Magnesium sulphate versus lytic cocktail for eclampsia.

BACKGROUND Eclampsia, the occurrence of a seizure in association with pre-eclampsia, is a rare but serious complication of pregnancy. A number of different anticonvulsants have been used to control eclamptic fits and to prevent further seizures. OBJECTIVES The objective of this review was to assess the effects of magnesium sulphate compared with lytic cocktail (usually chlorpromazine, promethazine and pethidine) when used for the care of women with eclampsia. Magnesium sulphate is compared with diazepam and with phenytoin in other Cochrane reviews. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010) and the Cochrane Central Register of Trials (The Cochrane Library 2010, Issue 2). SELECTION CRITERIA Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with lytic cocktail for women with a clinical diagnosis of eclampsia. DATA COLLECTION AND ANALYSIS Two review authors (L Duley and D Chou) assessed trial quality and extracted data. MAIN RESULTS We included three small trials (total 397 women) of average quality in the review. Magnesium sulphate was associated with fewer maternal deaths (risk ratio (RR) 0.14, 95% confidence interval (CI) 0.03 to 0.59; 3 trials, 397 women) and was better at preventing further seizures (RR 0.06, 95% CI 0.03 to 0.12; 3 trials, 397 women) than lytic cocktail. Magnesium sulphate was also associated with less respiratory depression (RR 0.12, 95% CI 0.02 to 0.91; 2 trials, 198 women), less coma (RR 0.04, 95% CI 0.00 to 0.74; 1 trial, 108 women), and less pneumonia (RR 0.20, 95% CI 0.06 to 0.67; 2 trials, 307 women). There was no clear difference in the RR for any death of the baby (RR 0.35, 95% CI 0.05 to 2.38, random effects; 2 trials, 177 babies). AUTHORS' CONCLUSIONS Magnesium sulphate, rather than lytic cocktail, for women with eclampsia reduces the RR of maternal death, of further seizures and of serious maternal morbidity (respiratory depression, coma, pneumonia). Magnesium sulphate is the anticonvulsant of choice for women with eclampsia; the use of lytic cocktail should be abandoned.

[1]  D. Henderson-smart,et al.  Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. , 2014, The Cochrane database of systematic reviews.

[2]  D. Henderson-smart,et al.  Drugs for treatment of very high blood pressure during pregnancy. , 2013, The Cochrane database of systematic reviews.

[3]  S. Brophy,et al.  Interventions for latent autoimmune diabetes (LADA) in adults. , 2011, The Cochrane database of systematic reviews.

[4]  D. Chou,et al.  Magnesium sulphate versus diazepam for eclampsia. , 2010, The Cochrane database of systematic reviews.

[5]  D. Chou,et al.  Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. , 2010, The Cochrane database of systematic reviews.

[6]  D. Henderson-smart,et al.  Magnesium sulphate versus phenytoin for eclampsia. , 2010, The Cochrane database of systematic reviews.

[7]  L. Duley,et al.  Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia. , 2010, The Cochrane database of systematic reviews.

[8]  M. Pittler.  Systematic Reviews in Health Care: Meta‐analysis in Context , 2010 .

[9]  Marilyn J. Cipolla,et al.  Magnesium Sulfate for the Treatment of Eclampsia: A Brief Review , 2009, Stroke.

[10]  Douglas G. Altman,et al.  Statistical Methods for Examining Heterogeneity and Combining Results from Several Studies in Meta‐Analysis , 2008 .

[11]  Douglas G. Altman,et al.  Systematic reviews in health care : meta-analysis in context , 2008 .

[12]  J. Villar,et al.  Reducing eclampsia-related deaths—a call to action , 2008, The Lancet.

[13]  R. Haslam,et al.  Antioxidants for preventing pre-eclampsia. , 2008, The Cochrane database of systematic reviews.

[14]  J. Grimshaw,et al.  Magnesium sulfate is not used for pre-eclampsia and eclampsia in Mexico and Thailand as much as it should be. , 2007, Bulletin of the World Health Organization.

[15]  M. Knight,et al.  Eclampsia in the United Kingdom 2005 , 2007 .

[16]  Á. Atallah,et al.  Dietary calcium supplementation for prevention of pre‐eclampsia and related problems: a systematic review and commentary , 2007, BJOG : an international journal of obstetrics and gynaecology.

[17]  L. Duley,et al.  Nitric oxide for preventing pre-eclampsia and its complications. , 2007, The Cochrane database of systematic reviews.

[18]  D. Henderson-smart,et al.  Antiplatelet agents for preventing pre-eclampsia and its complications. , 2007, The Cochrane database of systematic reviews.

[19]  J. Langhoff‐Roos,et al.  Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases , 2006, Acta obstetricia et gynecologica Scandinavica.

[20]  L. Duley,et al.  Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction. , 2006, The Cochrane database of systematic reviews.

[21]  L. Duley,et al.  Exercise or other physical activity for preventing pre-eclampsia and its complications. , 2006, The Cochrane database of systematic reviews.

[22]  A Metin Gülmezoglu,et al.  WHO analysis of causes of maternal death: a systematic review , 2006, The Lancet.

[23]  G. Igberase,et al.  Eclampsia: ten-years of experience in a rural tertiary hospital in the Niger delta, Nigeria , 2006, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[24]  D. Henderson-smart,et al.  Altered dietary salt for preventing pre-eclampsia, and its complications. , 2005, The Cochrane database of systematic reviews.

[25]  D. Henderson-smart,et al.  Interventions for preventing pre‐eclampsia and its consequences: generic protocol , 2005 .

[26]  D. Henderson-smart,et al.  Hypertensive disorders in pregnancy: a population‐based study , 2005, The Medical journal of Australia.

[27]  Mervi Jokinen,et al.  The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community , 2005, BMJ : British Medical Journal.

[28]  Kirsten Duckitt,et al.  Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies , 2005, BMJ : British Medical Journal.

[29]  B. Sibai.  Diagnosis, prevention, and management of eclampsia. , 2005, Obstetrics and gynecology.

[30]  A. Aisien,et al.  Maternal and fetal outcome in eclamptic patients in Benin City, Nigeria , 2004, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[31]  A. Weindling,et al.  The confidential enquiry into maternal and child health (CEMACH) , 2003, Archives of disease in childhood.

[32]  M. Belfort,et al.  Post Magpie: how should we be managing severe preeclampsia? , 2003, Current opinion in obstetrics & gynecology.

[33]  Jeani Chang,et al.  Pregnancy-Related Mortality Surveillance — United States , 1991 – 1999 , 2003 .

[34]  S. Arulkumaran,et al.  Preventing and treating eclamptic seizures , 2002, BMJ : British Medical Journal.

[35]  L. Duley,et al.  Interventionist versus expectant care for severe pre-eclampsia before term. , 2002, The Cochrane database of systematic reviews.

[36]  S. Sheth,et al.  Magnesium for preventing and treating eclampsia: time for international action , 2002, The Lancet.

[37]  U. Hanson,et al.  ECLAMPSIA IN SWEDEN , 2002, Hypertension in pregnancy.

[38]  James J. Walker,et al.  Pre-eclampsia , 2000, The Lancet.

[39]  J. Kuller,et al.  Preeclampsia into eclampsia: toward a new paradigm. , 2000, American journal of obstetrics and gynecology.

[40]  D. Henderson-smart,et al.  Plasma volume expansion for treatment of pre‐eclampsia , 1999 .

[41]  A. Gülmezoglu,et al.  Use of anticonvulsants in eclampsia and pre-eclampsia: survey of obstetricians in the United Kingdom and Republic of Ireland , 1998, BMJ.

[42]  A. Chatterjee,et al.  Comparative Study of Different Anticonvulsants in Eclampsia , 1997, The journal of obstetrics and gynaecology research.

[43]  S. Robson.  Magnesium sulphate: the time of reckoning , 1996, British journal of obstetrics and gynaecology.

[44]  D. Savitz,et al.  Hypertensive disorders of pregnancy and stillbirth in North Carolina, 1988 to 1991 , 1995, Acta obstetricia et gynecologica Scandinavica.

[45]  J. Neilson.  Magnesium sulphate: the drug of choice in eclampsia , 1995, BMJ.

[46]  R. Collins,et al.  WHICH ANTICONVULSANT FOR WOMEN WITH ECLAMPSIA - EVIDENCE FROM THE COLLABORATIVE ECLAMPSIA TRIAL , 1995 .

[47]  C. Redman,et al.  Eclampsia in the United Kingdom , 1994, BMJ.

[48]  G. Dhall,et al.  A Safer and More Effective Treatment Regimen for Eclampsia , 1994, The Australian & New Zealand journal of obstetrics & gynaecology.

[49]  Lippincott Williams Wilkins,et al.  National High Blood Pressure Education Program Working Group Report on Hypertension in Diabetes , 1994, Hypertension.

[50]  G. Saade,et al.  The effect of magnesium sulfate on maternal retinal blood flow in preeclampsia: a randomized placebo-controlled study. , 1992, American journal of obstetrics and gynecology.

[51]  G. Stirrat,et al.  Management of severe pre‐eclampsia and eclampsia by UK consultants , 1992, British journal of obstetrics and gynaecology.

[52]  L. Duley.  Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean , 1992, British journal of obstetrics and gynaecology.

[53]  M. Sadeh,et al.  Action of magnesium sulfate in the treatment of preeclampsia-eclampsia. , 1989, Stroke.

[54]  H. Dinsdale.  Does magnesium sulfate treat eclamptic seizures? Yes. , 1988, Archives of neurology.

[55]  S. Finkbeiner,et al.  Therapeutic use of magnesium sulfate in selected cases of cerebral ischemia and seizure. , 1988, The New England journal of medicine.

[56]  M. Swiet.  Medical Disorders in Obstetric Practice , 1984 .

[57]  F. Zuspan.  Problems encountered in the treatment of pregnancy-induced hypertension. A point of view. , 1978, American journal of obstetrics and gynecology.

[58]  M. Menon.  THE EVOLUTION OF THE TREATMENT OF ECLAMPSIA * , 1961, The Journal of obstetrics and gynaecology of the British Commonwealth.

[59]  J. Pritchard.  The use of the magnesium ion in the management of eclamptogenic toxemias. , 1955, Surgery, gynecology & obstetrics.

[60]  N. J. Eastman,et al.  The Management of Pre-Eclampsia. , 1945, Canadian Medical Association journal.

[61]  L. Goodman,et al.  THE PHARMACOLOGICAL BASIS OF THERAPEUTICS , 1966 .

[62]  E. Ota,et al.  Zinc supplementation for improving pregnancy and infant outcome. , 2012, The Cochrane database of systematic reviews.

[63]  G. ter Riet,et al.  Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling. , 2008, Health technology assessment.

[64]  H. Odendaal,et al.  Do women with pre-eclampsia and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial , 2002 .

[65]  C. Crowther,et al.  Magnesium supplementation in pregnancy. , 2001, The Cochrane database of systematic reviews.

[66]  L. Duley,et al.  Magnesium sulphate versus lytic cocktail for eclampsia. , 2001, The Cochrane database of systematic reviews.

[67]  A. Gülmezoglu,et al.  Anticonvulsants for women with pre-eclampsia. , 2000, The Cochrane database of systematic reviews.

[68]  Jean Golding,et al.  Geographic variation in incidence of hypertension in pregnancy , 1988 .

[69]  M. Leider.  Goodman & Gilman's The Pharmacological Basis of Therapeutics , 1985 .