USE OF BENZODIAZEPINES IN THE MANAGEMENT OF ECLAMPSIA

A GREAT variety of sedatives have been used in the management of eclampsia. At the Kandang Kerbau Hospital, the lytic “cocktail” and thiopentone sodium have been chiefly used (Hudson and Seah, 1956; Sheares, 1957); magnesium sulphate and promazine (Sparine) have also been used with favourable but inconsistent results. In 1965 good results for both mother and infant were obtained with Librium (also known as chlordiazepoxide . . . chemical formula 7-chloro-2-methylamino-5-phenyl-3H-l, 4-benzodiazepine 4-oxide) in the management of severe cases of pre-eclampsia and eclampsia (Ratnam et al., 1966). Very large doses were used with safety (Lean et al., 1968). The same impressions were recorded with the newer benzodiazepine derivative, Valium (also known as diazepam . . . chemical formula 7-chloro-1, 3-dihydro-lmethyl-5-phenyl-2H-1, 4-benzodiazepine-2-one) The benzodiazepines are the more recent psychotropic drugs which act mainly by depressing the reticular activating system and the basal ganglia of the brain. They do these without depressing the vital medullary centres. Besides its effects in counteracting anxiety (Smith, 1960; Iborra, 1963), Librium is an autonomic stabilizer and has sedative and hypnotic effects (Jenny, 1963). It causes muscular relaxation, including that of the uterus. Its anti-convulsive properties (Del Valle, 1961 ; Kaim and Rosenstein, 1960) enhance its value in the control of eclampsia. Some favourable reports on the use of the benzodiazepines on a smaller number of cases of eclampsia and pre-eclampsia have been published (Berger and Cavanagh, 1963; Leinzinger, 1964; Baumgarten, 1963 ; Kalkschmid, 1964; Gilbert, 1961). Gilbert was the first to report the successful use of Librium in a case of eclampsia. A favourable report on the use of Librium on 8 cases of eclampsia and 92 cases of severe pre-eclampsia has already been published (Ratnam et al., 1966).