Prefer diazepam for initial control of pre-eclampsic fits

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7017.1433 (Published 25 November 1995) Cite this as: BMJ 1995;311:1433
  1. Robert Fox,
  2. Tim Draycott
  1. Consultant obstetrician Department of Obstetrics and Gynaecology, Taunton and Somerset Hospital, Taunton TA1 5DA
  2. Obstetric registrar Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol BS2 8EG

    EDITOR,--James P Neilson1 draws attention to data from a recent trial comparing three anticonvulsant regimens for women with eclampsia.2 He suggests that magnesium sulphate is the drug of choice, its main advantage being the lower rate of recurrent convulsions. He makes no distinction, however, between the control of an active convulsion and the prevention of further fits.

    It is important to achieve rapid control of an eclamptic fit because of the risks of hypoxia (to the woman and fetus), inhalation of gastric contents, and physical injury. We believe that diazepam given intravenously is the best available agent for this. It is highly effective at stopping convulsions3 and can be given simply and quickly: it takes little more than a minute to obtain a syringe, needle, and phial of diazepam from the emergency trolley and to check, prepare, and start giving the drug. The convulsion generally stops within one minute of the injection being started. In addition, most doctors already have experience of using diazepam in status epilepticus. Magnesium sulphate has been used by some units to stop eclamptic convulsions,4 but the time needed to prepare the drug is longer, and most junior obstetricians will have had no experience of rapid intravenous infusion of magnesium sulphate when first faced with a woman having an eclamptic fit.

    We suggest that eclamptic convulsions should be controlled initially with intravenous diazepam and that further fits should then be prevented with magnesium sulphate.


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