L Duley1, D Henderson-Smart. 1. Resource Centre for Randomised Trials, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF. lelia.duley@ndm.ox.ac.uk
Abstract
BACKGROUND: A number of different anticonvulsants are used to control eclamptic fits and to prevent further seizures. OBJECTIVES: The objective of this review was to assess the effects of magnesium sulphate compared with phenytoin when used for the care of women with eclampsia. Magnesium sulphate is compared with diazepam and with lytic cocktail (in preparation) in other Cochrane reviews. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials Register, Issue 3 1999. SELECTION CRITERIA: Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with phenytoin for women with a clinical diagnosis of eclampsia. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extraction was done by two reviewers. MAIN RESULTS: Four trials involving 823 women were included. The trials were of good quality. Magnesium sulphate was associated with a substantial reduction in the recurrence of convulsions, when compared to phenytoin (relative risk 0.30, 95% confidence interval 0.20 to 0.46). The trend in maternal mortality favoured magnesium sulphate, but this difference was not statistically significant (RR 0.51, 95% CI 0.25-1.06). There was also a reduction in the risk of pneumonia (RR.44, 95% CI 0.24-0. 79), ventilation (RR.66, 95% CI 0.49-0.90) and admission to an intensive care unit (RR 0.67, 95% CI 0.50-0.89) associated with the use of magnesium sulphate. For the baby, magnesium sulphate was associated with fewer admissions to SCBU (RR 0.73, 95% CI 0.58-0.91) and fewer babies who died or were in SCBU for > 7 days (RR 0.77, 95% CI 0.63-0.95). REVIEWER'S CONCLUSIONS: Magnesium sulphate appears to be substantially more effective than phenytoin for treatment of eclampsia.
BACKGROUND: A number of different anticonvulsants are used to control eclamptic fits and to prevent further seizures. OBJECTIVES: The objective of this review was to assess the effects of magnesium sulphate compared with phenytoin when used for the care of women with eclampsia. Magnesium sulphate is compared with diazepam and with lytic cocktail (in preparation) in other Cochrane reviews. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials Register, Issue 3 1999. SELECTION CRITERIA: Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with phenytoin for women with a clinical diagnosis of eclampsia. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extraction was done by two reviewers. MAIN RESULTS: Four trials involving 823 women were included. The trials were of good quality. Magnesium sulphate was associated with a substantial reduction in the recurrence of convulsions, when compared to phenytoin (relative risk 0.30, 95% confidence interval 0.20 to 0.46). The trend in maternal mortality favoured magnesium sulphate, but this difference was not statistically significant (RR 0.51, 95% CI 0.25-1.06). There was also a reduction in the risk of pneumonia (RR.44, 95% CI 0.24-0. 79), ventilation (RR.66, 95% CI 0.49-0.90) and admission to an intensive care unit (RR 0.67, 95% CI 0.50-0.89) associated with the use of magnesium sulphate. For the baby, magnesium sulphate was associated with fewer admissions to SCBU (RR 0.73, 95% CI 0.58-0.91) and fewer babies who died or were in SCBU for > 7 days (RR 0.77, 95% CI 0.63-0.95). REVIEWER'S CONCLUSIONS:Magnesium sulphate appears to be substantially more effective than phenytoin for treatment of eclampsia.