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Magnesium sulphate is now recognised as the treatment of choice for convulsions
in eclampsia. There is evidence that it is a more effective anticonvulsant than
diazepam in the treatment of eclampsia (1). Also magnesium sulphate makes further
fits less likely than treatment with diazepam. It is difficult to identify
which patients are likely to have seizures from parameters such as degree of blood
pressure elevation, proteinuria, and oedema. Possible side effects of magnesium
sulphate include: - paralysis secondary to toxicity at the neuromuscular
junction
- respiratory depression is preceded by slurring of speech, flushes,
diplopia, nausea and loss of patellar reflexes. Treatment with magnesium sulphate
may be complicated by respiratory arrest
Further evidence has revealed
that magnesium sulphate reduces the risk of eclampsia in women with pre-eclampsia
(2,3) - a review (3) states that there is "robust evidence that,
for women with pre-eclampsia, magnesium sulphate more than halves the risk of
eclampsia (number needed to treat 100, 95% confidence interval 50 to 100) and
probably reduces the risk of maternal death... However, no overall difference
has been found in the risk of stillbirth or neonatal death. A quarter of women
allocated magnesium sulphate had side effects, primarily flushing"
Reference:
- Eclampsia Trial Collaborative group (1995). Which anticonvulsant for women
with eclampsia? Lancet, 345, 1455-9.
- The
Magpie Trial Collaborative Group (2002). Do women with pre-eclampsia, and their
babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled
trial. Lancet, 359, 1877-90.
- BMJ.
2006 Feb 25;332(7539):463-8.
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