Magnesium sulphate: a life saving drug

Abstract

A retrospective study of 68 eclamptic women who received Magnesium sulphate at Koshi Zonal Hospital were analyzed during a one year period (2006-2007 AD). Maternal conditions at admission, associated complications in mothers and babies, delivery outcomes and cause of death were also studied in each case. There were 5240 deliveries during the period of analysis. Of which 4976 were live births, pregnancy induced hypertension was 0.89% (47), 0.74% (39) presented with pre-eclampsia, 0.30 (16) cases with severe pre-eclampsia and 0.43 (23) cases with mild pre-eclampsia. During this period 1.3% (68) of eclampsia presented to the hospital. Of which 67.7% presented with ante-partum eclampsia, 22.1% with intrapartum eclampsia and 10.3% with post partum eclampsia. Majority of women (63.2%) were between 20-25 years of age, while teenage pregnancy contributed 30.88% of eclamptic cases. The diastolic blood pressure was >110 mm of Hg in 45.6% of cases, 90-110 mmHg in 50% of cases and in 4.4% the it was <90 mmHg. 94.1% presented to the hospital in an unconscious state, 79.4% of eclamptic women received the full dose of magnesium sulphate (initial loading plus maintenance dose), while rest failed to receive the full dose. Nine women with severe pre-eclampsia received magnesium sulphate as a prophylactic measure. 17.7% women had home delivery, one patient left against medical advice and one was referred to a tertiary care center. Caesarian Section (Lower Segment) was performed in 35.2% of cases, 30.8% had normal vaginal deliveries and 5.8% had pre term delivery. About 69.6% babies were born alive, 8.7% were still births, 11.6% were neonatal deaths and 4.4% of babies had to be admitted to the neonatal intensive care. Eclamptic women stayed less than one week in the hospital in majority of cases (64.7%), between 1-2 weeks in 32.4% and more than two weeks in 2.9%. Maternal complications included decreased urinary output, pulmonary edema in three cases; chest and wound infection two cases each; post partum psychosis, vulval haematoma, severe headache one case each. There were seven maternal deaths during this period and eclampsia contributed to one of the deaths. Eclampsia is a major cause of maternal and perinatal morbidity and mortality in our setup. Magnesium sulphate is an excellent drug of choice in management of eclampsia and pre-eclampsia. Wider coverage of pre-natal care, timely referral and optimal management of cases of eclampsia with magnesium sulphate in hospitals are key issues to prevent mortality/morbidity associated with it.