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Review
. 2010 Dec 8;2010(12):CD000127.
doi: 10.1002/14651858.CD000127.pub2.

Magnesium sulphate versus diazepam for eclampsia

Affiliations
Free PMC article
Review

Magnesium sulphate versus diazepam for eclampsia

Lelia Duley et al. Cochrane Database Syst Rev. .
Free PMC article

Abstract

Background: Eclampsia, the occurrence of a seizure in association with pre-eclampsia, remains a rare but serious complication of pregnancy. A number of different anticonvulsants are used to control eclamptic fits and to prevent further fits.

Objectives: The objective of this review was to assess the effects of magnesium sulphate compared with diazepam when used for the care of women with eclampsia. Magnesium sulphate is compared with phenytoin and with lytic cocktail in other Cochrane reviews.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2010) and CENTRAL (2010, Issue 3).

Selection criteria: Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with diazepam for women with a clinical diagnosis of eclampsia.

Data collection and analysis: Two authors assessed and extracted data independently.

Main results: We have included seven trials, involving 1396 women. Three trials (1030 women) were good quality. Magnesium sulphate was associated with a reduction in maternal death (seven trials;1396 women; risk ratio (RR) 0.59, 95% confidence interval (CI) 0.38 to 0.92) and recurrence of seizures (seven trials;1390 women; RR 0.43, 95% CI 0.33 to 0.55) compared to diazepam. There were no clear differences in other measures of maternal morbidity.There was no clear difference in perinatal mortality (four trials; 788 infants; RR 1.04, 95% CI 0.81 to 1.34) or neonatal mortality (four trials; 759 infants; RR 1.18, 95% CI 0.75 to 1.84). In the magnesium sulphate group, fewer liveborn babies had an Apgar score less than seven at one minute (two trials; 597 babies; RR 0.75, 95% CI 0.65 to 0.87) or at five minutes (RR 0.70, 95% CI 0.54 to 0.90), and fewer appeared to need intubation at the place of birth (two trials; 591 infants; RR 0.67, 95% CI 0.45 to 1.00). There was no difference in admission to a special care nursery (four trials; 834 infants; RR 0.91, 95% CI 0.79 to 1.05), but fewer babies in the magnesium sulphate group had a length of stay more than seven days (three trials 631 babies; RR 0.66, 95% CI 0.46 to 0.96).

Authors' conclusions: Magnesium sulphate for women with eclampsia reduces the risk ratio of maternal death and of recurrence of seizures, compared with diazepam.

Conflict of interest statement

Lelia Duley was the Principal Investigator for the Collaborative Eclampsia Trial Collab Trial 1995. Godfrey Walker was involved in securing funding for the Collaborative Eclampsia Trial. Trial eligibility, quality assessment and data extraction for this trial was carried out by two other members of the review team who were not directly involved in the study.

Figures

1.1
1.1. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 1 Maternal death.
1.2
1.2. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 2 Recurrence of seizures.
1.3
1.3. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 3 Cerebrovascular accident (stroke).
1.4
1.4. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 4 Any serious morbidity (stroke, renal failure, HELLP, DIC, pulmonary edema, cardiac arrest, or as reported.
1.5
1.5. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 5 Renal failure.
1.6
1.6. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 6 Liver failure.
1.7
1.7. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 7 Coagulopathy.
1.8
1.8. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 8 Side effects: local skin reaction.
1.9
1.9. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 9 Pulmonary oedema.
1.10
1.10. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 10 Pneumonia.
1.11
1.11. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 11 Respiratory depression.
1.12
1.12. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 12 Cardiac arrest.
1.13
1.13. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 13 Death or any serious maternal morbidity.
1.14
1.14. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 14 Woman admitted to intensive care unit.
1.15
1.15. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 15 Maternal ventilation.
1.16
1.16. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 16 Labour > 8 hours.
1.17
1.17. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 17 Caesarean section.
1.18
1.18. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 18 Blood loss at birth > 500 ml.
1.19
1.19. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 19 Death of the fetus or infant.
1.20
1.20. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 20 Preterm birth.
1.21
1.21. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 21 Apgar scores.
1.22
1.22. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 22 Admitted to special care baby unit (SCBU).
1.23
1.23. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 23 Death or in SCBU > 7 days.
1.24
1.24. Analysis
Comparison 1 Magnesium sulphate versus diazepam, Outcome 24 Intubation at place of birth.
2.1
2.1. Analysis
Comparison 2 Magnesium sulphate versus diazepam (subgroups by whether randomisation before or after birth), Outcome 1 Death.
2.2
2.2. Analysis
Comparison 2 Magnesium sulphate versus diazepam (subgroups by whether randomisation before or after birth), Outcome 2 Recurrence of seizures.
2.3
2.3. Analysis
Comparison 2 Magnesium sulphate versus diazepam (subgroups by whether randomisation before or after birth), Outcome 3 Stroke.
3.1
3.1. Analysis
Comparison 3 Magnesium sulphate versus diazepam (subgroups by whether anticonvulsants before randomisation), Outcome 1 Maternal death.
3.2
3.2. Analysis
Comparison 3 Magnesium sulphate versus diazepam (subgroups by whether anticonvulsants before randomisation), Outcome 2 Recurrence of seizures.
3.3
3.3. Analysis
Comparison 3 Magnesium sulphate versus diazepam (subgroups by whether anticonvulsants before randomisation), Outcome 3 Any serious maternal morbidity.
3.4
3.4. Analysis
Comparison 3 Magnesium sulphate versus diazepam (subgroups by whether anticonvulsants before randomisation), Outcome 4 Perinatal death.
3.5
3.5. Analysis
Comparison 3 Magnesium sulphate versus diazepam (subgroups by whether anticonvulsants before randomisation), Outcome 5 Neonatal death.
3.6
3.6. Analysis
Comparison 3 Magnesium sulphate versus diazepam (subgroups by whether anticonvulsants before randomisation), Outcome 6 Stay in SCBU > 7 days.
4.1
4.1. Analysis
Comparison 4 Magnesium sulphate versus diazepam (subgroups by route of magnesium maintenance), Outcome 1 Maternal cardiac arrest.
4.2
4.2. Analysis
Comparison 4 Magnesium sulphate versus diazepam (subgroups by route of magnesium maintenance), Outcome 2 Maternal respiratory depression.
4.3
4.3. Analysis
Comparison 4 Magnesium sulphate versus diazepam (subgroups by route of magnesium maintenance), Outcome 3 Pneumonia.
4.4
4.4. Analysis
Comparison 4 Magnesium sulphate versus diazepam (subgroups by route of magnesium maintenance), Outcome 4 Maternal ventilation.

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