A Shortened versus Standard Matched Postpartum Magnesium Sulphate Regimen in the Treatment of Eclampsia: a Randomised Controlled trial.

Calvin M. Chama, Ado D. Geidam Babagana Bako, Abdulkarim G. Mairiga, Adamu Atterwahmie

Abstract

Magnesium sulphate is currently the most ideal drug for the treatment of eclampsia but its use in Nigeria is still limited due its cost and clinicians inexperience with the drug. The purpose of this study was to determine whether a shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in controlling fits in eclampsia. Between January and June 2011, 98 eclamptic mothers presenting at the labour ward of the University of Maiduguri Teaching Hospital were randomised to receive either the standard Pritchard regimen of magnesium sulphate or a shortened postpartum course in which only two doses of intramuscular magnesium sulphate is given four hours apart. The maternal and fetal outcomes were compared. The primary outcome measure was recurrence of fits. The recurrence of fits and other maternal complications were similar in the two groups. The total dosage of magnesium sulphate in the shortened group was reduced by 40% in 66% of patients. The shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in the management of eclampsia. (Afr J Reprod Health 2013; 17[3]: 131-136).

 

Résumé

Le sulfate de magnésium est actuellement le médicament le plus idéal pour le traitement de l'éclampsie, mais son utilisation au Nigeria est encore limitée en raison de son coût et des cliniciens inexpérience avec la drogue. Le but de cette étude était de déterminer si un cours du post-partum raccourcie de sulfate de magnésium est aussi efficace que le traitement standard de Pritchard dans le contrôle unique de l'éclampsie. Entre janvier et juin 2011 98 mères éclampsie qui se présentent à la salle de travail du Centre Hospitalier de l’Université de Maiduguri ont été randomisés pour recevoir soit le traitement de Pritchard  standard de sulfate de magnésium ou d'un cours du post-partum raccourci dans lequel seulement deux doses de sulfate de magnésium par voie intramusculaire sont données quatre heures d'intervalle. Les résultats maternels et fœtaux ont été comparés. Le critère de jugement principal était la récurrence de crises. La récurrence des crises et autres complications maternelles étaient similaires dans les deux groupes. La dose totale de sulfate de magnésium dans le groupe raccourci a été réduite de 40% à 66% des patients. Le cours du post-partum abrégée du sulfate de magnésium est aussi efficace que le traitement standard de Pritchard dans la gestion de l'éclampsie. (Afr J Reprod Health 2013; 17[3]: 131-136).

 

 

Keywords: Eclampsia, postpartum magnesium sulphate, shortened regimen

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References

WHO 2011. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO document publication services, Geneva, Switzerland?

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Lock PF. WHO analysis of causes of maternal death: a systematic review. Lancet,2006, 1;367(9516):1066-1074

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367(9516):1066-1074

Ezugwu EC, Onah HE, Ezugwu FO, Okafor II. Maternal mortality in a transitional hospital in Enugu, south eastern Nigeria. Afr. J Reprod Health 2009;13(4):67-72

Okogbenin SA, Eigbefoh JO, Omorogbe F, Okogbo F, Okonta PI, Ohinoin AG. Eclampsia in Irrua specialist teaching hospital. Afr. J Reprod Health, 13(2):149-153

Aisien OA, Akuse JT, Omo-Aghoja LO, Bergstrom S, Okonofua FE. Maternal mortality and emergency obstetric care in Benin City, South-South Nigeria. J Clin Med Res;2010;2(4):55-60

Kullima AA, Kawuwa MB, Audu BM, Geidam AD, Mairiga AG. Trends in maternal mortality in a tertiary institution in Northern Nigeria. Ann. Afr Med 2009;8(4):221-224

Adamu YM, Salihu HM, Sathiakumar N, Alexander GR. Maternal mortality in Northern Nigeria. A population-based study. Eur J Obstet Gynaecol Reprod Biol; 2003;109(2):153-159

Bobzom DN, Chama CM, Mai MA, Muna DM. Maternal mortality in Maiduguri, Nigeria. J Obstet Gynaecol; 1998;18(2):22-24

Chama CM, Audu BM, Mairiga AG. The status of reproductive health facilities in Borno state. Borno Med J, 2006;3(1):11-15

Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia?. Evidence from the collaborative eclampsia trial. Lancet, 1995;345:1455-1463

RCOG. The management of severe pre-eclampsia and eclampsia. Royal college of obstetricians and gynaecologists. Guidelines No 103, 2006. http://www.rcog.org.uk/files/rcog-corp.

Federal Ministry of Health, Abuja, Nigeria. National essential Drug List, 2010.

Ekele BA. Use of magnesium sulphate to manage preeclampsia and eclampsia in Nigeria; overcoming the

odds. Ann. Afr Med; 2009;8(2):73-75

Ogu R, Bello Z, Omo-Aghoja LO, Nzeribe E, FeyiWaboso P, Okonofua FE. Magnesium sulphate for the management of eclampsia in low income countries. J Med Biomed Res, 2006;5(1):4-6

Pritchard JA, Cunningham FG, Pritchard SA. The Parkland Memorial Hospital Protocol for treatment of eclampsia; evaluation of 245 cases. Am J Obstet Gynecol;1984;148:951-963

Miles Jr JF, Martin Jr JN, Blake PG, Perry Jr KG, Martin RW, Meeks GR. Postpartum eclampsia: a recurrent perinatal dilemma. Obstet Gynecol 1990;76(3):328-331

Ascarelli MH, Johnson V, May WI, Martin RW, Martin Jr JN. Individually determined postpartum magnesium sulphate therapy with clinical parameters to safely and cost effectively shorten treatment for preeclampsia. Am J Obste Gynecol 1998;179(4):952-

Isler CM, Barrilleaux PS, Rinehart BK, Maggan EF, Martin Jr JN. Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy. Obstet Gynecol 2003;101(1):66-69

El-Nafaty AU, Melah GS, Massa AH, Audu BM. The analysis of eclamptic morbidity and mortality in specialist hospital, Gombe, Nigeria. J Obstet Gynaecol 2000;24(2):142-147

George IO, Jeremiah I. Perinatal outcome of babies delivered to eclamptic mothers: a prospective study from a Nigerian tertiary hospital. Int J Biomed.

;5(4):390-394

Onwuhafua PI, Oguntayo A. Perinatal mortality associated with eclampsia in Kaduna, northern Nigeria. Nig J Med; 2006;15(4):397-400

Bhattacharjee N, Saha SP, Ganguly RP, Patra KK, Dhali B. A randomized comparative study between lowdose intravenous magnesium sulphate and standard intramuscular regimen for treatment of eclampsia. J Obstet Gynaecol 2011;31(4):298-303

Nagar S, Jain S, Kumari S. Reassessment of therapy of eclampsia: comparison of mortality and morbidity of mother and fetus with parenteral magnesium sulphate and lytic cocktail therapy. Journal of Obstetrics and Gynaecology of India. 1988;38:250-255

Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulphate with phenytoin for the prevention of eclampsia. New England Journal of Medicine. 1995;333:201-206.

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