Therapeutic efficacy of low dose (Dhaka regimen) versus high dose (Pritchard regimen) magnesium sulphate for management of eclampsia and impending eclampsia

Nisha Bhagat; Preet Kamal Bedi; Davinder Pal; Arunima Saini

doi:10.18203/2320-1770.ijrcog20182345

Authors

Nisha Bhagat Department of Obstetrics and Gynecology, Government Medical College, Amritsar, Punjab, India
Preet Kamal Bedi Department of Obstetrics and Gynecology, Government Medical College, Amritsar, Punjab, India
Davinder Pal Department of Obstetrics and Gynecology, Government Medical College, Amritsar, Punjab, India
Arunima Saini Department of Obstetrics and Gynecology, Government Medical College, Amritsar, Punjab, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20182345

Keywords:

Dhaka regimen, Eclampsia, Magnesium sulphate (MgSO4), Pritchard regimen

Abstract

Background: To compare the efficacy of low dose (Dhaka regimen) vis-a vis high dose (Pritchard regimen) magnesium sulphate in management of eclampsia and impending eclampsia.

Methods: The open-label, comparative study was conducted on 90 pregnant patients. They were admitted to emergency Department of Obstetrics and Gynaecology, Government Medical College, Amritsar with eclampsia or impending eclampsia. 10 patients dropped out at various stages of study and finally, 80 were enrolled and randomized (1:1 ratio) into two groups. Group-1, N=40 were given low dose MgSO₄ (Dhaka regime) and Group-2, N=40 were given high dose MgSO₄ (Pritchard). Termination of pregnancy was done as per Bishop’s score, gestation age, maternal and fetal status. Primary outcome measure was therapeutic efficacy of equivalence for control of seizures whereas secondary outcome was adverse side-effects of both the regimens.

Results: Mean age in Group-1 was 24.90±4.02 years and that of Group-2 was 25.67±3.79 years. Antepartum eclampsia was the most common diagnosis among groups i.e., 47.5% and 55% respectively. After treatment, the seizure control was 97.5% in Group-1 and 100% in Group-2 with comparable results (????²=1.013; p=0.314). However, highly significant difference was observed among dosage of MgSO₄that was required for control of seizure (23.75±2.71 gm versus 41.35±4.76 gm; p<0.001). Group-1 showed lower incidence of side-effects that is, loss of deep tendon reflex as compared to Group-2, but neonatal outcomes were comparable in both groups.

Conclusions: Low dose (Dhaka regimen) was equally effective in control of seizures as compared to high dose (Pritchard regimen) with lower incidence of side-effects.

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References

Seth S, Nagrath A, Singh DK. Comparison of low dose, single loading dose and standard Pritchard regimen of magnesium sulphate in ante-partum eclampsia. Anatol J Obstet Gynecol. 2010;1(1):1-4.

Bangal VB, Purushottam A, Giri, Satyajit P Gavhane. A study to compare the efficacy of low dose magnesium sulphate regime with Pritchard regime in eclampsia. Int J Biomed Adv Research. 2012;3(1):53-7.

Ministry of Health and Family Welfare, India. Annual Report. NewDelhi; 2005:105-111. Available at: http://mohfw.nic.in/WriteReadData/l892s/6960144509Annual%20Report%20to%20the%20People%20o n%20Health.pdf. Accessed on December, 2011.

Tukur J. The use of magnesium sulphate for the treatment of severe preeclampsia and eclampsia. Ann African Med. 2009;8(2):76-80.

Arango MF, Bainbridge D. Magnesium for acute traumatic brain injury. Cochrane Database of Systematic Reviews 2008(4):cd005400.

Smith JM, Lowe RF, Fullerton J, Currie SM, Harris L, Felker-Kantor E. An integrative review of the side-effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC Pregnancy Childbirth. 2013;13:34.

Pritchard JA. The use of magnesium sulphate in preeclampsia eclampsia. J Reprod Med. 1979;23:107.

Sardesai SP, Patil A, Maira S, Patil U. Low dose magnesium sulphate therapy for eclampsia and imminent eclampsia: Regime tailored for Indian women. Int J Gynecol Obstet. 2000;70:45-6.

Begum R, Begum A, Johanson R, Ali MN, Akhter S. A low dose "Dhaka" magnesium sulphate regime for eclampsia. Acta Obstet Gynecol Scand. 2001;80(11):998-1002.

Begum MR, Begum A, Quadir E. Loading dose versus standard regime of magnesium sulfate in the management of eclampsia: A randomized trial. J Obstet Gynaecol. 2002;28(3):154-9.

Sharma A, Gupta KB, Nigam A, Pathania K. Comparison of low dose Dhaka regimen of magnesium sulphate with standard Pritchard regimen in eclampsia. Int J Reprod Contracept Obstet Gynecol. 2016;5:3954-8.

Jana N, Dasgupta S, Das AK, Santra D, Samanta B. Experience of a low-dose magnesium sulfate regimen for the management of eclampsia over a decade. Int J Gynaecol Obstet. 2013;122:13-7.

Sahu L, Singh S, Tempe A, Koner BC. A randomized comparative study between low-dose magnesium sulphate and standard dose regimen for management of eclampsia. Int J Reprod Contracept Obstet Gynecol. 2014;3:79-86.

Chowdhury JR, Chowdhury S, Bhattacharya N, Biswas PK. Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia. J Obstet Gynaecol Res. 2009;35(1):119-2.