PHENYTOIN VERSUS MAGNESIUM-SULFATE IN PREECLAMPSIA - A PILOT-STUDY

A randomized clinical trial was designed to determine whether there ar e clinically demonstrable advantages of phenytoin over magnesium sulfa te in preeclamptic patients because of the latter drug's uterine relax ant properties. An intravenous infusion, immediately after randomizati on, of either phenytoin or magnesium sulfate, with subsequent measurem ent of serum concentrations and maintenance of therapeutic levels was given to 103 preeclamptic and two eclamptic women. Observed were the r ate of cervical dilation during active labor and change in hematocrit between predelivery and 24-hour postdelivery values and the incidence of side effects ascertained by interview. Compared with those receivin g magnesium sulfate, patients receiving phenytoin had more rapid cervi cal dilation (3.3 cm/hr versus 1.5 cm/hr, p = 0.016) and a smaller fal l in hematocrit after delivery (-4.7% versus -7.6%, p = 0.034). A sign ificantly lower incidence of hot flushes (15% versus 46%, p <0.005) an d a trend toward less dyspnea and weakness were reported by phenytoin- treated patients. Our phenytoin regimen produced acceptable serum phen ytoin levels (10 to 25 mug/ml) in 96% of patients.