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Meta-Analysis
. 2010 Aug 4;2010(8):CD007388.
doi: 10.1002/14651858.CD007388.pub2.

Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia

Lelia Duley  1 , Hosam E Matar, Muhammad Qutayba Almerie, David R Hall
Affiliations
Meta-Analysis

Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia

Lelia Duley et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Magnesium sulphate remains the drug of choice for both prevention and treatment of women with eclampsia. Regimens for administration of this drug have evolved over the years, but have not yet been formally evaluated.

Objectives: To assess the comparative effects of alternative regimens for the administration of magnesium sulphate when used for the care of women with pre-eclampsia or eclampsia, or both.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2010).

Selection criteria: Randomised trials comparing different regimens for administration of magnesium sulphate used for the care of women with pre-eclampsia or eclampsia, or both.

Data collection and analysis: All four review authors assessed trial quality and extracted data independently.

Main results: We identified 17 studies of which six (866 women) met the inclusion criteria: two trials (451 women) compared regimens for women with eclampsia and four (415 women) for women with pre-eclampsia.Treatment of eclampsia: one trial compared loading dose alone with loading dose plus maintenance therapy for 24 hours (401 women). There was no clear difference between the groups in the risk ratio (RR) of recurrence of convulsions (RR 1.13, 95% confidence interval (CI) 0.42 to 3.05) or stillbirth (RR 1.13, 95% CI 0.66 to 1.92), and the CIs are wide. One trial compared a low dose regimen with a standard dose regimen over 24 hours (50 women). This study was too small for any reliable conclusions about the comparative effects.Prevention of eclampsia: one trial compared intravenous with intramuscular maintenance regimen for 24 hours (17 women). This trial was too small for any reliable conclusions. Three trials compared short maintenance regimens postpartum with continuing for 24 hours after the birth (398 women), even taken together these trials were too small for any reliable conclusions.

Authors' conclusions: Although strong evidence supports the use of magnesium sulphate for prevention and treatment of eclampsia, trials comparing alternative treatment regimens are too small for reliable conclusions.

PubMed Disclaimer

Conflict of interest statement

Lelia Duley was the Principal Investigator for the Collaborative Eclampsia Trial and the Magpie Trial. Jim Neilson (Editor for this review) was a co‐investigator on the Magpie Trial.

Figures

1.1
1.1. Analysis
Comparison 1 Treatment of eclampsia: loading dose alone versus loading dose + maintenance regimen, Outcome 1 Recurrence of convulsions.
1.2
1.2. Analysis
Comparison 1 Treatment of eclampsia: loading dose alone versus loading dose + maintenance regimen, Outcome 2 Maternal death.
1.3
1.3. Analysis
Comparison 1 Treatment of eclampsia: loading dose alone versus loading dose + maintenance regimen, Outcome 3 Caesarean section.
1.4
1.4. Analysis
Comparison 1 Treatment of eclampsia: loading dose alone versus loading dose + maintenance regimen, Outcome 4 Stillbirth.
2.1
2.1. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 1 Recurrence of convulsions.
2.2
2.2. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 2 Oliguria.
2.3
2.3. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 3 Absent tendon reflexes.
2.4
2.4. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 4 Any baby death.
2.5
2.5. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 5 Stillbirth.
2.6
2.6. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 6 Neonatal death.
2.7
2.7. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 7 Respiratory distress syndrome.
2.8
2.8. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 8 Neonatal hypotonia.
2.9
2.9. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 9 Neonatal respiratory depression.
2.10
2.10. Analysis
Comparison 2 Treatment of eclampsia: lower dose regimens versus standard dose regimens, Outcome 10 Admission to special care baby unit.
3.1
3.1. Analysis
Comparison 3 Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen (subgroups by dose of regimen), Outcome 1 Eclampsia.
3.2
3.2. Analysis
Comparison 3 Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen (subgroups by dose of regimen), Outcome 2 Magnesium sulphate toxicity.
3.3
3.3. Analysis
Comparison 3 Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen (subgroups by dose of regimen), Outcome 3 Renal failure.
3.4
3.4. Analysis
Comparison 3 Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen (subgroups by dose of regimen), Outcome 4 Antenatal antihypertensive.
3.5
3.5. Analysis
Comparison 3 Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen (subgroups by dose of regimen), Outcome 5 Intrapartum antihypertensive.
3.6
3.6. Analysis
Comparison 3 Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen (subgroups by dose of regimen), Outcome 6 Caesarean section.
3.7
3.7. Analysis
Comparison 3 Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen (subgroups by dose of regimen), Outcome 7 Stillbirth.
4.1
4.1. Analysis
Comparison 4 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by severity of pre‐eclampsia), Outcome 1 Eclampsia.
4.2
4.2. Analysis
Comparison 4 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by severity of pre‐eclampsia), Outcome 2 Progression to more severe pre‐eclampsia.
4.3
4.3. Analysis
Comparison 4 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by severity of pre‐eclampsia), Outcome 3 Duration of allocated maintenance regimen extended, or therapy restarted.
4.4
4.4. Analysis
Comparison 4 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by severity of pre‐eclampsia), Outcome 4 Absent tendon reflexes.
4.5
4.5. Analysis
Comparison 4 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by severity of pre‐eclampsia), Outcome 5 Magnesium sulphate toxicity.
4.6
4.6. Analysis
Comparison 4 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by severity of pre‐eclampsia), Outcome 6 Length of postpartum hospital stay (days).
4.7
4.7. Analysis
Comparison 4 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by severity of pre‐eclampsia), Outcome 7 Antihypertensive drug at discharge.
5.1
5.1. Analysis
Comparison 5 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by type of short regimen), Outcome 1 Eclampsia.
5.2
5.2. Analysis
Comparison 5 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by type of short regimen), Outcome 2 Progression to more severe pre‐eclampsia.
5.3
5.3. Analysis
Comparison 5 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by type of short regimen), Outcome 3 Duration of allocated maintenance regimen extended, or therapy restarted.
5.4
5.4. Analysis
Comparison 5 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by type of short regimen), Outcome 4 Absent tendon reflexes.
5.5
5.5. Analysis
Comparison 5 Duration of postpartum maintenance regimen: short versus for 24 hours after delivery (subgroups by type of short regimen), Outcome 5 Magnesium sulphate toxicity.
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References

References to studies included in this review

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Bangladesh 2009 {published data only}
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Brazil 2010 {published data only}
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India 2009 {published data only}
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Iran 2005 {published data only}
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Thailand 1999 {published data only}
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