Magnesium sulphate versus phenytoin for eclampsia

Lelia Duley; David J Henderson‐Smart; Doris Chou

doi:10.1002/14651858.CD000128.pub2

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Analysis 1.1

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 1 Maternal death.

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Analysis 1.2

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 2 Recurrence of convulsions.

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Analysis 1.3

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 3 Cerebrovascular accident.

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Analysis 1.4

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 4 Any serious morbidity.

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Analysis 1.5

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 5 Renal failure.

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Analysis 1.6

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 6 Liver failure.

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Analysis 1.7

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 7 Cardiac arrest.

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Analysis 1.8

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 8 HELLP.

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Analysis 1.9

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 9 Coagulopathy.

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Analysis 1.10

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 10 Respiratory depression.

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Analysis 1.11

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 11 Pulmonary oedema.

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Analysis 1.12

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 12 Pneumonia.

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Analysis 1.13

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 13 Admission to intensive care unit.

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Analysis 1.14

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 14 Ventilation.

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Analysis 1.15

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 15 Haemodialysis.

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Analysis 1.16

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 16 Caesarean section.

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Analysis 1.17

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 17 Labour > 8 hours.

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Analysis 1.18

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 18 Blood loss at delivery > 500 ml.

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Analysis 1.19

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 19 Mortality for the fetus or infant.

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Analysis 1.20

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 20 Apgar scores.

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Analysis 1.21

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 21 Utilisation of special care baby unit (SCBU).

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Analysis 1.22

Comparison 1 Magnesium sulphate versus phenytoin, Outcome 22 Death or in SCBU > 7 days.

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Analysis 2.1

Comparison 2 Magnesium sulphate vs phenytoin (subgroup by whether delivered or not at trial entry), Outcome 1 Recurrent convulsion.

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Analysis 3.1

Comparison 3 Magnesium sulphate vs phenytoin (subgroup by whether or not received anticonvulsant prior to trial entry), Outcome 1 Maternal death.

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Analysis 3.2

Comparison 3 Magnesium sulphate vs phenytoin (subgroup by whether or not received anticonvulsant prior to trial entry), Outcome 2 Recurrent convulsion.

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Analysis 4.1

Comparison 4 Magnesium sulphate vs phenytoin (subgroup by IV or IM magnesium maintenance), Outcome 1 Pulmonary oedema.

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Analysis 4.2

Comparison 4 Magnesium sulphate vs phenytoin (subgroup by IV or IM magnesium maintenance), Outcome 2 Ventilation.

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Comparison 1. Magnesium sulphate versus phenytoin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal death Show forest plot	3	847	Risk Ratio (M‐H, Fixed, 95% CI)	0.50 [0.24, 1.05]

2 Recurrence of convulsions Show forest plot	6	972	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.24, 0.49]

3 Cerebrovascular accident Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.20, 1.46]

4 Any serious morbidity Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.73, 1.20]

5 Renal failure Show forest plot	3	902	Risk Ratio (M‐H, Fixed, 95% CI)	1.52 [0.98, 2.36]

6 Liver failure Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	1.50 [0.54, 4.16]

7 Cardiac arrest Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.39, 3.43]

8 HELLP Show forest plot	1	77	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.06, 13.54]

9 Coagulopathy Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.66, 1.16]

10 Respiratory depression Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.46, 1.09]

11 Pulmonary oedema Show forest plot	3	902	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.45, 1.89]

12 Pneumonia Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.24, 0.79]

13 Admission to intensive care unit Show forest plot	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.50, 0.89]

14 Ventilation Show forest plot	2	825	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.50, 0.91]

15 Haemodialysis Show forest plot	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 15.12]

16 Caesarean section Show forest plot	2	650	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.86, 1.03]

17 Labour > 8 hours Show forest plot	1	628	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.85, 1.67]

18 Blood loss at delivery > 500 ml Show forest plot	1	628	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.74, 1.30]

19 Mortality for the fetus or infant Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

19.1 Stillbirth	2	665	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.61, 1.13]
19.2 Perinatal death	2	665	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.67, 1.09]
19.3 Neonatal death	2	665	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.59, 1.53]
20 Apgar scores Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

20.1 Apgar < 7 at 1 minute	1	518	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.66, 0.93]
20.2 Apgar < 7 at 5 minutes	1	518	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.52, 1.43]
21 Utilisation of special care baby unit (SCBU) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.1 Admission to SCBU	1	518	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.58, 0.91]
21.2 In SCBU > 7 days	1	518	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.33, 0.86]
22 Death or in SCBU > 7 days Show forest plot	1	643	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.63, 0.95]

Comparison 1. Magnesium sulphate versus phenytoin

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Comparison 2. Magnesium sulphate vs phenytoin (subgroup by whether delivered or not at trial entry)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Recurrent convulsion Show forest plot	6	972	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.24, 0.51]

1.1 Antepartum at entry	1	628	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.19, 0.53]
1.2 Postpartum at trial entry	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.15, 1.20]
1.3 Mixed	5	197	Risk Ratio (M‐H, Fixed, 95% CI)	0.40 [0.21, 0.75]

Comparison 2. Magnesium sulphate vs phenytoin (subgroup by whether delivered or not at trial entry)

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Comparison 3. Magnesium sulphate vs phenytoin (subgroup by whether or not received anticonvulsant prior to trial entry)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal death Show forest plot	3	847	Risk Ratio (M‐H, Fixed, 95% CI)	0.50 [0.24, 1.05]

1.1 Did receive anticonvulsant	1	22	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Mixed	2	825	Risk Ratio (M‐H, Fixed, 95% CI)	0.50 [0.24, 1.05]
2 Recurrent convulsion Show forest plot	6	963	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.23, 0.47]

2.1 Did receive anticonvulsant	2	624	Risk Ratio (M‐H, Fixed, 95% CI)	0.27 [0.15, 0.50]
2.2 Did not receive anticonvulsant	3	265	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.26, 0.70]
2.3 Mixed	2	74	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.06, 0.74]

Comparison 3. Magnesium sulphate vs phenytoin (subgroup by whether or not received anticonvulsant prior to trial entry)

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Comparison 4. Magnesium sulphate vs phenytoin (subgroup by IV or IM magnesium maintenance)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pulmonary oedema Show forest plot	3	897	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.45, 1.87]

1.1 IM maintenance	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 70.30]
1.2 IV maintenance	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	0.25 [0.01, 6.03]
1.3 Mixed	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.43, 1.99]
2 Ventilation Show forest plot	2	825	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.50, 0.91]

2.1 IM maintenance	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 70.30]
2.2 Mixed	1	775	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.49, 0.90]

Comparison 4. Magnesium sulphate vs phenytoin (subgroup by IV or IM magnesium maintenance)

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