Title: Loading Dose Only Vs Standard 24 Hrs Pritchard’s Regimen of Magnesium Sulphate in Severe Pre-Eclampsia - A Randomised Trial

Authors: Dr Prachi, Dr Soma Bandyopadhyay, Dr Rashmi Sinha

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.60

Abstract

Introduction

Hypertensive disorders of pregnancy affect about 10% of all pregnant women around the world. The pre-eclampsia affects 2-8% of all pregnancies worldwide. The primary aim of treatment in severe pre-eclampsia is to prevent eclamptic seizures & resultant morbidity & mortality. Magnesium sulphate is drug of choice for prevention of seizures in pre-eclampsia as well as treatment of seizures in eclampsia.

PRITCHARD REGIME recommends giving 4gms Inj MgSO4 IV over 5 minutes followed immediately by 10 gms IM and 5 gms IM every 4 hours. It has recently been suggested that an initial dose of inj MgSO4 is sufficient to arrest convulsion. We also observed that most of the patient did not receive maintenance therapy due to suspicion of toxicity & they did not convulse further. On the basis of these observations, a study was done to compare the efficacy of loading only & standard regime.

Aims and Objective

To determine the efficacy & safety of only loading dose of Pritchard regimen of MgSO4 therapy in patients of severe pre-eclampsia.

References

  1. Noor S, Halimi M, Faiz N R , Akbar N. Magnesium sulphate in the prophylaxis and treatment of eclampsia . J Ayub Med Coll Abbottabad ;16 (2).
  2. Bhalla A K, Dhall GI, Dhall K. A Safer and more effective treatment for eclampsia . Aust N J Obstet Gynaecol 1994 ; 34: 144-148.
  3. American college of Obstetrician and Gynaecologists. Diagnosis and management of pre eclampsia and eclampsia. ACOG practice bulletin no:33. Obstet Gynecol 2002;99:159-165.
  4. Sibai BM. Magnesium sulphate prophylaxis in pre eclampsia. Lessons learned from recent trials. Am J Obstet Gynecol 2004; 190 : 1520-1526.
  5. Sibai BM, Lipshitz J, Anderson GD, Dilts PV. Re assessment of intravenous MgSO4 therapy in Pre eclampsia - eclampsia. Obstet Gynecol 1981;57:199-202.
  6. Ascarelli MH, Johnson V, May WL, Martin RW, Martin JN Jr. Individually determined postpartum Magnesium sulphate therapy with clinical parameters to safely an cost - effectively shorten treatment for pre eclampsia. Am J Obstet Gynecol 1998 ; 179:952-956.
  7. Fontenot MT, Lewis DF, Frederick JB, Wang Y, Defranco EA, Groome LJ, Evans AT. A Prostective randomised trial of Magnesium sulphate in severe pre eclampsia : Use of diuresis as a clinical para meter to determine the duration of postpartum therapy. Am J Obstet Gynecol 2005; 192:1784 – 1794.
  8. Livingston JC, Livingston LW, Ransay R, Mable BC, Sibai BM. Magnesium sulphate in women with mild pre eclampsia: A Randomised controlled trial.
  9. Witlin AG, Friedman SA, Sibai BM. The effect of Magnesium sulphate on the duration of labour in women with mild pre eclampsia at term : A randomised, double blind, placebo controlled trial. Am J Obstet Gynecol 1997 : 176:623-627.
  10. Buchbinder A, Sibai BM, Claritis S, et al. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild pre eclampsia. Am J Obstet  Gynecol 2002 ; 186 : 66.

Corresponding Author

Dr Prachi

PGT 3rd year, Dept. of obstetrics and Gynaecology, KMCH