It is the convulsive manifestation of preeclampsia and one of several clinical manifestations at the severe end of the preeclampsia spectrum table 1. Mar 23, 2020 magnesium sulfate injection, usp 50% is a sterile, nonpyrogenic, concentrated solution of magnesium sulfate heptahydrate in water for injection. For centuries, practitioners of midwifery have feared the occurrence of convulsions during pregnancy because they carried a particularly grave prognosis for both mother and fetus. Magnesium sulfate is the anticonvulsant of choice for preeclampsia. Magnesium sulfate prophylaxis in preeclampsia american journal. The trial also called magpie trial was a randomized, placebocontrolled study that enrolled over 10,000 women. Eclampsia refers to the occurrence of newonset, generalized, tonicclonic seizures or coma in a woman with preeclampsia. Sudden weight gain, headaches and changes in vision are.
Progression from nonsevere previously referred to as mild to severe on the disease spectrum table 2 may be. Adminstration of magnesium sulphate mgso4 for eclampsia. A serum magnesium level of 6 mg100 ml is considered optimal for seizure control. Cipolla, phd background and purposemagnesium sulfate is used extensively for prevention of eclamptic seizures. Magnesium sulfate management of hypertensive disorders of pregnancy uncontrolled document when printed published. Intravenously, a dose of 4 to 5 g in 250 ml of 5% dextrose injection, usp or 0. Despite advances in detection and management, preeclampsia eclampsia. Preeclampsia is a multisystem, progressive disorder characterized by the new onset of hypertension and proteinuria or hypertension and endorgan dysfunction with or without proteinuria in the last half of pregnancy table 1. High strong magnesium sulfate is recommended for the treatment of women with eclampsia in preference to other anticonvulsants. The uses of magnesium sulfate in the context of appropriate clinical obstetric practice include, in particular, prevention and treatment of seizures in women with preeclampsia or eclampsia and fetal neuroprotection before anticipated early preterm less than 32 weeks of gestation delivery 8 9 12. Magnesium sulfate for eclampsia was associated with lower risks of maternal death, recurrent seizure, and major morbidity. Pdf magnesium sulphate therapy in eclampsia and pre.
The guideline development group believed that capacity for clinical surveillance of women and. Purpose this document outlines the guideline or procedure details for the indications, contraindications, administration and monitoring of magnesium sulfate sulphate use at the womens. Magnesium sulfate is a lifesaving drug and should be available in all healthcare facilities throughout the health system. It is usually given by either the intramuscular or intravenous routes. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most. Jan 27, 2014 magnesium sulfate toolkit pdf date published. Magnesium sulfate given intravenously is the treatment of choice for severe preeclampsia to prevent eclampsia or after eclampsia develops to prevent recurrence. Supporting vaginal birth and reducing primary cesareans toolkit. In severe preeclampsia or eclampsia, the total initial dose is 10 to 14 g of magnesium sulfate. Administration of magnesium sulphate is one of the prime treatment modalities in eclampsia and severe preeclampsia. But theres a risk of magnesium overdose, called magnesium toxicity. Methods a total of 222 women with mild preeclampsia were randomized to receive intravenous magnesium sulfate n 109 or matched placebo n 1.
Many, but not all, doctors will also treat every preeclamptic patient with magnesium sulfate during labor, even when the disease appears mild. The royal womens hospital clinical guidelines present statements of best. Most importantly, the following facts should have been. It is administered by the intravenous iv or intramuscular im routes as an electrolyte replenisher or anticonvulsant. However, there is a need for a randomized controlled trial to determine efficacy of magnesium sulfate therapy for women with mild preeclampsia and gestational hypertension.
Background preeclampsiaeclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries. Magnesium sulfate also may be used for the shortterm prolongation of pregnancy up to 48 hours to allow for the administration of antenatal corticosteroids. Pdf magnesium sulphate therapy in eclampsia and preeclampsia. Magnesium sulfate is a mineral that reduces seizure risks in women with preeclampsia. We have not gotten into the problems with pregnancy next year, including preeclampsia of which there were a bunch that had to do wtih mag sulfate and preeclampsia. Magnesium sulfate mgso4 is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe preeclampsia. Magnesium sulfate for preeclampsia and eclampsia management. However, the guideline development group noted that a higher number of women need to be treated to prevent one seizure. Magnesium sulfate is a naturally occurring mineral used to control low blood levels of magnesium.
Who recommendation on magnesium sulfate regimen to prevent. It has a role as an anticonvulsant, a cardiovascular drug, a calcium channel blocker, an anaesthetic, a tocolytic agent, an antiarrhythmia drug and an analgesic. Magnesium sulfate toolkit pdf california maternal quality. Magnesium sulfate fda prescribing information, side effects. The use of magnesium sulphate for the treatment of severe pre. The intramuscular regimen is most commonly a 4 g intravenous loading dose. Sep, 2012 magnesium sulfate mgsc4 is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe preeclampsia.
Jul 03, 1999 magnesium sulphate has been used for treating eclampsia in the united states for much of the 20th century. Simultaneously, intramuscular doses of up to 10 g 5 g or 10 ml of the undiluted 50% solution in each buttock are given. We wish to commend the archives for focusing on certain controversies regarding the use of magnesium sulfate for preeclampsia, or frank eclampsia, but have misgivings on the manner in which the problem was presented. Magnesium sulfate is the anticonvulsant of choice for preeclampsia prophylaxis and treatment and treatment of eclampsia. If further seizures occur after the commencement of the infusion take blood for urgent magnesium level and give a further bolus of 2 g magnesium sulphate over 20 minutes intravenously 50ml of the premixed bag. Sep 12, 2018 magnesium sulfate can be beneficial to some with preeclampsia. Magnesium sulphate mgso 4 was first introduced to control convulsions in 1925, but it was the collaborative eclampsia trial in 1995 that confirmed the efficacy of mgso 4 in the treatment of severe preeclampsia and eclampsia. The pharmacokinetic basis of magnesium sulphate mgso 4 dosing regimens for eclampsia prophylaxis and treatment is not clearly established objectives. Magnesium sulphate infusion as per protocol for prophylaxis. Magnesium sulphate management of hypertensive disorders of. Taking too much magnesium can be lifethreatening to both. The need to continue therapy is based on the continuing presence of patellar reflex and adequate respiratory function. Magnesium sulfate and preeclampsia or eclampsia jama. The risk of eclampsia is probably reduced by magnesium sulphate, but, even if this reduction is by as much as 50%, very large numbers of women will need to be treated to prevent a single fit.
Magnesium sulfate for the treatment of eclampsia aha journals. Preeclampsia affects at least 5 percent of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure, swelling and protein in the urine. Magnesium sulfate is effective in preventing seizures in both mild and severe preeclampsia. In the us, parenteral magnesium sulfate has been used for the prevention of recurrent seizures in patients with eclampsia for over 80 years.
Perspective from the new england journal of medicine magnesium sulfate for preeclampsia. Careful attention to the monitoring guidelines can prevent toxicity. Apr 25, 2007 i just took the nln achievement test for maternal and child health nursing. A full report of the recommendations can be found in. Magnesium sulfate injection is also used for pediatric acute nephritis and to prevent seizures in severe preeclampsia, eclampsia, or toxemia of pregnancy. Who recommendations for prevention and treatment of preeclampsia and eclampsia. Magnesium sulphate for eclampsia or eclampsia prophylaxis. Empirical and clinical evidence supports the effectiveness of magnesium sulfate.
Preeclampsia, eclampsia and hellp syndrome are disorders that occur only during pregnancy and the postpartum period, which affect both the mother and the unborn baby. Magnesium sulfate is indicated for the prevention and control of seizures in preeclampsia and eclampsia, for neuroprotection of the fetus before anticipated early preterm delivery, and for the. It is the firstline treatment for any pregnant woman who suffers a seizure, including women with. Magnesium, which has a beneficial effect in eclampsia, may act by opposing calciumdependent arterial constriction, thereby relieving vasospasm. Magnesium sulfate in eclampsia and preeclampsia ncbi nih. Magnesium sulphate management of hypertensive disorders.
Magnesium sulfate is a magnesium salt having sulfate as the counterion. Moderate strong the full intravenous or intramuscular magnesium sulfate. Objective to determine whether magnesium sulfate prevents disease progression in women with mild preeclampsia. Magnesium sulfate therapy in preeclampsia and eclampsia. Maternal and perinatal mortality and morbidity remains high during pregnancy in the presence of eclampsia, it can have severe adverse. Women administered magnesium sulfate had a 52 and 67 percent lower rate of convulsions than those treated with diazepam and phenytoin, respectively. Magnesium sulfate is available under the following different brand names. Clinical pharmacokinetic properties of magnesium sulphate in. Figure 1 is a guideline for administration of magnesium sulphate to treat severe preeclampsia and eclampsia. Magnesium sulfate is recommended for the prevention of eclampsia in women with severe preeclampsia in preference to other anticonvulsants. The intramuscular regimen is most commonly a 4g intravenous loading dose, immediately followed by 10g intramuscularly and then by 5g intramuscularly every 4 hours in. A healthcare provider will give the medication intravenously. Action of magnesium sulfate in the treatment of preeclampsia eclampsia menachem sadeh, md recent evidence supports the concept that cerebral vasospasm is involved in the pathogenesis of eclampsia. A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia.
Magnesium sulfate can be beneficial to some with preeclampsia. The full intravenous or intramuscular magnesium sulfate regimens are recommended for the prevention and treatment of eclampsia. In 2002, the magpie trial reported that women with severe preeclampsia given magnesium sulfate had a 58% lower risk of developing eclampsia compared to the placebo group. Even for women with severe preeclampsia, the risk of eclampsia is lowaround 1%. Mild preeclampsia was defined as blood pressure of at least 14090 mm hg taken on two.
The guideline has been drawn up with reference to the guidance of the royal. The evidence to date confirms the efficacy of magnesium sulfate therapy for women with eclampsia and severe preeclampsia. Action of magnesium sulfate in the treatment of preeclampsia. Magnesium sulfate preparation for intravenous administration. A small colorless crystal used as an anticonvulsant, a cathartic.