizures in patients with severe PE. 34 Other antihypertensive drugs, such as clonidine, diazoxide, frusemide and hydralazine, show no effect on the production of sFlt-1 and sENG from the placentas of patients with PE. 35 This study, however, demonstrated the inhibitory effect of MgSO 4 therapy on serum levels of antiangiogenic growth factors and its ability to increase NO metabolic end products in the serum and urine of the PRE þ MgSO 4 group.…”

The use of magnesium sulphate for the treatment of severe pre-eclampsia and eclampsia

“…[20] There are indeed several reports of its successful introduction in several countries including Nigeria and its effectiveness and safety for mother and baby. [21][22][23][24] However, the drug has remained largely unavailable in several developing countries where it is incidentally needed the most. Leading advocates, researchers, non-governmental organizations, representatives of the WHO and national health ministries from all over the world recently met and identified the main barriers to the use and availability of MgSO 4 .…”