A study on the effect of a low-dose magnesium sulfate regimen for the management of eclampsia
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262795Keywords:
Eclampsia, Magnesium sulfate, Low-dose regimen, Pritchard regimen, Seizure control, Maternal outcomeAbstract
Background: Magnesium sulfate is the anticonvulsant of choice for eclampsia, but the standard Pritchard regimen uses repeated intramuscular injections and requires careful toxicity monitoring. This study compared a half-dose regimen with the standard Pritchard regimen.
Methods: In this prospective randomized study, 50 women with eclampsia were allocated equally to a low-dose group or a standard Pritchard group. The low-dose regimen comprised 2 g intravenous and 5 g intramuscular loading doses, followed by 2.5 g intramuscularly every four hours for 24 hours after delivery or the last seizure. The primary outcome was control of convulsions. Repeat dosing, treatment failure, clinical toxicity, perinatal outcome, injection-site discomfort, ambulation, magnesium sulfate use, and cost were assessed. Categorical data were compared using Fisher's exact test or the chi-square test.
Results: Convulsions were controlled in 25/25 women (100%) in the low-dose group and 24/25 (96%) in the Pritchard group (p=1.000). Repeat doses were required in 3/25 (12%) and 2/25 (8%), respectively (p=1.000). No treatment failure occurred with the low-dose regimen; one failure occurred in the Pritchard group in a woman with hepatic capsule rupture. No clinical evidence of magnesium toxicity was observed in the low-dose group. Live-birth rates were 88% and 92%, respectively (p=1.000). The low-dose regimen used half the magnesium sulfate and reduced the calculated drug cost by 50%.
Conclusions: The low-dose regimen achieved seizure control comparable to the standard regimen in this small study and reduced drug use and cost. Larger multicentre non-inferiority trials are required before routine substitution.
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