Magnesium sulphate versus lytic cocktail for eclampsia

Abstract

Background: Eclampsia, the occurrence of a seizure in association with pre-eclampsia, is a rare but serious complication of pregnancy. A number of different anticonvulsants are used to control eclamptic fits and to prevent further seizures.

Objectives: The aim of this review was to compare the effects of magnesium sulphate with those of lytic cocktail when used for the care of women with eclampsia.

Search strategy: The register of trials held by the Cochrane Pregnancy and Childbirth Group was searched for relevant trials. The Cochrane Controlled Trials Register in The Cochrane Library Issue 2, 2000 was also searched.

Selection criteria: Randomised trials recruiting women with eclampsia, and comparing any use of magnesium sulphate with any use of lytic cocktail.

Data collection and analysis: Data were extracted from each report without any blinding of the results or of the treatments which women received.

Main results: Two trials with 199 women were included in the review. These were both small and of average quality. Magnesium sulphate was better than lytic cocktail at preventing further fits (relative risk (RR) 0.09, 95% confidence interval (CI) 0.03-0.24; risk difference (RD) 0.43, 95% CI -0.53, -0.34; number needed to treat (NNT) 3, 95% CI 2-3) and was associated with less respiratory depression (RR 0.12, 95% CI 0.02-0.91). Magnesium sulphate was also associated with fewer maternal deaths than lytic cocktail, but the difference was not statistically significant (RR 0.25, 95% CI 0.04-1.43).

Reviewer's conclusions: Magnesium sulphate is the anticonvulsant of choice for women with eclampsia. Lytic cocktail should be abandoned.