Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Abstract

Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime.

Hypertensive disorders in pregnancy at the federal medical centre, Yenagoa, South-South Nigeria: a 5 year review

“…34 35 Pritchard is the recommended regimen for the administration of MgSO4, by both SOGON and the Nigerian federal ministry of health (FMOH), and is also the preferred and most commonly used regimen in resource-constrained settings like ours, as it can be administered by lower-cadre maternity staff, with less risk of toxicity compared to the Zuspan regimen. 15 Even though majority of the women in our study were delivered through Caesarean section, vaginal delivery in women with HDP is a safe alternative, barring any contraindication to vaginal delivery. 7 HDP contributed significantly to the high Caesarean section rate of 42.4% in our Centre.…”

“…14 Nausea, vomiting, headache, muscle weakness, visual disturbances, and palpitations can also occur. 15,16 Dyspnoea or chest pain may be symptoms of pulmonary oedema. 14 Toxicity of MgSO4 includes loss of deep tendon reflexes, respiratory depression, cardiac arrest and coma.…”

“…If the cervix is unfavourable, there is foetal compromise or vaginal delivery is not feasible within 6-8 hours, emergency Caesarean section should be done preferably. 15,16 If mild preeclampsiaoccurs remote from term, when foetal lung maturity is yet to be achieved, conservative management until foetal lung maturity is achieved, is recommended. 14 When severe pre-eclampsiaoccursremote from term, some clinicians advocate immediate delivery.…”

“…14 When severe pre-eclampsiaoccursremote from term, some clinicians advocate immediate delivery. 15,16 Complications of pre-eclampsia include maternal and foetal. Some of the maternal complications include placental abruption, eclampsia, HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelet count), disseminated intravascular coagulation (DIC), acute kidney injury (AKI), cerebrovascular haemorrhage, cortical blindness, and adult respiratory distress syndrome.…”