An evaluation on the use of intravenous magnesium Sulphate in the management of Eclampsia at the University teaching Hospital Lusaka Zambia

Abstract

Background:There is now compelling evidence that magnesium sulphate is effective and recommended for use in the prevention and treatment of eclampsia seizures(1'2). The benefits of magnesium sulphate (MgSC>4) includes reduction of recurrent seizures by more than 50%, and improved maternal and neonatal outcomes. The reduction in maternal mortality can only be optimally achieved if the drug is administered in the setting of a high-dependency unit staffed by trained health care professionals as there would need to be great emphasis on monitoring of patients, strict adherence to magnesium sulphate administration protocols and looking out for adverse effects of the drug. Parenteral magnesium sulphate was introduced in the management of eclampsia seizures at the UTH, Lusaka in 2000. Since then no formal evaluation has been performed on its utilisation.Methods:In this cross sectional prospective study conducted over a 3-month period at the UTH in 2005, the use of magnesium sulphate in the management of 80 eclamptic women was assessed. The evaluation assessed adherence to regimen of use of magnesium sulphate, and medical outcomes including seizure recurrence and maternal and perinatal outcome.Findings:Of the 80 eclamptic patients, 62 (77.5%) had all three parameters of reflexes, urine output and respiratory rate monitored. Monitoring for most of the patients (n=70, 87.5%) was undertaken infrequently at longer than the recommended 1-2 hours, though it was noted that sicker patients had more frequent monitoring. 81.3% of the study subjects received a total of 24 doses of magnesium sulphate irrespective of the time from the last fit or delivery. Whether the magnesium sulphate doses were given for 24 hours after the last fit or for 24 hours after delivery did not impact maternal and perinatal outcome. A seizure recurrence while on magnesium sulphate occurred in 9 of the 80 cases (11.3%). There was one maternal mortality and 10 perinatal deaths in this cohort of 80 patients (1.25% and 12.5% respectively).Interpretation:The regime for the administration of magnesium sulphate in the management of eclampsia at UTH has been effectively implemented with favourable maternal and perinatal outcomes. Challenges remain in fully adhering to the guidelines of administration of magnesium sulphate and of monitoring of patients.