COMPARISON OF INTRAMUSCULAR MAGNESIUM SULPHATE WITH LOW DOSE INTRAVENOUS REGIMEN IN THE MANAGEMENT OF ECLAMPSIA IN OAUTH COMPLEX, ILE-IFE

Abstract

BACKGROUND: Eclampsia is a major cause of maternal and perinatal morbidity
and mortality. Magnesium sulphate is currently the gold standard in the management
of eclamptic fit. As a result of its toxicity, current efforts are being geared towards
discovering a lower dosage without compromising its efficacy.

OBJECTIVE: To compare the effectiveness of low-dose magnesium sulphate and
standard Pritchard regimen in controlling eclamptic fit and preventing adverse
maternal and neonatal outcomes in eclamptic patients that were managed in Obafemi
Awolowo University Teaching Hospitals Complex, Ile Ife.

METHODOLOGY: This study was a randomized double-blind clinical trial
comparing low-dose magnesium sulphate with standard Pritchard regimen. Twenty
eight patients (the cases) randomized into low-dose regimen group received 4g
loading dose, intravenously and a maintenance dose of 0.6g/hr through intravenous
infusion for a period of 24 hours post-delivery or after the last fit. The control arm of
the study were twenty eight patients who had the Pritchard regimen comprising of a
loading dose of 14g followed by maintenance dose of 5g 4 hourly for a period of 24
hours post-delivery or after the last fit. In both study groups, additional 2g of
intravenously magnesium sulphate was given for recurrent convulsions. Outcome
measures includes: recurrent convulsion, apgar score, perinatal death and maternal
complications including death.
RESULTS: The mean age of the 56 patients was 25.5 ± 5.7 years. Thirty-three
(58.9%) were nullipara, 54 (96.4%) were unbooked, 33 (58.9%) had antepartum
eclampsia, 17 (30.4%) had preterm delivery, 2 (3.6%) had primary postpartum
haemorrhage which was the commonest complication. Recurrent rate of convulsion
ranges between 3.6% and 7.1% and was not different between study groups. There
was no difference in neonatal outcomes between the two groups.

CONCLUSION: From this study, low-dose magnesium sulphate appears to be as
effective as the standard Pritchard regimen in controlling eclamptic fit. The additional
benefits of the intravenous low-dose magnesium sulphate are: it costs less and the
chances of toxicity are reduced.

COMPARISON OF INTRAMUSCULAR MAGNESIUM SULPHATE WITH LOW DOSE INTRAVENOUS REGIMEN IN THE MANAGEMENT OF ECLAMPSIA IN OAUTH COMPLEX, ILE-IFE