SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Magnesium sulphate for the management of preeclampsia and eclampsia in low and middle income countries: a systematic review of tested dosing regimens.

Gordon, R; Magee, LA; Payne, B; Firoz, T; Sawchuck, D; Tu, D; Vidler, M; de Silva, D; von Dadelszen, P (2014) Magnesium sulphate for the management of preeclampsia and eclampsia in low and middle income countries: a systematic review of tested dosing regimens. Journal of Obstetrics and Gynaecology Canada, 36 (2). pp. 154-163. ISSN 1701-2163 https://doi.org/10.1016/S1701-2163(15)30662-9
SGUL Authors: von Dadelszen, Peter

[img]
Preview
PDF Published Version
Available under License ["licenses_description_publisher" not defined].

Download (875kB) | Preview

Abstract

OBJECTIVE: To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment). DATA SOURCES: We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications. STUDY SELECTION: Our search yielded 753 publications, of which 26 (10 randomized controlled trials and 16 observational studies) evaluated MgSO4 for preeclampsia and/or eclampsia in World Bank-classified LMICs. DATA EXTRACTION: Independent, by two authors. DATA SYNTHESIS: Twenty-five studies were conducted in hospital settings and one in the community. Rates of eclampsia were usually < 5% (median 3.0%, range 0.0% to 26.5%) even when MgSO4 was administered for eclampsia. When dosage varied from the standard Pritchard or Zuspan regimens, almost all (n = 22) reduced the dose or duration of treatment, most commonly because of concerns about maternal safety, cost, or resource availability. Four trials of a loading dose only (4 g IV + 10 g IM) versus loading plus maintenance dosing of 5 g/4 hr IM found no difference in eclampsia recurrence (RR 1.64; 95% CI 0.48 to 5.65, n = 396). One study documented less eclampsia recurrence associated with community administration of a MgSO4 loading dose before referral to a care facility versus treatment in a care facility (RR 0.23; 95% CI 0.11 to 0.49, n = 265). CONCLUSION: Use of MgSO4 for eclampsia treatment and prevention has been well-studied in LMICs, but concern remains about potential toxicity. Further studies are needed to identify the minimum effective dosage of MgSO4 for management of preeclampsia and eclampsia and whether MgSO4 loading can be safely administered in the community.

Item Type: Article
Additional Information: © 2014 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved. Made available with permission from the publisher. Contact publisher for any further re-use.
Keywords: anticonvulsants, developing countries, eclampsia, magnesium sulfate, preeclampsia, Africa South of the Sahara, Asia, Eclampsia, Female, Humans, Income, MEDLINE, Magnesium Sulfate, Poverty, Pre-Eclampsia, Pregnancy, Randomized Controlled Trials as Topic, Recurrence, Treatment Outcome, Humans, Eclampsia, Pre-Eclampsia, Recurrence, Magnesium Sulfate, Treatment Outcome, Pregnancy, Poverty, MEDLINE, Income, Africa South of the Sahara, Asia, Female, Randomized Controlled Trials as Topic, 1114 Paediatrics And Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Journal of Obstetrics and Gynaecology Canada
ISSN: 1701-2163
Language: eng
Dates:
DateEvent
1 February 2014Published
Publisher License: Publisher's own licence
PubMed ID: 24518915
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107525
Publisher's version: https://doi.org/10.1016/S1701-2163(15)30662-9

Actions (login required)

Edit Item Edit Item