Preventing and treating eclamptic seizures

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7365.609 (Published 21 September 2002) Cite this as: BMJ 2002;325:609

Magnesium sulphate is effective and recommended for use

  1. James M Roberts (rsijmr@mail.magee.edu), past president,
  2. Jose Villar (villarj@who.int), coordinator,
  3. Sabaratnam Arulkumaran (sarulkum@sghms.ac.uk), treasurer
  1. International Society for the Study of Hypertension in Pregnancy, Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, USA
  2. Maternal Health Research Department of Reproductive Health and Research, World Health Organization, Geneva 27, Switzerland
  3. Fédération Internationale de Gynécologie et d'Obstétrique, Department of Obstetrics & Gynaecology, St George's Medical School, London SW17 0RE

    Ninety nine percent of all maternal deaths occur in developing countries. Pre-eclampsia or eclampsia is responsible for many of these, accounting for 50 000 deaths annually. Large randomised trials in developing countries and systematic reviews have shown the usefulness of magnesium sulphate in treating recurrent eclamptic seizures and in the prophylaxis of eclampsia.13 Despite this evidence magnesium sulphate remains underused.

    In 1995 the Eclampsia Trial Collaborative Group did an impressive study in developing countries and showed unequivocally that magnesium sulphate given intramuscularly or intravenously is superior to phenytoin or diazepam in reducing recurrent eclamptic seizures.1 Seizures were a half or a third less likely to recur after treatment with magnesium. Maternal mortality was also lower in women allocated magnesium rather than phenytoin or diazepam, although this did not achieve statistical significance. Recent Cochrane reviews, however, indicated a significant reduction in maternal mortality with magnesium.2 Magnesium was also associated with less maternal and neonatal morbidity than phenytoin.

    Recently the findings of this study were extended to indicate the …

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