Standardized treatment of 154 consecutive cases of eclampsia

Abstract

Since 1955 standardized treatment applied uniformly to all cases of eclampsia at Parkland Memorial Hospital has consisted of (1) magnesium sulfate intravenously and intramuscularly to control convulsions, (2) intravenous hydralazine intermittently to lower diastolic blood pressure when it exceeded 110 mm. Hg, and (3) steps to effect vaginal delivery as soon as the woman has regained consciousness. The dosage schedules for magnesium sulfate and hydralazine, while empiric, have been extensively tested for both efficacy and toxicity. Delivery usually was accomplished vaginally and conduction anesthesia was avoided. Neither diuretics nor osmotic agents in the form of hypertonic glucose, mannitol, or albumin were used to treat eclampsia. Heparin was never given. To date 154 cases of eclampsia have been so treated with no maternal death. All fetuses alive when treatment was started and weighing 1,800 Gm. (4 pounds) or more survived. The results provide a standard against which new drugs and treatment regimens can be compared.