Magnesium sulphate versus diazepam for eclampsia
Abstract
Background
Eclampsia, the occurrence of a convulsion in association with pre‐eclampsia, remains a rare but serious complication of pregnancy. A number of different anticonvulsants are used to control eclamptic fits and to prevent further fits.
Objectives
The objective of this review was to assess the effects of magnesium sulphate compared with diazepam when used for the care of women with eclampsia. Magnesium sulphate is compared with phenytoin and with lytic cocktail in other Cochrane reviews.
Search methods
We searched the Cochrane Pregnancy and Childbirth trials register (January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002).
Selection criteria
Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with diazepam for women with a clinical diagnosis of eclampsia.
Data collection and analysis
Both reviewers assessed and extracted data.
Main results
Seven trials involving 1441 women are included. Most of the data are from trials of good quality. Magnesium sulphate is associated with a reduction in maternal death when compared to diazepam (six trials 1336 women; relative risk (RR) 0.59, 95% confidence interval (CI) 0.37 to 0.94). There is also a substantial reduction in the risk recurrence of further fits (seven trials 1441 women; RR 0.44, 95% CI 0.34 to 0.57). There were few differences in any other measures of outcome, except for fewer Apgar scores less than seven at five minutes (two trials 597 babies; RR 0.72, 95% CI 0.55 to 0.94) and fewer babies with a length of stay in special care baby unit more than seven days (three trials 631 babies; RR 0.66, 95% CI 0.46 to 0.95) associated with magnesium sulphate.
Authors' conclusions
Magnesium sulphate appears to be substantially more effective than diazepam for treatment of eclampsia.
PICOs
Plain language summary
Magnesium sulphate versus diazepam for eclampsia
Magnesium sulphate saves more mothers' lives than diazepam when given for eclamptic fits.
Some women develop raised blood pressure along with protein in the urine (pre‐eclampsia or 'toxaemia') in pregnancy, and this can cause considerable ill health for those women and their babies. A few of these women have fits or convulsions (eclampsia), either in pregnancy or shortly after birth. Some of these women die, particularly those in income‐poor countries. The review of trials found that magnesium sulphate was more effective than diazepam in reducing death and other problems for women. Other drugs have also been compared with magnesium sulphate in other reviews, magnesium sulphate was more effective than these too.
