Reproductive Health Unit, Department of Obstetrics and Gynecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Arch Gynecol Obstet. 2013 Jan;287(1):43-6. doi: 10.1007/s00404-012-2523-z. Epub 2012 Aug 29.
Magnesium sulphate is now the gold standard for the control of eclamptic fits. The place of low-dose magnesium sulphate for the control of eclamptic seizures is yet to be determined.
To determine the effectiveness of low-dose magnesium sulphate in controlling eclamptic fits.
Randomized controlled trial comparing low-dose with standardized dosing regimen.
Labour Unit of the department of Obstetrics and Gynecology Federal Medical Centre Azare, north-eastern Nigeria.
Thirty-nine patients randomized into the low-dose regimen group received 9 g loading dose (4 g iv and 5 g im) and im maintenance of 2.5 g four hourly for 24 h post-delivery or post last fit, while the 33 patients in the standard dose regimen group received loading dose of 14 g followed by im maintenance dose of 5 g four hourly. In both study groups, 2 g iv of magnesium sulphate is given for breakthrough fits and 10 ml of 10 % calcium gluconate (slowly iv) was administered in the event of toxicity. Outcome measures include recurrent fits, mode of delivery, mean Apgar Score at 5 min, perinatal death, maternal complications including death.
The mean age of the 72 patients was 22.3 ± 5.4 years and 60 % were primigravidas. Intrapartum eclampsia was encountered in 44 % of the patients followed by antepartum eclampsia (26 %). Overall 4.2 % recurrent convulsion rate was documented and it is not different among the study groups. There were also no differences in both foetal and maternal outcomes in the two study groups.
The effectiveness of low-dose regimen of magnesium sulphate appeared comparable to the 'standard dose regimen'. Low-dose regimen may guarantee more safety and in an environment (such as ours) where cost is an important determinant of accessibility to qualitative health services, it is certainly attractive. More studies are needed to establish the place of low-dose regimen of magnesium sulphate in the management of eclampsia.
硫酸镁目前是控制子痫发作的金标准。低剂量硫酸镁控制子痫发作的地位尚未确定。
确定低剂量硫酸镁控制子痫发作的有效性。
比较低剂量与标准剂量方案的随机对照试验。
尼日利亚东北部阿扎雷州妇产科学系联邦医疗中心的产房。
39 名患者随机分为低剂量组，给予 9 g 负荷剂量（4 g 静脉推注和 5 g 肌肉注射），分娩后或最后一次发作后 24 小时内每 4 小时肌肉注射 2.5 g 维持剂量；33 名患者在标准剂量组给予 14 g 负荷剂量，然后每 4 小时肌肉注射 5 g 维持剂量。在两组研究中，对于突破性发作，给予 2 g 硫酸镁静脉注射，出现毒性时给予 10 ml 10%葡萄糖酸钙（缓慢静脉注射）。结局指标包括复发发作、分娩方式、5 分钟时平均 Apgar 评分、围产儿死亡、包括死亡在内的母体并发症。
72 例患者的平均年龄为 22.3±5.4 岁，60%为初产妇。分娩时子痫发生率为 44%，其次为产前子痫（26%）。总的来说，有 4.2%的患者出现复发性抽搐，两组之间无差异。两组的胎儿和母体结局也没有差异。
低剂量硫酸镁方案的有效性似乎与“标准剂量方案”相当。低剂量方案可能更安全，在成本是获得高质量卫生服务的重要决定因素的环境（如我们的环境）中，它肯定更具吸引力。需要更多的研究来确定低剂量硫酸镁方案在子痫管理中的地位。
