Efficacy of MgSO4 to prevent eclampsia in women with severe pre-eclampsia and impending eclampsia
Keywords:Hypertension, Impending eclampsia, MgSO4, Preeclampsia
Background: Preeclampsia is a multi-system disorder that is frequently accompanied by proteinuria and new-onset hypertension. Poor placental perfusion and a general disease process that may affect multiple organ systems are the hallmarks of the syndrome. While eclampsia is a complicated condition brought on by cerebral dysrhythmia due to various pathogenesis steps that include abnormal trophoblastic invasion which led to vasospasm, endothelial dysfunction, and platelet aggregation. Maternal complications of severe preeclampsia/eclampsia can lead to maternal, fetal, and neonatal morbidity and mortality. One of the anticonvulsants MgSO4 is known to reduce the risk of eclampsia. The present study was conducted with the aim to analyse the effect of MgSO4 to reduce the incidence of eclampsia in pregnant women with preeclampsia and impending eclampsia.
Methods: A total of 114 women with preeclampsia and impending eclampsia were included in present study. Mgso4 was given as a loading dose and the Zuspan regimen as required. Women were categorised based on raised blood pressure (>140/90 mmHg), deranged lab parameters which includes renal function tests (urea, uric acid, creatinine), coagulation profile (PT, APTT, INR, LDH, platelet count), liver function tests (total bilirubin, SGOT/SGPT) and clinical symptoms which include headache, blurring of vision, epigastric pain. The incidence of eclampsia even after a dose of MgSO4 was calculated.
Results: The mean age of the women was 28.17±4.69 years. The diagnosis of pre-eclampsia was made based on systolic and diastolic blood pressure. Out of 114 pregnant women with severe preeclampsia or impending eclampsia who were given a dose of MgSO4, only 2 women have developed eclampsia.
Conclusions: The incidence of eclampsia after the dose of MgSO4 among women with preeclampsia or impending eclampsia was reported to be only 1.75% which confirms MgSO4 therapy as an effective tool in preventing perinatal morbidity and mortality.
Khanum S, Naz N, Souza M. Prevention of pre-eclampsia and eclampsia. A systematic review. Open J Nurs. 2018;8:26-44.
Lu JF, Nightingale CH. Magnesium sulfate in eclampsia and pre-eclampsia: pharmacokinetic principles. Clin Pharmacokinet. 2000;38(4):305-14.
Nagaria T, Mitra S, Banjare SP. Single loading low dose MgSo4 regimen: a simple, safe and effective alternative to Pritchard’s regimen for Indian Women. J Clin Diagn Res. 2017;11(8):QC08-12.
Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. WHO multicountry survey on maternal and newborn health research network. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121(1):14-24.
Steyn DW, Steyn P. Low-dose dopamine for women with severe pre-eclampsia. Cochrane Database Syst Rev. 2007;2007(1):CD003515.
WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia. Geneva: World Health Organization; 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK140561/. Accessed on 1 May 2022.
Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005;105(2):402-10.
Khan KS, Wojdyla D, Say L, Gu¨lmezoglu AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006;367:1066-74.
Lazard EM. A preliminary report on the intravenous use of magnesium sulphate in puerperal eclampsia. Am J Obstet Gynecol. 1925;9:178-88.
Coetzee EJ, Dommisse J, Anthony J. A randomized controlled trial of intravenous magnesium sulphate versus placebo in the management of women with pre-eclampsia. Br J Obstet Gynecol. 1998;105:300-3.
Charoenvidhya D, Manotaya S. Magnesium sulfate maintenance infusion in women with preeclampsia: a randomized comparison between 2 gram per hour and 1 gram per hour. J Med Assoc Thai. 2013;96:395-8.
Aali BS, Khazaeli P, Ghasemi F. Ionized and total magnesium concentration in women with severe preeclampsia-eclampsia undergoing magnesium sulfate therapy. J Obstet Gynecol Res. 2007;33:138-43.
Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;2010(11):CD000025.
The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995;354:1455-63.
Chesley LC, Tepper I. Levels of magnesium attained in magnesium sulfate therapy for preeclampsia and eclampsia. Surg Clin North Am. 1957;37:353-67.
Eastman NJ, Steptoe PP. The management of pre-eclampsia. Can Med Assoc J. 1945;52:562-8.
Sibai BM, Graham JM, McCubbin JH. A comparison of intravenous and intramuscular magnesium sulfate regimens in preeclampsia. Am J Obstet Gynecol. 1984;150:728-33.
Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med. 1995;333(4):201-5.
Okereke E, Ahonsi B, Tukur J, Ishaku SM, Oginni AB. Benefits of using magnesium sulphate (MgSO4) for eclampsia management and maternal mortality reduction: lessons from Kano State in Northern Nigeria. BMC Res Notes. 2012;5:421.
Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomized placebo-controlled trial. Lancet. 2002;359(9321):1877-90.
Duley L, Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev. 2010;2010(12):CD000127.
Tukur J. The use of magnesium sulphate for the treatment of severe pre-eclampsia and eclampsia. Ann Afr Med. 2009;8(2):76-80.
Padda J, Khalid K, Colaco LB, Padda S, Boddeti NL, Khan AS, et al. Efficacy of Magnesium Sulfate on Maternal Mortality in Eclampsia. Cureus. 2021;13(8):e17322.
Cotton DB, Janusz CA, Berman RF. Anticonvulsant effects of magnesium sulfate on hippocampal seizures: therapeutic implications in preeclampsia-eclampsia. Am J Obstet Gynecol. 1992;166(4):1127-34.
Altura BM, Altura BT, Carella A, Gebrewold A, Murakawa T, Nishio A. Mg2+ -Ca2+ interaction in contractility of vascular smooth muscle: Mg2+ versus organic calcium channel blockers on myogenic tone and agonist-induced responsiveness of blood vessels. Can J Physiol Pharmacol. 1987;65(4):729-45.
Zheng XY, Yao J, Zhu JM, Li M, Qiu SQ, Zhu ZX, et al. Effect of magnesium sulfate, nifedipine tablet combined salvia injection on ET-1/NO, TXA2/PGI2 and hemorheology of preeclampsia women. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2015;35(8):962-5.
Belfort MA, Moise KJ Jr. Effect of magnesium sulfate on maternal brain blood flow in preeclampsia: a randomized, placebo-controlled study. Am J Obstet Gynecol. 1992;167(3):661-6.