Magnesium sulfate versus diazepam in the management of eclampsia: a randomized controlled trial

Article Abstract:

Eclampsia is a complication of pregnancy marked by maternal high blood pressure, swelling, protein in the urine and convulsions. Treatment is aimed at reducing blood pressure with antihypertensive agents, controlling seizures with anticonvulsive agents, increasing fluids and prompt delivery of the fetus. Magnesium sulfate, currently the drug most widely used in the US, can cause heart and lung failure and can collect in the blood of the fetus. Diazepam, an anticonvulsant that produces heavy sedation, can result in pneumonia and other respiratory problems in the newborn. Since eclampsia occurs infrequently, large population studies examining the effectiveness of anticonvulsant are difficult. The relative effectiveness of diazepam and magnesium sulfate in controlling recurrent seizures and preventing maternal and fetal complications was studied among 51 women with eclampsia. Heart, lung and kidney functioning and blood coagulation problems were experienced more often in the mothers receiving magnesium sulfate. One woman in the magnesium sulfate-treated group died. Recurrent seizures were experienced in five out of 24 women (21 percent) treated with magnesium sulfate and seven out of 27 women (26 percent) receiving diazepam. Twelve women receiving diazepam had a significant decrease urine output and required diuretics to release fluids, as compared with only three in the magnesium sulfate group. A low Apgar score, which is a measurement of fetal well-being at one and five minutes after birth, was seen more often among infants born to mothers receiving diazepam than among those born to mothers receiving magnesium sulfate. Two infants in the magnesium-treated group died after birth and three stillbirths were reported in the diazepam-treated group. The fact that 67 percent of the patients received diazepam before they entered the study, in conjunction with the small number of study patients, makes these results difficult to interpret. Magnesium sulfate appears to be more the more favorable anticonvulsant for the treatment of women with eclampsia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diazepam

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Post partum eclampsia and acute renal failure; treatment with prostacyclin. Case report

Article Abstract:

Eclampsia is a condition characterized by headache, hypertension, convulsive seizures and coma; it can occur between the 20th week of pregnancy and the first week after childbirth. Eclampsia occurs in Britain in fewer than 1 in 1,000 births. A case report is presented to illustrate the development of acute kidney (renal) failure in an eclamptic woman, a rare occurrence in the Western world. The patient was a 20-year-old woman with an apparently normal pregnancy and delivery, who became restless and developed a headache during the first few hours after delivery. Her blood pressure increased to 180/120, and a grand mal seizure (convulsion) occurred. She was given drugs to lower blood pressure and to prevent further seizures, as well as prostacyclin, an agent that dilates blood vessels and inhibits the aggregation of platelets (clumping of cells essential for blood clotting). Prostaglandin was administered because a decrease in the numbers of platelets was noted, a condition that predisposes to excess bleeding. The patient recovered after intensive treatment. In normal pregnancies, another factor known as thromboxane A2 counteracts the actions of prostacyclin. However, in preeclampsia (the stage that precedes eclampsia), prostacyclin levels fall, as does the ratio of thromboxane/prostacyclin; these changes may cause the blood vessel constriction, increased activity of platelets, and damage to blood vessel linings (endothelial tissue) which are typical of preeclampsia. A brief review is presented of the effectiveness of prostacyclin in treating severe pre-eclampsia. Whether the drug was responsible for the recovery of this patient, who suffered from eclampsia, could not be determined with certainty. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Physiological aspects, Development and progression, Preeclampsia, Prostacyclin

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Phenytoin sodium and magnesium sulphate in the management of eclampsia

Article Abstract:

Eclampsia is a complication of pregnancy marked by maternal high blood pressure, swelling, protein in the urine and convulsions. The mechanisms behind eclampsia and preeclampsia (a similar condition but unaccompanied by convulsions) are not well known, treatment is aimed at reducing blood pressure with antihypertensive agents, controlling seizures with anticonvulsive agents, increasing fluid and prompt delivery. Currently, magnesium sulphate is the anticonvulsant of choice. However, this compound is rapidly eliminated from the body, making large doses of the drug necessary to maintain effectiveness. Phenytoin is an anticonvulsant used to treat epilepsy. The relative effectiveness of phenytoin and magnesium sulphate was compared in 22 similarly-matched patients with eclampsia. No side effects were experienced during therapy achieving therapeutic doses (between 1.25 and 2.5 millimoles per liter of magnesium sulphate and 40-100 micromoles per liter of phenytoin). None of the 11 patients receiving magnesium sulphate had recurrent convulsions, while four out of 11 patients treated with phenytoin had repeated seizures. Therefore, phenytoin was not as effective as magnesium sulphate in preventing recurrent seizures in patients with eclampsia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Phenytoin

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