Use of magnesium sulfate in pre-eclampsia and eclampsia in teaching hospitals in Addis Ababa: a practice audit

Abstract

Background: Magnesium sulphate is shown to be the drug of choice in the management of severe pre-eclampsia-eclampsia for over two decades. However, the drug was introduced in practice in teaching hospitals in Addis Ababa recently. Hence, it is important to audit its use at this stage.

Objectives: To audit the experience of magnesium sulfate use for management of severe pre-eclampsia and eclampsia on its introduction in teaching hospitals in Addis Ababa.

Methodology: A retrospective medical record review was conducted to audit use of magnesium sulfate, MgSO4, in two teaching hospitals in Addis Ababa between February and August 2006.

Results: One hundred three women received magnesium sulfate during the study period (February to August, 2006). It was possible to retrieve the charts of 95 women (92.2% chart retrieval rate). Seventy-four percent (54/73) of the eligible cases from Tikur Anbesa Hospital and 63.6% (49/77) from Gandhi Memorial Hospital received the drug. Patient selection for administration of magnesium sulfate was appropriate in 93.7% (89/95) of women with hypertension in pregnancy. Correct loading dose of MgSO4 was given for 90.4% (85/95) of the patients. No woman with severe pre-eclampsia convulsed after initiation of magnesium sulfate, while four of the eclamptic mothers had recurrence of seizures. The overall clinical monitoring of patients who were on treatment was inadequate with respect to the protocol of the hospitals. Only one (1.1%) woman was reported to have developed signs of a major side effect of magnesium sulfate and two mothers died. Both of these deaths were not attributed to magnesium sulfate toxicity.

Conclusion and recommendations: This study showed that a good proportion (more than two-thirds) of the eligible cases has received magnesium sulfate. It is recommended that the respective hospitals should give due attention to the suboptimal patient monitoring.