Preeclampsia and eclampsia have remained a major global public health threat in contributing significantly to maternal and perinatal morbidity and mortality with incidence of 2.16% and 0.28% respectively. The treatment modalities of eclampsia and severe pre-eclampsia include initial stabilization, rational use of antihypertensives, anticonvulsants and planning for delivery. Magnesium Sulphate, as anticonvulsant is drug of choice for convulsion prophylaxis but its benefit should always outweigh its adverse effects. Traditionally the use of magnesium sulphate has been recommended for 24 hour postpartum. By reducing the duration of therapy, the frequency of postpartum maternal monitoring may be curtailed and the possibility for the women to ambulate early and care for her newborn may be increased. The purpose of present study is to compare the effectiveness, side effects and maternal outcome of magnesium sulphate administration as single dose and 12 hours postpartum with the conventional 24 hours in the cases of severe preeclampsia.
Aims and Objectives: To compare abbreviated regimens of single dose and 12 hours magnesium sulphate administration with the conventional 24 hours postpartum in severe preeclampsia.
Material and Methods: A randomized prospective clinical trial was conducted on pregnant women presenting with severe preeclampsia. The patients were randomly allocated into group I (single dose), group II (12hour) and group III (24hour) postpartum MgSO4. The dosage and the route of administration of magnesium sulphate was similar in all three groups before delivery as per Prichard regimen. After delivery, a single maintenance dose of magnesium sulphate was given in group I, 12 hours group II and for 24 hours postpartum in group III. During the study period, the patients were assessed for various outcome parameters such as seizures, clinical outcomes such as time to return to ambulation in hours, duration of indwelling urinary catheter in hours, time until contact with the newborn infant in hour, urine output, adverse effects and evidence of toxicity in mother.
Results: All patients in three groups were comparable with regards to demographic as well as obstetric characteristics. None of the patient in group I had any of the signs of MgSO4 toxicity, however in group II, one patient had loss of patellar reflex and in group III, two patients had loss of patellar reflexes and another two had oliguria. None of the patient had respiratory depression or convulsion in any of the three groups. The patients in group I and group II, ambulated much earlier as and had less duration of catheter as compared to group III. However there was no significant difference in the average time until contact with the newborn between the three groups.
Conclusion: Magnesium sulphate for 24hrs is the drug of choice for seizure prophylaxis in patients with severe preeclampsia and eclampsia but benefits of magnesium sulphate should outweigh its adverse effects. But there was increase in the feeling of wellbeing in shorter regimens with early ambulation, lesser duration of indwelling catheter and early breastfeeding leading to better capability of the mother to take care of newborn. The present study suggests that the abbreviated postpartum MgSO4 regimens can be effective alternatives to the conventional 24 hours regimen for postpartum seizure prophylaxis in severe preeclampsia.