MAGNESIUM-SULFATE IN THE TREATMENT OF ECLAMPSIA AND PREECLAMPSIA - ANOVERVIEW OF THE EVIDENCE FROM RANDOMIZED TRIALS

Objective To evaluate the effectiveness of magnesium sulphate in the t reatment of eclampsia and pre-eclampsia by a systematic quantitative o verview of controlled clinical trials. Design Online searching of the MEDLINE database between 1966 and 1995, and scanning of the bibliograp hy of known primary studies and review articles on the use of magnesiu m sulphate in eclampsia and pre-eclampsia. Study selection, study qual ity assessment and data extraction were performed independently by two reviewers under masked conditions. Where possible outcome data from t rials were pooled and summarised using the Mantel-Haenszel method. Par ticipants One thousand seven hundred and forty-three women with eclamp sia and 2390 with pre-eclampsia included in nine randomised trials tha t evaluated the effects of magnesium sulphate. Main outcome measures S eizure activity and maternal death. Results In eclampsia, recurrence o f seizures was less common with magnesium sulphate therapy compared wi th phenytoin (odds ratio [OR] 0.27, 95% CI 0.17-0.45, P = 0.00) and di azepam (OR 0.41, 95% CI 0.30-0.57, P = 0.00). As indicated by the poin t estimate, there was a trend towards a reduction in maternal mortalit y with magnesium sulphate in eclampsia (OR 0.51, 95% CI 0.24-1.07, P = 0.10 versus phenytoin; OR 0.78, 95% CI 0.41-1.45, P = 0.52 versus dia zepam). When used for seizure prophylaxis in pre-eclampsia, magnesium sulphate was found to be more effective than phenytoin (OR 0.15, 95% C I 0.03-0.72, P = 0.01). Conclusion Magnesium sulphate is a superior dr ug in preventing the recurrence of seizures in eclampsia and in seizur e prophylaxis in pre-eclampsia.