Magnesium sulfate is the anticonvulsant of choice for preeclampsia prophylaxis and treatment and treatment of eclampsia. There is need to provide the most effective management to preeclamptic and eclamptic patients. Preeclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality. Single loading dose of magnesium sulphate in severe preeclampsia and eclampsiais it effective.
A randomized controlled trial of intravenous magnesium sulphate versus placebo in the management of women with severe pre eclampsia. The intramuscular regimen is most commonly a 4g intravenous loading dose, immediately followed by 10g intramuscularly and then by 5g intramuscularly every 4 hours in. In the triennium 20062008 there were 19 maternal deaths resulting from severe pre eclampsia and eclampsia. Prophylactic magnesium sulphate in severe preeclampsia. Most often it is during the second half of pregnancy. Although preeclampsia eclampsia and preterm labour utilises different clinical endpoints of therapy, quite similar serum values result23. The study of magnesium sulphate vs diazepam in eclampsia. The distinction between pregnancy induced hypertension and preeclampsia is important. Magnesium sulphate since the collaborative eclampsia trial and the magpie trial has been established as the gold standard in the management of severe pre. A comparative analysis of protocols 1997 and 2008 definitions of preeclampsia of gestational hypertension and either proteinuria or onemore adverse condition,14 current recommendations to use mgso 4 for eclampsia prevention and treatment grade ia for. Magnesium sulfate preparation for intravenous administration.
Pre eclampsia eclampsia pee is a lifethreatening multisystem disorder affecting 2 8% of all pregnancies worldwide 1,2 that has substantial effect on maternal and newborn health. Magnesium sulphate management of hypertensive disorders of. Magnesium sulphate for eclampsia and fetal neuroprotection. If seizures reoccur while receiving magnesium sulfate magnesium sulfate 2 g iv over 5 minutes o may be repeated after 2 minutes diazepam 510 mg iv at a rate of. Magnesium sulfate in eclampsia and preeclampsia ncbi. Risks sequelae intracranial hemorrhage retinal detachment transient neurologic deficits 3. Eclampsia is the onset of seizures convulsions in a woman with pre eclampsia. The uses of magnesium sulfate in the context of appropriate clinical obstetric practice include, in particular, prevention and treatment of seizures in women with preeclampsia or eclampsia and fetal neuroprotection before anticipated early preterm less than 32 weeks of gestation delivery 8 9 12. Magnesium sulphate mgso 4 was first introduced to control convulsions in 1925, but it was the collaborative eclampsia trial in 1995 that confirmed the efficacy of mgso 4 in the treatment of severe preeclampsia and eclampsia. The guideline has been drawn up with reference to the guidance of the royal. Magnesium sulfate fda prescribing information, side effects. Regional guideline for the management of pre eclampsia.
Magnesium sulphate since the collaborative eclampsia trial and the magpie trial has been. New magnesium sulphate protocol for preeclampsia the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Magnesium sulphate in the management of severe preeclampsia and eclampsia in health facilities in nigeria. Severe pre eclampsia and eclampsia are relatively uncommon but can cause serious complications of pregnancy.
The distinction between pregnancy induced hypertension and pre eclampsia is important. Magnesium sulfate mgso4 is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe preeclampsia. Magnesium sulfate mgsc4 is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe preeclampsia. Preeclampsiaeclampsia pee is a lifethreatening multisystem disorder affecting 2 8% of all pregnancies worldwide 1,2 that has substantial effect on maternal and newborn health. The trial also called magpie trial was a randomized, placebocontrolled study that enrolled over 10,000 women. Magnesium sulphate for the management of preeclampsia. Magnesium sulfate reduced eclampsia compared to phenytoin relative risk 0. Mar 23, 2020 in severe pre eclampsia or eclampsia, the total initial dose is 10 to 14 g of magnesium sulfate. Intravenously, a dose of 4 to 5 g in 250 ml of 5% dextrose injection, usp or 0. Side effects of magnesium sulfate magnesium sulfate. Magnesium sulphate in management of severe preeclampsia and eclampsia.
But theres a risk of magnesium overdose, called magnesium toxicity. Maternal and perinatal mortality and morbidity remains high during pregnancy in the presence of eclampsia, it can have severe adverse. Based on current evidence, 1 gh is therefore the correct dose. Alternative magnesium sulphate regimens for women with preeclampsia and eclampsia. In the journal, october 9, a correspondents inquiry as to the intravenous use of magnesium sulphate in eclampsia is answered, in part, as follows. The intravenous regimen used in the trial was 1 gh, and monitoring was clinical rather than by serum concentrations of magnesium. Magnesium sulfate fda prescribing information, side. Adminstration of magnesium sulphate mgso4 for eclampsia. Practical considerations in magnesium sulphate therapy although a standard dosing regime for magnesium sulphate in preventing eclampsia exists, there is debate regarding the appropriate time and clinical situation for the instigating therapy, and how serum. Individual patient circumstances may mean that practice diverges from this lop. Urine output should be maintained at 100 ml or more during the 4 hours preceding each dose. Who recommendation on magnesium sulfate regimen to prevent. The guideline development group believed that capacity for clinical surveillance of women and.
Listing a study does not mean it has been evaluated by the u. Magnesium sulfate for the treatment of eclampsia stroke. Magnesium sulfate may act as a vasodilator, with actions in the peripheral vasculature or the cerebrovasculature, to decrease peripheral vascular resistance or relieve vasoconstriction. Magnesium is removed from the body solely by the kidneys. Magnesium sulfate is an inorganic salt with the formula mgso 4 h 2 o x where 0. Background pre eclampsia eclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries.
Background preeclampsiaeclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries. The intramuscular regimen is most commonly a 4 g intravenous loading dose. The use of magnesium sulphate for the treatment of severe. The overall global annual usage in the mid1970s of the monohydrate was 2. Use of magnesium sulphate prophylaxis with magnesium sulphate should be implemented where there are premonitory signs of eclampsia increased reflexes associated with clonus andor severe headache, visual changes or following diagnosis of severe preeclampsia diastolic bp 110 mmhg, proteinuria 300mg24 hours, abnormal ast and alt and. Magnesium sulfate an overview sciencedirect topics.
This lop is developed to guide clinical practice at the royal hospital for women. May 03, 20 new magnesium sulphate protocol for pre eclampsia the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Do women with preeclampsia, and their babies, benefit from magnesium sulphate. The seizures are of the tonicclonic type and typically. In the triennium 20062008 there were 19 maternal deaths resulting from severe preeclampsia and eclampsia. Do women with pre eclampsia, and their babies, benefit from magnesium sulphate. A serum magnesium level of 6 mg100 ml is considered optimal for seizure control. Eclampsia is the onset of seizures convulsions in a woman with preeclampsia. It is usually given by either the intramuscular or intravenous routes. Use of mgso4 for eclampsia treatment and prevention has been wellstudied in. The collaborative eclampsia trial1 confirmed that magnesium sulphate is the drug of choice in eclampsia.
Magnesium sulfate injection is a naturally occurring mineral used to control low blood levels of magnesium. Sep, 2012 magnesium sulfate mgsc4 is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre eclampsia. Preeclampsia is a disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction. Use of magnesium sulphate prophylaxis with magnesium sulphate should be implemented where there are premonitory signs of eclampsia increased reflexes associated with clonus andor severe headache, visual changes or following diagnosis of severe pre eclampsia diastolic bp 110 mmhg, proteinuria 300mg24 hours, abnormal ast and alt and. Severe preeclampsia and eclampsia are relatively uncommon but can cause serious complications of pregnancy. Magnesium sulphate was indicated as a prophylactic in 88 patients and as treatment. Is the prophylactic administration of magnesium sulphate in women with preeclampsia indicated prior to labour. Pharmacological strategies for control of blood pressure are described in detail. Magnesium sulphate in management of severe preeclampsia.
Magnesium sulfate for preeclampsia and eclampsia management. Pdf magnesium sulphate therapy in eclampsia and pre. Magnesium sulfate can be beneficial to some with preeclampsia. Jan 17, 2017 magnesium sulfate injection is a naturally occurring mineral used to control low blood levels of magnesium. Magnesium sulphate prevented eclampsia in women with pre. The use of magnesium sulphate for the treatment of severe pre. Magnesium sulphate management of hypertensive disorders.
Sep 12, 2018 magnesium sulfate can be beneficial to some with preeclampsia. Magnesium sulphate leads to fewer maternal deaths and fewer further seizures than diazepam valium when given for eclamptic seizures fits. Jul 03, 1999 magnesium sulphate has been used for treating eclampsia in the united states for much of the 20th century. Contraindications parenteral administration of the drug is contraindicated in patients with heart block or myocardial damage. It is the firstline treatment for any pregnant woman who suffers a seizure, including women with known epilepsy. Magnesium sulphate in the treatment of eclampsia and pre. New magnesium sulphate protocol for preeclampsia full text. Pre eclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. Pdf magnesium sulphate therapy in eclampsia and preeclampsia. Magnesium sulfate is the drug of choice for the prevention and treatment of seizures in eclampsia. Two regimens of magnesium sulphate were used, with different success rates in controlling further convulsions.
Administration of magnesium sulphate is one of the prime treatment modalities in eclampsia and severe preeclampsia. Out of recruited women, 78% were diagnosed with preeclampsia and 22% were diagnosed with eclampsia. Administer magnesium sulphate intravenously via either a central or peripheral line using an infusion pump. Taking too much magnesium can be lifethreatening to both. The study of magnesium sulphate vs diazepam in eclampsia tariq masood khan and aisha malik department of obstetrics and gynecology, pakistan corresponding author. Magnesium sulfate injection is also used for pediatric acute nephritis and to prevent seizures in severe pre eclampsia, eclampsia, or toxemia of pregnancy. Loading dose of magnesium sulphate, followed by maintenance infusion. New magnesium sulphate protocol for preeclampsia full. It is often encountered as the heptahydrate sulphate mineral epsomite mgso 4 7h 2 o, commonly called epsom salt.
Between two and eight in every 100 pregnant women develop preeclampsia toxaemia, which usually means they have high blood pressure and protein in the urine. The full intravenous or intramuscular magnesium sulfate regimens are recommended for the prevention and treatment of eclampsia. Magnesium sulfate is the anticonvulsant of choice for preeclampsia. Mgso, was first used to prevent eclamptic seizures in 1906 by horn in ger many, who injected it intrathecally. Magnesium sulphate is the drug of choice for women with eclampsia5 although its use is fraught with many uncertainties. The conventional regime of magnesium sulphate is an empirical approach developed over the years based on its clinical efficacy. Magnesium sulphate 4 g in 100 ml sodium chloride 0. A randomized controlled trial of intravenous magnesium sulphate versus placebo in the management of women with severe preeclampsia. Magnesium sulfate infusion therapy, preeclampsia purpose. Caring for the preeclamptic woman needing magnesium therapy to prevent seizures. Judicious use of magnesium sulfate for eclampsia mdedge. Tariq masood khan, familyemergency medicine specialist, department of obstetrics and gynecology, pakistan.
Magnesium sulphate for eclampsia or eclampsia prophylaxis. Before beginning any infusion of magnesium sulfate. Magnesium sulfate is a lifesaving drug and should be available in all healthcare facilities throughout the health system. Judicious use of magnesium sulfate for eclampsia mdedge obgyn. Intravenous regimes for magnesium administration are described with alternative intramuscular regimes for settings where. In the magpie trial, magnesium sulfate administration was associated with a reduction in the incidence of eclampsia of approximately 56% placebo. A randomised controlled trial of intravenous magnesium sulphate versus placebo in the management of women with severe pre eclampsia.
Magnesium sulfate, although not actually an antihypertensive, has proved valuable in the treatment of pre eclampsia. Single loading dose of magnesium sulphate in severe. Magnesium sulfate mgso4 is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre eclampsia. Administration of magnesium sulphate is one of the prime treatment modalities in eclampsia and severe pre eclampsia.
Management of eclampsia and magnesium toxicity eugene chang, md professor. Magnesium sulfate for the treatment of eclampsia aha journals. Magnesium sulfate should be used for the prevention and treatment of seizures in women with severe preeclampsia or eclampsia. Magnesium sulfate mgso 4 has been used throughout the 20th century for prevention of eclamptic seizures, 1,2 and it continues to be used extensively. The need to continue therapy is based on the continuing presence of patellar reflex and adequate respiratory function. Intravenous line should not be used to inject any other drugs. It is the firstline treatment for any pregnant woman who suffers a. Data from the collaborative eclampsia trial provided strong evidence that magnesium sulphate is the drug of choice for women with eclampsia. Training manual trainee version on the use of magnesium. Conclusion magnesium sulphate is a superior drug in preventing the recurrence of seizures in eclampsia and in seizure prophylaxis in pre.
Monitoring serum magnesium and patient clinical status is essential to avoid overdose in toxemia of pregnancy. It is a twoyear project involving all the 36 states and fct. Safety and efficacy of low dose intramuscular magnesium sulphate mgso4 compared to intravenous regimen for treatment of eclampsia. Training manual on the use of magnesium sulphate in the. Figure 1 is a guideline for administration of magnesium sulphate to treat severe pre eclampsia and eclampsia. In women with preeclampsia, does magnesium sulphate reduce the risk of eclampsia and improve pregnancy. Magnesium sulfate management of hypertensive disorders of pregnancy uncontrolled document when printed published.
Magnesium sulphate administration is indicated to treat eclamptic seizures and prevent seizures in women with severe preeclampsia. Conclusions though the specific mechanisms of action remain unclear, the effect of magnesium sulfate in the prevention of eclampsia is likely multifactorial. Lowdose magnesium sulphate in the control of eclamptic fits. Side effects of magnesium sulfate injection include. Figure 1 is a guideline for administration of magnesium sulphate to treat severe preeclampsia and eclampsia. Eclampsia and role of magnesium sulfate the obg project. There is now evidence that magnesium sulphate is the most effective anticonvulsant. Parenteral use in renal insufficiency may lead to magnesium intoxication. Preeclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. Magnesium sulphate has been used for treating eclampsia in the united states for much of the 20th century. Pre eclampsia is a disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction.