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. 2023 Oct 10;10(10):CD007388.
doi: 10.1002/14651858.CD007388.pub3.

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

Virginia Diaz  1 , Qian Long  2 , Olufemi T Oladapo  3
Affiliations

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

Virginia Diaz et al. Cochrane Database Syst Rev. .

Abstract

Background: Magnesium sulphate is the drug of choice for the prevention and treatment of women with eclampsia. Regimens for administration of this drug have evolved over the years, but there is no clarity on the comparative benefits or harm of alternative regimens. This is an update of a review first published in 2010.

Objectives: To assess if one magnesium sulphate regimen is better than another when used for the care of women with pre-eclampsia or eclampsia, or both, to reduce the risk of severe morbidity and mortality for the woman and her baby.

Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (29 April 2022), and reference lists of retrieved studies.

Selection criteria: We included randomised trials and cluster-randomised trials comparing different regimens for administration of magnesium sulphate used in women with pre-eclampsia or eclampsia, or both. Comparisons included different dose regimens, intramuscular versus intravenous route for maintenance therapy, and different durations of therapy. We excluded studies with quasi-random or cross-over designs. We included abstracts of conference proceedings if compliant with the trustworthiness assessment.

Data collection and analysis: For this update, two review authors assessed trials for inclusion, performed risk of bias assessment, and extracted data. We checked data for accuracy. We assessed the certainty of the evidence using the GRADE approach.

Main results: For this update, a total of 16 trials (3020 women) met our inclusion criteria: four trials (409 women) compared regimens for women with eclampsia, and 12 trials (2611 women) compared regimens for women with pre-eclampsia. Most of the included trials had small sample sizes and were conducted in low- and middle-income countries. Eleven trials reported adequate randomisation and allocation concealment. Blinding of participants and clinicians was not possible in most trials. The included studies were for the most part at low risk of attrition and reporting bias. Treatment of women with eclampsia (four comparisons) One trial compared a loading dose-alone regimen with a loading dose plus maintenance dose regimen (80 women). It is uncertain whether either regimen has an effect on the risk of recurrence of convulsions or maternal death (very low-certainty evidence). One trial compared a lower-dose regimen with standard-dose regimen over 24 hours (72 women). It is uncertain whether either regimen has an effect on the risk of recurrence of convulsion, severe morbidity, perinatal death, or maternal death (very low-certainty evidence). One trial (137 women) compared intravenous (IV) versus standard intramuscular (IM) maintenance regimen. It is uncertain whether either route has an effect on recurrence of convulsions, death of the baby before discharge (stillbirth and neonatal death), or maternal death (very low-certainty evidence). One trial (120 women) compared a short maintenance regimen with a standard (24 hours after birth) maintenance regimen. It is uncertain whether the duration of the maintenance regimen has an effect on recurrence of convulsions, severe morbidity, or side effects such as nausea and respiratory failure. A short maintenance regimen may reduce the risk of flushing when compared to a standard 24 hours maintenance regimen (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.08 to 0.93; 1 trial, 120 women; low-certainty evidence). Many of our prespecified critical outcomes were not reported in the included trials. Prevention of eclampsia for women with pre-eclampsia (five comparisons) Two trials (462 women) compared loading dose alone with loading dose plus maintenance therapy. Low-certainty evidence suggests an uncertain effect with either regimen on the risk of eclampsia (RR 2.00, 95% CI 0.61 to 6.54; 2 trials, 462 women) or perinatal death (RR 0.50, 95% CI 0.19 to 1.36; 2 trials, 462 women). One small trial (17 women) compared an IV versus IM maintenance regimen for 24 hours. It is uncertain whether IV or IM maintenance regimen has an effect on eclampsia or stillbirth (very low-certainty evidence). Four trials (1713 women) compared short postpartum maintenance regimens with continuing for 24 hours after birth. Low-certainty evidence suggests there may be a wide range of benefit or harm between groups regarding eclampsia (RR 1.99, 95% CI 0.18 to 21.87; 4 trials, 1713 women). Low-certainty evidence suggests there may be little or no effect on severe morbidity (RR 0.96, 95% CI 0.71 to 1.29; 2 trials, 1233 women) or side effects such as respiratory depression (RR 0.80, 95% CI 0.25 to 2.61; 2 trials, 1424 women). Three trials (185 women) compared a higher-dose maintenance regimen versus a lower-dose maintenance regimen. It is uncertain whether either regimen has an effect on eclampsia (very low-certainty evidence). Low-certainty evidence suggests that a higher-dose maintenance regimen has little or no effect on side effects when compared to a lower-dose regimen (RR 0.79, 95% CI 0.61 to 1.01; 1 trial 62 women). One trial (200 women) compared a maintenance regimen by continuous infusion versus a serial IV bolus regimen. It is uncertain whether the duration of the maintenance regimen has an effect on eclampsia, side effects, perinatal death, maternal death, or other neonatal morbidity (very low-certainty evidence). Many of our prespecified critical outcomes were not reported in the included trials.

Authors' conclusions: Despite the number of trials evaluating various magnesium sulphate regimens for eclampsia prophylaxis and treatment, there is still no compelling evidence that one particular regimen is more effective than another. Well-designed randomised controlled trials are needed to answer this question.

Trial registration: ClinicalTrials.gov NCT02091401 NCT02396030 NCT1408979 NCT02317146 NCT01846156 NCT02835339 NCT03164304 NCT03112551 NCT03318211 NCT03549767 NCT03661775.

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Conflict of interest statement

Virginia Diaz: is a researcher at Centro Rosarino de Estudios Perinatales, an obstetrician and gynaecologist at Maternidad Martin and Hospital de Emergencias Dr Clemente Alvarez, Rosario, Argentina, and has no conflicts of interest.

Qian Long: none known.

Olufemi T Oladapo: was an Editor for Cochrane Pregnancy and Childbirth, but had no involvement in the editorial processing of this review.

Figures

1
1
Study flow diagram.
2
2
Using the Cochrane Pregnancy and Childbirth criteria for assessing the trustworthiness of a study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Treatment eclampsia: loading dose alone versus loading dose plus maintenance dose regimen, Outcome 1: Recurrence of convulsion
1.2
1.2. Analysis
Comparison 1: Treatment eclampsia: loading dose alone versus loading dose plus maintenance dose regimen, Outcome 2: Maternal death
1.3
1.3. Analysis
Comparison 1: Treatment eclampsia: loading dose alone versus loading dose plus maintenance dose regimen, Outcome 3: Maternal admission to intensive care unit
1.4
1.4. Analysis
Comparison 1: Treatment eclampsia: loading dose alone versus loading dose plus maintenance dose regimen, Outcome 4: Caesarean section
1.5
1.5. Analysis
Comparison 1: Treatment eclampsia: loading dose alone versus loading dose plus maintenance dose regimen, Outcome 5: Vaginal birth
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: Perinatal death
2.3
2.3. Analysis
Comparison 2: Treatment of eclampsia: lower‐dose regimens versus standard‐dose regimens, Outcome 3: Maternal death
2.4
2.4. Analysis
Comparison 2: Treatment of eclampsia: lower‐dose regimens versus standard‐dose regimens, Outcome 4: Severe morbidity: renal failure
2.5
2.5. Analysis
Comparison 2: Treatment of eclampsia: lower‐dose regimens versus standard‐dose regimens, Outcome 5: Caesarean section
2.6
2.6. Analysis
Comparison 2: Treatment of eclampsia: lower‐dose regimens versus standard‐dose regimens, Outcome 6: Placental abruption
3.1
3.1. Analysis
Comparison 3: Treatment of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 1: Recurrence of convulsions
3.2
3.2. Analysis
Comparison 3: Treatment of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 2: Stillbirth
3.3
3.3. Analysis
Comparison 3: Treatment of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 3: Neonatal death
3.4
3.4. Analysis
Comparison 3: Treatment of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 4: Maternal death
3.5
3.5. Analysis
Comparison 3: Treatment of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 5: Severe morbidity: left heart failure and pulmonary oedema
3.6
3.6. Analysis
Comparison 3: Treatment of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 6: Postpartum haemorrhage
4.1
4.1. Analysis
Comparison 4: Treatment of eclampsia: duration of postpartum maintenance regimen: short versus 24 hours after delivery, Outcome 1: Recurrence of convulsions
4.2
4.2. Analysis
Comparison 4: Treatment of eclampsia: duration of postpartum maintenance regimen: short versus 24 hours after delivery, Outcome 2: Severe morbidity: renal failure
4.3
4.3. Analysis
Comparison 4: Treatment of eclampsia: duration of postpartum maintenance regimen: short versus 24 hours after delivery, Outcome 3: Side effect: respiratory failure
4.4
4.4. Analysis
Comparison 4: Treatment of eclampsia: duration of postpartum maintenance regimen: short versus 24 hours after delivery, Outcome 4: Side effect: nausea
4.5
4.5. Analysis
Comparison 4: Treatment of eclampsia: duration of postpartum maintenance regimen: short versus 24 hours after delivery, Outcome 5: Side effect: flushing
5.1
5.1. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 1: Eclampsia
5.2
5.2. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 2: Perinatal death
5.3
5.3. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 3: Stillbirth
5.4
5.4. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 4: Neonatal death
5.5
5.5. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 5: Maternal death
5.6
5.6. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 6: Admission to intensive care unit (maternal)
5.7
5.7. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 7: Poor blood pressure control: non‐use of antihypertensive drugs
5.8
5.8. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 8: Severe maternal morbidity: HELLP syndrome
5.9
5.9. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 9: Severe morbidity: renal failure
5.10
5.10. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 10: Severe morbidity: liver failure
5.11
5.11. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 11: Severe morbidity: coagulopathy
5.12
5.12. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 12: Caesarean section
5.13
5.13. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 13: Vaginal birth
5.14
5.14. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 14: Placental abruption
5.15
5.15. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 15: Postpartum haemorrhage
5.16
5.16. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 16: Admission to neonatal intensive care unit
5.17
5.17. Analysis
Comparison 5: Prevention of eclampsia: loading dose alone versus loading dose plus maintenance regimen, Outcome 17: Neonatal respiratory morbidity: respiratory depression requiring intubation
6.1
6.1. Analysis
Comparison 6: Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 1: Eclampsia
6.2
6.2. Analysis
Comparison 6: Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 2: Stillbirth
6.3
6.3. Analysis
Comparison 6: Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 3: Caesarean section
6.4
6.4. Analysis
Comparison 6: Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 4: Vaginal delivery
6.5
6.5. Analysis
Comparison 6: Prevention of eclampsia: IV maintenance versus standard IM maintenance regimen, Outcome 5: Assisted vaginal delivery
7.1
7.1. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 1: Eclampsia
7.2
7.2. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 2: Severe morbidity
7.3
7.3. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 3: Side effect: respiratory depression
7.4
7.4. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 4: Treatment discontinued because of side effects or adverse effects
7.5
7.5. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 5: Maternal death
7.6
7.6. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 6: Poor blood pressure control: progression to more severe pre‐eclampsia
7.7
7.7. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 7: Poor blood pressure control: postpartum IV antihypertensive therapy
7.8
7.8. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 8: Need for additional anticonvulsant
7.9
7.9. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 9: Severe morbidity: liver failure
7.10
7.10. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 10: Severe morbidity: renal failure
7.11
7.11. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 11: Severe morbidity: disseminated intravascular coagulation
7.12
7.12. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 12: Severe morbidity: stroke
7.13
7.13. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 13: Severe morbidity: pulmonary oedema
7.14
7.14. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 14: Caesarean section
7.15
7.15. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 15: Placental abruption
7.16
7.16. Analysis
Comparison 7: Prevention of eclampsia: short versus standard maintenance regimen (subgroups by type of short regimen), Outcome 16: Postpartum haemorrhage
8.1
8.1. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 1: Eclampsia
8.2
8.2. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 2: Side effects
8.3
8.3. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 3: Severe morbidity: kidney failure
8.4
8.4. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 4: Side effects: flushing
8.5
8.5. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 5: Side effects: nausea
8.6
8.6. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 6: Side effects: vomiting
8.7
8.7. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 7: Side effects: problems at injection site
8.8
8.8. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 8: Perinatal death
8.9
8.9. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 9: Maternal intensive care unit admission
8.10
8.10. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 10: Need for additional anticonvulsant: need to extend treatment
8.11
8.11. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 11: Need for additional anticonvulsant: need to reinitiate treatment
8.12
8.12. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 12: Caesarean section
8.13
8.13. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 13: Vaginal birth
8.14
8.14. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 14: Instrumental vaginal delivery
8.15
8.15. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 15: Postpartum haemorrhage
8.16
8.16. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 16: Admission to special care nursery or neonatal intensive care unit
8.17
8.17. Analysis
Comparison 8: Prevention of eclampsia: higher versus lower IV maintenance regimen, Outcome 17: Composite neonatal morbidity
9.1
9.1. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 1: Eclampsia
9.2
9.2. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 2: Side effect
9.3
9.3. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 3: Treatment discontinuation
9.4
9.4. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 4: Perinatal death
9.5
9.5. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 5: Maternal death
9.6
9.6. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 6: Caesarean section
9.7
9.7. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 7: Vaginal birth
9.8
9.8. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 8: Postpartum haemorrhage
9.9
9.9. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 9: Admission to neonatal intensive care unit
9.10
9.10. Analysis
Comparison 9: Prevention of eclampsia: maintenance regimen by continuous infusion versus a serial IV bolus regimen, Outcome 10: Neonatal respiratory morbidity
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Update of

References

References to studies included in this review

Abbade 2010 {published data only}
    1. Abbade JF, Costa RA, Martins AM, Borges VT, Rudge MV, Peraçoli JC. Zuspan's scheme versus an alternative magnesium sulfate scheme: Randomized clinical trial of magnesium serum concentrations. Hypertension in Pregnancy 2010;29(1):82-92. - PubMed
    1. Abbade JF, Costa RAA, Martins AMVC, Rudge MVC, Peracoli JC. Zuspan's scheme versus alternative scheme of magnesium sulphate to prevent or to treat eclampsia: comparison of magnesium serum concentrations [abstract]. Hypertension in Pregnancy 2006;25(Suppl 1):152.
Bhattacharjee 2011 {published data only}
    1. Bhattacharjee N, Saha SP, Ganguly RP, Patra KK, Dhali B, Das N, et al. A randomised comparative study between low-dose intravenous magnesium sulphate and standard intramuscular regimen for treatment of eclampsia. Journal of Obstetrics and Gynaecology 2011;31(4):298-303. - PubMed
Brookfield 2020 {published data only}
    1. Brookfield K, Rincon M, Tuel K, Vinson A, Caughey AB, Carvalho B. 19: a randomized trial of an alternate dosing protocol of magnesium sulfate in obese preeclamptic women. American Journal of Obstetrics and Gynecology 2020;222(1):S19. [CENTRAL: CN-02075396] [EMBASE: 2004455447] - PMC - PubMed
    1. Brookfield KF, Tuel K, Rincon M, Vinson A, Caughey AB, Carvalho B. Alternate dosing protocol for magnesium sulfate in obese women with preeclampsia: a randomized controlled trial. Obstetrics and Gynecology 2020;136(6):1190-4. [CENTRAL: CN-02201104] [EMBASE: 633364340] [PMID: ] - PMC - PubMed
    1. Vinson A, Rincon M, Tuel K, Carvalho B, Caughey AB, Brookfield K. 789: do alternative magnesium sulfate protocols in obese preeclamptic women impact neonatal morbidity? American Journal of Obstetrics and Gynecology 2020;222(1):S500. [CENTRAL: CN-02075416] [EMBASE: 2004456107]
Chissel 1994 {published data only}
    1. Chissell S, Botha JH, Moodley J, McFadyen L. Intravenous and intramuscular magnesium sulphate regimens in severe pre-eclampsia. South African Medical Journal 1994;84:607-10. - PubMed
Easterling 2018 {published data only}
    1. Easterling T, Hebert M, Bracken H, Darwish E, Ramadan MC, Shaarawy S, et al. A randomized trial comparing the pharmacology of magnesium sulfate when used to treat severe preeclampsia with serial intravenous boluses versus a continuous intravenous infusion. BMC Pregnancy and Childbirth 2018;18(1):290. - PMC - PubMed
Ehrenberg 2006 {published data only}
    1. Ehrenberg H, Mercer B. Abbreviated post-partum magnesium sulfate therapy for women with mild preeclampsia [abstract]. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S73. - PubMed
    1. Ehrenberg HM, Mercer BM. Abbreviated postpartum magnesium sulfate therapy for women with mild preeclampsia: a randomized controlled trial. Obstetrics & Gynecology 2006;108(4):833-8. - PubMed
    1. NCT00344058. Abbreviated post-partum magnesium sulfate seizure prophylaxis in preeclampsia: a comparison of 12 and 24 hour regimens. clinicaltrials.gov/ct2/show/record/NCT00344058 (first received 26 June 2006).
Katz 2016 {published data only}
    1. Katz L, Pascoal AC, Medeiros MH, Braga LC, Santos CA, Maia SB, et al. Serum magnesemia during maintenance dose of 1 g/h vs. 2 g/h of magnesium sulfate infusion for the prevention of eclampsia in women with severe preeclampsia: Randomized trial. Pregnancy Hypertension 2016;6:144. [NCT02396030]
    1. NCT02396030. Effectiveness and safety of 1g/hour vs. 2g/hour of magnesium sulfate maintenance dose for eclampsia prevention: randomized clinical trial. https://clinicaltrials.gov/show/NCT02396030 (first received 24 March 2015). [NCT02396030]
    1. Pascoal AC, Katz L, Pinto MH, Santos CA, Braga LC, Maia SB, et al. Serum magnesium levels during magnesium sulfate infusion at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in women with severe preeclampsia: a randomized clinical trial. Medicine 2019;98(32):e16779. [CENTRAL: CN-01981065] [EMBASE: 628903167] [PMID: ] - PMC - PubMed
Keepanasseril 2018 {published data only}
    1. Keepanasseril A, Kumar Maurya D, Manikandan K, Yavana Suriya J, Habeebullah S, Raghavan SS. Prophylactic magnesium sulphate in prevention of eclampsia in women with severe preeclampsia: randomised controlled trial (PIPES trial). Journal of Obstetrics and Gynaecology 2018;38(3):305-9. - PubMed
Leal 2014 {published data only}
    1. Leal NV, Amorim MM, Franca-Neto AH, Katz L, Maia SB, Noronha-Neto C. 12-hour compared with 24-hour postpartum magnesium sulfate therapy in preeclampsia: a randomized clinical trial. Obstetrics and Gynecology 2014;123(5 Suppl):64S.
    1. Maia SB, Katz L, Neto CN, Caiado BV, Azevedo AP, Amorim MM. Abbreviated (12-hour) versus traditional (24-hour) postpartum magnesium sulfate therapy in severe pre-eclampsia. International Journal of Gynecology & Obstetrics 2014;126:260-4. - PubMed
    1. NCT01408979. Postpartum prophylaxis with short course magnesium sulfate in severe preeclampsia: a randomized clinical trial. https://clinicaltrials.gov/ct2/show/record/NCT01408979 (first received 3 August 2011).
Muhammad 2013 {published data only}
    1. Abdul MA, Nasir UI, Khan N, Yusuf MD. Low-dose magnesium sulphate in the control of eclamptic fits: A randomized controlled trial. Archives of Gynecology and Obstetrics 2013;287(1):43-6. - PubMed
    1. Muhammad A, Ibrahim U, Nighat K, Muhammad Y, Abdullahi A. Low dose magnesium sulfate in the control of eclamptic fits: a randomized control trial. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S277-S278.
Rao 2015 {published data only}
    1. Rao SI, Shaheen U, Hussna S. Comparison of efficacy and safety of magnesium sulphate in 12 hours versus 24 hours after last fit in eclamptic patients. Medical Forum Monthly 2015;26(8):7-10.
Regmi 2010 {published data only}
    1. Regmi MC, Aggrawal A, Pradhan T, Rijal P, Subedi A, Uprety D. Loading dose versus standard regimen of magnesium sulphate in eclampsia – a randomized trial. Nepal Medical College Journal: NMCJ 2010;12(4):244-7. - PubMed
Rimal 2017 {published data only}
    1. Rimal SP, Rijal P, Bhatt R, Thapa K. Loading dose only versus standard dose magnesium sulfate seizure prophylaxis in severe pre-eclamptic women. Journal of the Nepal Medical Association 2017;56(208):388-94. - PubMed
    1. Rimal SP, Rijal R, Bhatt R. A randomized controlled trial of loading dose only versus standard dose magnesium sulfate seizure prophylaxis in severe pre-eclamptic women. Journal of Maternal-Fetal and Neonatal Medicine 2016;29(Suppl 1):55. - PubMed
Tungmanowutthikul 2019 {published data only}
    1. TCTR20180122001. Comparison of magnesium sulphate protocol by weight-adjusted versus 2 grams per hour for preventing convulsion in preeclampsia: a randomized trial. www.who.int/trialsearch/Trial2.aspx?TrialID=TCTR20180122001 (first received 2018). [CENTRAL: CN-01897318]
    1. Tungmanowutthikul S, Champawong R, Songthamwat S, Songthamwat M. Comparison of magnesium sulphate protocols by weight-adjusted versus two grams per hour for preventing convulsion in preeclampsia: a randomised controlled trial. Journal of Clinical and Diagnostic Research 2019;13(2):QC01-4. [CENTRAL: CN-01793189] [EMBASE: 2001523917]
Vigil‐De Gracia 2017 {published data only}
    1. NCT02317146. A novel protocol for postpartum magnesium sulfate in severe preeclampsia when the woman received less that 8 hours before delivery. Six versus twenty-four hours postpartum. clinicaltrials.gov/ct2/show/record/NCT02317146 (first received 15 December 2014). [NCT02317146]
    1. Vigil-De Gracia P, Ramirez R, Duran Y, Quintero A. Magnesium sulfate for 6 vs 24 hours post delivery in patients who received magnesium sulfate for less than 8 hours before birth: a randomized clinical trial. BMC Pregnancy and Childbirth 2017;17(1):241. [NCT02317146] - PMC - PubMed
Vigil‐De Gracia 2018 {published data only}
    1. Ludmir J, Vigil-De Gracia P. Is magnesium sulfate use of benefit post partum? A randomized controlled trial. American Journal of Obstetrics and Gynecology 2017;216(1):S3-S4, Abstract no: 4.
    1. NCT02307201. Magnesium sulfate during the postpartum in women with severe preeclampsia [Magnesium sulfate during the postpartum in women with severe preeclampsia receiving treatment for more than 8 hours before delivery. A randomized multicenter clinical trial]. clinicaltrials.gov/show/NCT02307201 (first received 4 December 2014). [CENTRAL: CN-01550661]
    1. Scott J. Safety of eliminating postpartum magnesium sulfate: intriguing but not yet proven. BJOG: an International Journal of Obstetrics and Gynaecology 2018;125(10):1312. - PubMed
    1. Vigil-De Gracia P, Ludmir J, Ng J, Reyes-Tejada O, Nova C, Beltre A, et al. Is there benefit to continue magnesium sulfate post-partum in women receiving magnesium sulfate prior to delivery? A randomized controlled study. BJOG: an International Journal of Obstetrics and Gynaecology 2018;125(10):1304-11. [CLINICALTRIALS.GOV: NCT02307201] - PubMed

References to studies excluded from this review

Anjum 2016a {published data only}
    1. Anjum S, Rajaram GP, Bano I. Short-course postpartum (6-h) magnesium sulfate therapy in severe preeclampsia. Archives of Gynecology and Obstetrics 2016;293(5):983-6. - PubMed
Anjum 2016b {published data only}
    1. Anjum S, Goel N, Sharma R, Mohsin Z, Garg N. Maternal outcomes after 12 hours and 24 hours of magnesium sulfate therapy for eclampsia. International Journal of Gynecology & Obstetrics 2016;132(1):68-71. - PubMed
    1. CTRI/2016/03/006762. Post partum seizure prophylaxis with short course magnesium sulfate therapy in severe preeclampsia. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=14387 (first received 23 March 2016).
Chowdhury 2009 {published data only}
    1. Chowdhury JR, Chaudhuri S, Bhattacharyya N, Biswas PK, Panpalia M. Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia. Journal of Obstetrics and Gynaecology Research 2009;35(1):119-25. - PubMed
Dewan 2011 {published data only}
    1. Dewan M, Munshi S. Different anticonvulsant regimen of magnesium sulphate and feto-maternal outcome in treatment of eclampsia. In: 54th All India Congress of Obstetrics and Gynaecology; 2011 Jan 5-9; Hyderabad, Andhra Pradesh, India. 2011:55.
Ghahiri 2005 {published data only}
    1. Ghahiri A, Berjis K. A comparison between intravenous magnesium sulfate and oral magnesium chloride in mild preeclampsia. Journal of Research in Medical Sciences 2005;10(1):6-9.
Gloeb 1989 {published data only}
    1. Gloeb DJ, O'Sullivan MJ. Comparison of effects of intramuscular and intravenous magnesium sulfate regimens in pre-eclamptic patients on intrapartum events and maternal/neonatal outcome. In: 9th Annual Meeting of the Society of Perinatal Obstetricians; 1989 Feb 1-4; New Orleans, Louisiana, USA. 1989:494.
Malapaka 2011 {published data only}
    1. Malapaka SV, Ballal PK. Low-dose magnesium sulfate versus Pritchard regimen for the treatment of eclampsia imminent eclampsia. International Journal of Gynecology & Obstetrics 2011;115(1):70-2. - PubMed
Sinha 2010 {published data only}
    1. Sinha S, Suneja A, Vaid NB, Ahuja S. Is a 24 hour postpartum magnesium sulfate regime justified for all patients with severe preeclampsia? Personal communication 2010.
Stallworth 1981 {published data only}
    1. Stallworth JC, Yeh SY, Petrie RH. The effect of magnesium sulfate on fetal heart rate variability and uterine activity. American Journal of Obstetrics and Gynecology 1981;140:702-6. - PubMed
Swathi 2015 {published data only}
    1. Swathi A, Bellad M, Ganachari MS. Addition of lignocaine in intramuscular injection of magnesium sulphate: Does it reduce pain in women with severe preeclampsis and conscious eclamptic women? A randomized controlled trial. International Journal of Gynecology & Obstetrics 2015;131(Suppl 5):E455-E456.

References to studies awaiting assessment

Agarwal 2019 {published data only}
    1. Agarwal A, Sharma M, Das V, Pandey A, Agrawal S, Kumar N. Modification of Pritchard regimen of magnesium sulphate for the conditions of a developing country. BJOG: an International Journal of Obstetrics and Gynaecology 2019;126:150-1. [CENTRAL: CN-01960577] [EMBASE: 628473806]
Agrawal 2015 {published data only}
    1. Agrawal S, Das V, Verma V, Agarwal A, Pandey A, Jain V. Evaluation of medium dose versus standard Pritchard regime of magnesium sulfate in the management of eclampsia in developing nation. International Journal of Gynecology and Obstetrics 2015;131(Suppl 5):E183.
Begum 2002 {published data only}
    1. Begum A. Loading dose vs standard regime of magnesium sulphate in the management of eclampsia – a randomized trial [abstract]. In: XVI FIGO World Congress of Obstetrics & Gynecology (Book 2); 2000 Sep 3-8; Washington, DC, USA. 2000:47.
    1. Begum MR, Begum A, Quadir E. Loading dose versus standard regime of magnesium sulfate in the management of eclampsia: a randomized trial. Journal of Obstetrics and Gynaecology Research 2002;28:154-9. - PubMed
Begum 2010 {published data only}
    1. Begum K. A lower dose of magnesium sulphate for control of convulsion in eclamptic women of Bangladesh. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S124.
    1. Sultana N, Begum K, Begum A, Akhter U. A lower dose of magnesium sulphate for control of convulsion in eclamptic women of Bangladesh. Bangladesh Journal of Obstetrics and Gynecology 2010;25(2):71-6.
Beyuo 2019 {published data only}
    1. Beyuo T, Lawrence E, Langen ES, Oppong SA. Open-labelled randomised controlled trial of 12 hours versus 24 hours modified Pritchard regimen in the management of eclampsia and pre-eclampsia in Ghana (MOPEP Study): study protocol. BMJ Open 2019;9(10):e032799. [CENTRAL: CN-02005573] [EMBASE: 629724314] [PMID: ] - PMC - PubMed
    1. Beyuo TK, Lawrence ER, Kobernik EK, Oppong SA. A novel 12-hour versus 24-hour magnesium sulfate regimen in the management of eclampsia and preeclampsia in Ghana (MOPEP Study): a randomized controlled trial. International Journal of Gynaecology and Obstetrics 2022;159(2):495-504. [CENTRAL: CN-02385595] [PMID: ] - PubMed
Chama 2013 {published data only}
    1. Chama CM, Geidam AD, Bako B, Mairiga AG, Atterwahmie A. A shortened versus standard matched postpartum magnesium sulphate regimen in the treatment of eclampsia: a randomised controlled trial. African Journal of Reproductive Health 2013;17(3):131-6. - PubMed
Charoenvidhya 2013 {published data only}
    1. Charoenvidhya D, Manotaya S. Magnesium sulfate maintenance infusion in women with preeclampsia: a randomized comparison between 2 gram per hour and 1 gram per hour. Journal of the Medical Association of Thailand 2013;96(4):395-8. - PubMed
    1. TCTR20120000009. Magnesium sulfate maintenance infusion in woman with preeclampsia, compares between 2gm/hr and 1 gm/hr. www.who.int/trialsearch/Trial2.aspx?TrialID=TCTR20120000009 (first received 2012). [CENTRAL: CN-01845259]
CTRI/2012/04/002553 {published data only}
    1. CTRI/2012/04/002553. Randomized controlled trial comparing two different regimes of magnesium sulphate in severe pre-eclampsia: a pilot study. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=4131 (first received 9 April 2012).
CTRI/2020/05/025165 {published data only}
    1. CTRI/2020/05/025165. Is the Z track technique of intramuscular injection reduces the pain, drug leakage, post injection gluteal inflammation? [A randomized control trial to assess the effectiveness of Z track technique of intramuscular administration of magnesium sulphate on level of pain at the injection site, drug leakage, post injection gluteal inflammation, occurrence of seizure among patients with pre-eclampsia in Obstetrics and Gynaecology Department of Nehru Hospital, PGIMER, Chandigarh 2019-21]. www.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2020/05/025165 (first received 2020). [CENTRAL: CN-02167997]
Darngawn 2012 {published data only}
    1. Darngawn L, Jose R, Regi A, Bansal R, Jeyaseelan L. A shortened postpartum magnesium sulfate prophylaxis regime in pre-eclamptic women at low risk of eclampsia. International Journal of Gynecology & Obstetrics 2012;116(3):237-9. - PubMed
Dasgupta 2021 {published data only}
    1. Dasgupta S, Das A, Mallick A, Ghosh C. Abbreviated (8 hours) versus traditional (24 hours) postpartum mgso4 prophylaxis in severe preeclampsia: a randomised control trial. Journal of Clinical and Diagnostic Research 2021;15(9):1-4. [CENTRAL: CN-02320544] [EMBASE: 2014411645]
El‐Khayat 2016 {published data only}
    1. El-Khayat W, Atef A, Abdelatty S, El-Semary A. A novel protocol for post partum magnesium sulphate in severe pre-eclampsia: a randomized controlled pilot trial. Journal of Maternal-Fetal & Neonatal Medicine 2016;29(1):154-8. - PubMed
    1. NCT01846156. New magnesium sulphate protocol for pre-eclampsia. clinicaltrials.gov/show/NCT01846156 (first received 1 May 2013).
Franch 2011 {published data only}
    1. EUCTR2011-002095-17-ES. Magnesium sulphate in continuous administration compare to discontinuous administration in the expectant management of severe preeclampsia: randomized controlled trial. clinicaltrialsregister.eu/ctr-search/trial/2011-002095-17/ES/ (first received 19 July 2011).
Grillo 2021 {published data only}
    1. Grillo EO, Awonuga DO, OF Dedeke I, Abiodun O. Y-011. Comparison of zuspan regime and its 12-hour modification in women with severe pre-eclampsia and eclampsia in two hospitals in Abeokuta, South Western Nigeria. Pregnancy Hypertension 2021;25:e21. [CENTRAL: CN-02322485] [EMBASE: 2014576289] - PubMed
Gupta 2019 {published data only}
    1. Gupta N, Agarwal M, Singh S, Ara A. Low-dose intravenous magnesium sulfate: efficacy and safety in eclamptic Indian women. Journal of SAFOG 2019;11(2):85-9. [CENTRAL: CN-01996873] [EMBASE: 2002766647]
Kashanian 2016 {published data only}
    1. IRCT201207182624N10. A comparison between 2 methods of magnesium sulfate administration for 12 or 24 hours after delivery in patients with severe preeclampsia. http://en.search.irct.ir/view/10284 (first received 23 April 2013).
    1. Kashanian M, Koohpayehzadeh J, Sheikhansari N, Bararpour F, Sahraian G, Asadolla S. A comparison between the two methods of magnesium sulfate administration for duration of 12 versus 24 h after delivery in patients with severe preeclampsia. Journal of Maternal-Fetal & Neonatal Medicine 2016;29(4):2282-7. - PubMed
Khalifa 2019 {published data only}
    1. Khalifa A, Farahat M, Alsaudi K. Management of women with severe preeclampsia by different regimens of magnesium sulfate. Egyptian Journal of Hospital Medicine 2019;74(8):1849-56.
Khan 2021 {published data only}
    1. Khan S, Humayun P, Awan SN, Naqvi SB, Mohsin R, Jawad Z. Comparison of 12 hours versus 24 hours intravenous administration of MgSO4 in the management of eclampsia. Pakistan Journal of Medical and Health Sciences 2021;15(2):365-7. [CENTRAL: CN-02275292] [EMBASE: 2011768439]
Kitiyodom 2016 {published data only}
    1. Kitiyodom S. Comparison of the level of magnesium during maintenance between 2 gram and 1 gram per hour infusion in overweight mothers with preeclampsia. Journal of the Medical Association of Thailand 2016;99(Suppl 7):S133-7. - PubMed
    1. TCTR20141219001. Magnesium sulfate maintenance infusion effect between 2 gram per hour and 1 gram per hour in maternal excessive weight with preeclampisa: a double-blinded randomized controlled trial. http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsea... (first received 19 December 2014).
Laiteerapong 1999 {published data only}
    1. Laiteerapong U, Leelahakorn S. Comparative study of serum magnesium levels attained from magnesium sulfate therapy for severe pre-eclamptic patients between 1 gm/hr and 2 gm/hr regimen. Thai Journal of Obstetrics and Gynaecology 1999;11(4):281.
Manorot 1996 {published data only}
    1. Manorot M, Tongsong T, Khettglang T. A comparison of serum magnesium sulfate levels in pregnant women with severe preeclampsia between intravenous and intramuscular magnesium sulfate regimens: a randomized controlled trial. Journal of the Medical Association of Thailand 1996;79(2):76-82. - PubMed
Mundle 2009 {published data only}
    1. Easterling T, Salinger D, Mundle S, Regi A, Bracken H, Winkioff B, et al. Magnesium sulfate for prevention of eclampsia: are intramuscular and intravenous regimens equivalent? Pregnancy Hypertension 2012;2(3):194. - PubMed
    1. Mundle S, Regi A, Biswas B, Bracken H, Easterling T, Winikoff B. Preeclampsia in low-resource settings: a randomized trial of IV MgSO4 via flow controlled pump. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S278.
    1. Mundle S, Regi A, Easterling T, Biswas B, Bracken H, Khedekar V, et al. Treatment approaches for preeclampsia in low-resource settings: A randomized trial of the Springfusor pump for delivery of magnesium sulfate. Pregnancy Hypertension 2012;2(1):32-8. - PubMed
    1. NCT00666133. Treatment approaches for preeclampsia in low-resource settings. https://clinicaltrials.gov/ct2/show/record/NCT00666133 (first received 24 April 2008).
    1. Salinger DH, Mundle S, Regi A, Bracken H, Winikoff B, Vicini P, et al. Magnesium sulphate for prevention of eclampsia: are intramuscular and intravenous regimens equivalent? A population pharmacokinetic study. BJOG: an International Journal of Obstetrics and Gynaecology 2013;120:894-900. - PubMed
Nautiyal 2016 {published data only}
    1. Nautiyal R, Srivastava A, Chauhan N, Nautiyal HK. Feasibility of low dose magnesium sulphate for eclampsia – a randomized study. Indian Journal of Obstetrics and Gynecology Research 2016;3(2):121-5.
NCT02091401 {published data only}
    1. NCT02091401. A trial comparing treatment with the Springfusor Infusion Pump to the IV magnesium sulfate regimen. clinicaltrials.gov/show/NCT02091401 (first received 17 March 2014).
NCT02835339 {published data only}
    1. NCT02835339. Randomized trial of magnesium sulfate in obese preeclamptic women. https://clinicaltrials.gov/ct2/show/record/NCT02835339 (first received 18 July 2016).
NCT03164304 {published data only}
    1. NCT03164304. Efficacy and safety of one gram versus two grams intravenous maintenance dose of magnesium sulfate in women with severe pre-eclampsia: a randomized clinical trial. clinicaltrials.gov/show/NCT03164304 (first received 23 May 2017).
NCT04474704 {published data only}
    1. NCT04474704. Use of Cheetah® Cardiac Monitoring System to guide discontinuation of magnesium sulfate in women with severe preeclampsia [Use of Cheetah® Non-invasive Cardiac Monitoring System to guide discontinuation of postpartum magnesium sulfate in women with severe preeclampsia: a pilot randomized control trial]. clinicaltrials.gov/show/NCT04474704 (first received 17 July 2020). [CENTRAL: CN-02137229]
NCT04501289 {published data only}
    1. NCT04501289. Low dose magnesium sulphate versus standard Pritchard regimen in management of severe preeclampsia/eclampsia [Low dose magnesium sulphate versus standard Pritchard regimen in management of severe preeclampsia/eclampsia: a randomised controlled trial]. clinicaltrials.gov/show/NCT04501289 (first received 6 August 2020). [CENTRAL: CN-02145857]
Ononge 2021 {published data only}
    1. Ononge S, Nakimuli A, Byamugisha J, Sterling T, Bracken H. Magnesium sulphate for preeclampsia and eclampsia with Springfusor® pump versus intramuscular approach. BJOG: an International Journal of Obstetrics and Gynaecology 2021;128(Suppl 2):175-6. [CENTRAL: CN-02285024] [EMBASE: 635302025]
Orji 2012 {published data only}
    1. Orji EO, Ogoke G, Fasubaa OB. Efficacy of a single loading dose of magnesium sulphate versus the standard Pritchard regimen in the management of severe preeclampsia in an African population. International Journal of Gynecology & Obstetrics 2012;119(Suppl 3):S447.
PACTR202201609390328 {published data only}
    1. PACTR202201609390328. Magnesium sulphate loading dose only versus standard Pritchard regimen in the management of eclampsia – a multi-centre randomized clinical trial. trialsearch.who.int/Trial2.aspx?TrialID=PACTR202201609390328 (first received 2021). [CENTRAL: CN-02379123]
Rahat 2022 {published data only}
    1. Rahat F, Iqbal S, Yahya S, Naz A, Khanam A, Khawaja NP, et al. Comparison of magnesium sulphate loading dose with & without maintenance regimen for management of patients presenting with eclampsia – randomized control trial. Pakistan Journal of Medical and Health Sciences 2022;16(3):138-140. [EMBASE: 2017656012]
Ranganna 2014 {published data only}
    1. Ranganna H, Saha SC, Thami MR, Kumar P. Prophylactic magnesium sulphate in severe preeclampsia – loading dose only vs. conventional 24 hour therapy of modified Pritchard regime – a randomised trial. IOSR Journal of Pharmacy 2014;4(6):39-47.
Saha 2017 {published data only}
    1. CTRI/2009/091/000339. Safety and efficacy of low dose MgSo4 regimen for treatment of eclampsia. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=572 (first received 5 August 2009).
    1. CTRI/2016/07/007076. Safety and efficacy of abbreviated (12 hr) magnesium sulphate (mgso4) therapy) vs. traditional 24 hrs therapy after delivery in severe preeclampsia: a randomised clinical trial. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=8468 (first received 12 July 2016).
    1. Saha PK, Kaur J, Goel P, Kataria S, Tandon R, Saha L. Safety and efficacy of low dose intramuscular magnesium sulphate (mgso4) compared to intravenous regimen for treatment of eclampsia. Journal of Obstetrics and Gynaecology Research 2017;43(10):1543-9. - PubMed
Sahu 2014 {published data only}
    1. Sahu L, Singh S, Tempe A, Koner BC. A randomized comparative study between low-dose magnesium sulphate and standard dose regimen for management of eclampsia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2014;3(1):79-86.
Sahu 2015 {published data only}
    1. Sahu L, Yadav P, Tempe A. Randomized comparative study between short duration (4 hour) vs. 24 hour post-partum magnesium sulphate therapy in severe preeclampsia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2015;4(3):770-5.
Sharma 2018 {published data only}
    1. CTRI/2018/06/014649. Comparison of modified low dose MgSO4 regime with standard pritchard regime in severe preeclampsia and eclampsia: a randomized control trial. http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=15615&amp... (first received 28 June 2018).
Shilva 2007 {published data only}
    1. Shilva, Saha SC, Kalra J, Prasad R. Safety and efficacy of low-dose MgS04 in the treatment of eclampsia. International Journal of Gynecology & Obstetrics 2007;97(2):150-1. - PubMed
Singh 2011 {published data only}
    1. CTRI/2008/091/000119. Low dose magnesium sulphate regimen for management of eclampsia – a randomized controlled trial (An ICMR Task Force Study). ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=153 (first received 8 September 2008).
    1. Singh S, Behera AK. Eclampsia in eastern India: Incidence, demographic profile and response to three different anticonvulsant regimes of magnesium sulphate. Internet Journal of Gynecology and Obstetrics 2011;15(2).
Suneja 2008 {published data only}
    1. Suneja A, Sinha S, Vaid N, Ahuja S. A prospective randomized controlled trial to individualize the duration of post partum magnesium sulfate therapy. Hypertension in Pregnancy 2008;27(4):504.
Tongsong 1992 {published data only}
    1. Tongsong T, Dejkijwikrom W, Tansuwannont W, Jantachai U, Siangpura U. A comparison of intravenous magnesium sulfate regimens in preeclampsia-eclampsia between rate 1 gram and 2 grams per hour. Siriraj Hospital Gazette 1992;44(7):509-16.
Unwaha 2019 {published data only}
    1. Unwaha EA, Bello FA, Bello OO, Oladokun A. Intravenous magnesium sulfate in the management of severe pre-eclampsia: a randomized study of 12-hour versus 24-hour maintenance dose. International Journal of Gynaecology and Obstetrics 2019;149(1):37-42. [CENTRAL: CN-02051018] [EMBASE: 2004056648] [PMID: ] - PubMed
Wang 2005 {published data only}
    1. Fontenot MT, Lewis DF, Frederick JB, Wang Y, DeFranco EA, Groome LJ, et al. A prospective randomized trial of magnesium sulfate in severe preeclampsia: use of diuresis as a clinical parameter to determine the duration of postpartum therapy. American Journal of Obstetrics and Gynecology 2005;192:1788-94. - PubMed
    1. Wang Y, Zhang Y, Canzoneri BJ, Gu Y, Philibert L, Lewis DF. Prostacyclin and thromboxane levels in women with severe preeclampsia undergoing magnesium sulfate therapy during antepartum and postpartum periods. Hypertension in Pregnancy 2008;27(1):17-27. - PMC - PubMed

References to ongoing studies

CTRI/2008/091/000118 {published data only}
    1. CTRI/2008/091/000118. Treatment approaches for pre eclampsia in low resource settings. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=152 (first received 29 July 2008).
CTRI/2012/04/002594 {published data only}
    1. CTRI/2012/04/002594. Comparision of two regimens of low dose magnesium sulphate for treatment of eclampsia: loading plus 24-hour maintenance dose versus loading dose only. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=4010 (first received 24 April 2012).
CTRI/2021/08/035456 {published data only}
    1. CTRI/2021/08/035456. Low dose magnesium sulphate for treatment of seizures in pregnancy [A66014: Simplified Treatment for Eclampsia Prevention using Magnesium sulfate: A phase III, randomized, open label, active controlled, multicountry, multicentre, non-inferiority trial of simplified magnesium sulfate regimen for eclampsia prophylaxis (The STEP-Mag Trial) – The STEP-Mag Trial]. www.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2021/08/035456 (first received 2021). [CENTRAL: CN-02328408]
    1. PACTR202112816270738. The STEP-Mag Trial [Simplified Treatment for Eclampsia Prevention using Magnesium sulfate: A phase III, randomized, open label, active-controlled, multicountry, multicentre, non-inferiority trial of simplified magnesium sulfate regimen for eclampsia prophylaxis]. trialsearch.who.int/Trial2.aspx?TrialID=PACTR202112816270738 2021. [CENTRAL: CN-02379110]
CTRI/2022/01/039776 {published data only}
    1. CTRI/2022/01/039776. Randomized controlled trial comparing the effectiveness and safety of 12 hours duration with the 24 hours duration of magnesium sulphate in maintenance therapy in patients of severe preeclampsia [Randomized controlled trial comparing Zuspan regime with the alternative regime In the maintenance therapy of magnesium sulphate in severe pre-eclampsia]. trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2022/01/039776 (first received 2022). [CENTRAL: CN-02377532]
IRCT20200503047287N1 {published data only}
    1. IRCT20200503047287N1. Comparison treatment of magnesium sulfate for 12-hours and 24-hours in preeclampsia [Comparison of therapeutic regime of magnesium sulfate for 12-hours and 24-hours in postpartum severe preeclampsia]. www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20200503047287N1 (first received 2020). [CENTRAL: CN-02187800]
ISRCTN13244564 {published data only}ISRCTN13244564
    1. ISRCTN13244564. Pharmacokinetics profile of magnesium after intravenous and intramuscular magnesium sulfate administration in Indonesian pregnant women with pre-eclampsia. isrctn.com/ISRCTN13244564 (first received 31 August 2015).
NCT03112551 {published data only}
    1. NCT03112551. Safety and efficacy of twelve hours duration of magnesium sulphate in the treatment of eclampsia in low resource setting in Sudan. clinicaltrials.gov/ct2/show/record/NCT03112551 (first received 13 April 2017).
NCT03318211 {published data only}
    1. NCT03318211. Continuation versus discontinuation of magnesium sulfate after delivery in women with severe preeclampsia. a randomized controlled trial. https://clinicaltrials.gov/ct2/show/record/NCT03318211 (first received 23 October 2017).
NCT03549767 {published data only}
    1. NCT03549767. Randomized trial to compare magnesium sulphate administration for preeclampsia and eclampsia: springfusor versus standard of approach. https://clinicaltrials.gov/ct2/show/NCT03549767 (first received 8 June 2018).
NCT03661775 {published data only}
    1. NCT03661775. Serum magnesium level between administered rate of 2 g/hr versus 2.5 g/hr in severe pre-eclampsia obese pregnancy, multicentered randomized study. https://clinicaltrials.gov/ct2/show/NCT03661775 (first received 7 September 2018).
PACTR201712002887266 {published data only}
    1. PACTR201712002887266. Randomized trial to compare magnesium sulphate administration for preeclampsia and eclampsia: springfusor versus standard approach. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=2887 (first received 18 December 2017).
PACTR201811515303983 {published data only}
    1. PACTR201811515303983. A comparative study of modified versus standard pritchard regimen in the management of eclampsia and preeclampsia. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4690 (first received 7 November 2018).
TCTR20150511001 {published data only}
    1. TCTR20150511001. A comparative controlled trial of serum magnesium level in severe preeclamptic women between two standard magnesium sulphate regimens. www.who.int/trialsearch/Trial2.aspx?TrialID=TCTR20150511001 (first received 2015). [CENTRAL: CN-01858440]
UMIN000039038 {published data only}
    1. UMIN000039038. Magnesium sulfate versus combination of magnesium and phentolamine for control of blood pressure in pregnancy induced hypertension [Magnesium sulfate versus combination of magnesium and phentolamine for control of blood pressure in pregnancy induced hypertension – Magnesium sulfate versus combination of magnesium and phentolamine in pregnancy induced hypertension]. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000039038 (first received 2020). [CENTRAL: CN-02188647]

Additional references

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Belfort 1992
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Carlisle 2017
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Chesley 1978
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Collab Trial 1995
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Crowther 1985
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Dinsdale 1988
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Donaldson 1992
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Dorsett 1926
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Douglas 1994
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Duley 1992
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Duley 1996
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Duley 2010b
    1. Duley L, Gulmezoglu AM, Chou D. Magnesium sulphate versus lytic cocktail for eclampsia. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No: CD002960. [DOI: 10.1002/14651858.CD002960.pub2] - DOI - PMC - PubMed
Duley 2010c
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References to other published versions of this review

Duley 2010a
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