Low-dose Magnesium Sulphate in the Control of Eclamptic Fits: a Randomized Controlled Trial

Context: Magnesium sulphate is now the gold standard for the control of eclamptic fits. The place of low-dose magnesium sulphate for the control of eclamptic seizures is yet to be determined.

Objectives: To determine the effectiveness of low-dose magnesium sulphate in controlling eclamptic fits.

Study Design: Randomized controlled trial comparing low-dose with standardized dosing regimen.

Setting: Labour Unit of the department of Obstetrics and Gynecology Federal Medical Centre Azare, north-eastern Nigeria.

Protocol: Thirty-nine patients randomized into the low-dose regimen group received 9 g loading dose (4 g iv and 5 g im) and im maintenance of 2.5 g four hourly for 24 h post-delivery or post last fit, while the 33 patients in the standard dose regimen group received loading dose of 14 g followed by im maintenance dose of 5 g four hourly. In both study groups, 2 g iv of magnesium sulphate is given for breakthrough fits and 10 ml of 10 % calcium gluconate (slowly iv) was administered in the event of toxicity. Outcome measures include recurrent fits, mode of delivery, mean Apgar Score at 5 min, perinatal death, maternal complications including death.

Result: The mean age of the 72 patients was 22.3 ± 5.4 years and 60 % were primigravidas. Intrapartum eclampsia was encountered in 44 % of the patients followed by antepartum eclampsia (26 %). Overall 4.2 % recurrent convulsion rate was documented and it is not different among the study groups. There were also no differences in both foetal and maternal outcomes in the two study groups.

Conclusion: The effectiveness of low-dose regimen of magnesium sulphate appeared comparable to the 'standard dose regimen'. Low-dose regimen may guarantee more safety and in an environment (such as ours) where cost is an important determinant of accessibility to qualitative health services, it is certainly attractive. More studies are needed to establish the place of low-dose regimen of magnesium sulphate in the management of eclampsia.