Safety of Magnesium sulfate in severe preeclampsia

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Malek-mellouli Monia
Youssef Atef
Fethi Ben Amara
Maher Nasr
Néji Khaled
Mourad Bouchnack
Hayen Maghrebi
Hédi Reziga

Abstract

Background: Several observational studies and randomized trials have described the use of various regimens of magnesium sulfate to prevent or reduce the rate of seizures and complications in women with severe preeclampsia.
Aim: To assess the validity of a service protocol in the management of severe pre-eclampsia all specifying the benefits, complications and side effects of magnesium sulfate .
Methods: We have performed a retrospective descriptive study over two years (2009-2010) concerning 150 patients affected with severe preeclampsia in the department “B” of gynecology and obstetrics of the “Rabta” at the Centre of Maternity and Neonatology of Tunis (third level maternity). The protocol consisted in the administration of 3 grammes of magnesium sulfate followed by intravenous dose of 1 g/hour associated with an anti-hypertensive treatment.
Results: One hundred and forty patients (93%) had 2 or more criteria of severity associated. Seventy-eight (52 %) patients with severe preeclampsia have profited an anti-hypertensive treatment based on nicardipine associated with magnesium sulfate without notable secondary effects. In two cases (1.3 %) an eclampsia was noted with magnesium sulfate, 27.4 % of severe preeclampsia was noted at a term within 34 week of amenorrhea. Only one case of surdosage was noted in post partum.
Conclusion: The use of magnesium sulfate in practice does not appear to increase the risk of complications or major side effects in the mother and fetus.

Keywords:

Magnesium sulfate; severe preeclampsia; prevention; pregnancy.

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References

  1. Girard B, Bencher G, Muris C, Simonet T, Dreyfus M. Sulfate de magnésium et préeclampsie sévère : innocuité en pratique courante dans des indications ciblées. J Gynecol obstet Biol Reprod 2005; 34: 17-22.
  2. WHO, UNICEF Revised 1990 estimates of maternal mortality: WHO/FRH/MSM/96.11.Geneva: WHO; 1996.
  3. Sibai BM, Magnesium sulfate is the ideal anticonvulsant in preeclampsia-eclampsia. Am J Obstet Gynecol 1990; 162: 1141- 5.
  4. The eclampsia collaborative group. Which anticonvulsivant for women with eclampsia? Evidence from the collaborative eclampsia trial. Lancet 1995; 345: 1455-63.
  5. The Magpie trial Group. Do women with pre-eclampsia and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomized placebo controlled trial. The Magpie trial collaborative Group. Lancet 2002; 359: 1877-90.
  6. Mittendorf R, Covert R, Boman J, Khoshnood B, Lee K.S, Siegler M. Is tocolytic magnesium sulphate associated with increased Total pediatric Mortality? Lancet 1997; 350: 1517-8.
  7. Mittendorf R, Dambrosia J, Pryde PG, et al. Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants. Am J Obstet Gynecol 2002; 186: 1111-8.
  8. ACGO practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Obstet gynecol 2002; 99:159-67.
  9. Organisation mondiale de la santé les troubles tensionnels au cours de la grossesse. Série de rapport d'un groupe d'étude. OMS Genève 1987 ; 758.
  10. Chelli D, Dimassi K, Zouaoui B, Sfar E, Chelli H, Chennoufi MB. Evolution de la mortalité maternelle dans une maternité tunisienne de niveau 3 entre 1998 et 2007. J Gynecol Obstet Biol Reprod 2009 ; 38 :655-61.
  11. Rachdi R, Kaabi M, Zayene H et al. Pronostic maternel et f?tal au cours de la toxémie gravidique sévère. Tun Med 2005 ; 83 :67-71.
  12. Néji K. Pronostic materno-foetal lors des prééclampsies sévères. A propos de 250 cas. Thèse de doctorat en médecine Tunis 1994.
  13. Sibai BM. Magnesium sulfate is the ideal anti convulsivant in preeclampsia-eclampsia. Am J obstet Gynecol 1990; 162: 1141-5.
  14. Belfort MA, Anthony J, Saade GR, Allen JC. For the Nimodipine study group a comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med 2003; 348: 304-11.
  15. Coetzee E, Dommisse J, Anthony J. A randomized controlled trial of intravenous magnesium sulfate versus placebo in the management of women with severe preeclampsia. Br J Obstet Gynaecol 1998; 105:300-3.
  16. Hall DR, Odendaal HJ, Smith M. is prophylactic administration of magnesium sulfate in women with preeclampsia indicated prior to labour? Br J Obstet Gynaecol 2000; 107: 903-8.
  17. Boudaya F, Zouaoui B, Ghodbène I et al. Eclampsie : Profil épidémiologique et prise en charge à propos de 28 cas. Tun Med 2008 ; 86 :685-88.
  18. Witlin AG, Friedman SA, Sibai BM. The effect of magnesium sulfate therapy on the duration of labor in women with mild preeclampsia at term: a randomized, double-blind, placebocontrolled trial. Am J Obstet Gynecol 1997; 176: 623-7.
  19. Livingston JC, Livingston LW, Ramsey R, Mabie BC, Sibai BM. Magnesium sulfate in women with mild preeclampsia: a randomized controlled trial. Obstet Gynecol 2003 ; 101 : 217-20.
  20. Pitchard JA, Cunningham FG, Pritchard SA, The parkland Memorial Hospital protocol for treatment of eclampsia : evaluation of 245 cases. Am J Obstet Gynecol 1984; 148: 951-63.
  21. Pottecher T, Luton D, Zupan V, Collet M. Prise en charge multidsciplinaire des formes graves de pré-éclampsie. J Gynécol Obstet Biol Reprod 2009; 38:351-57.
  22. Crowther CA, Hiller JE, Doyle LW, Haslam RR. Magnesium sulfate for preventing pretern birth in threatened preeclampsia labour (cochrane Review). In: the cochrane library; Issue 3, Oxford: update software; 2003.