Loading dose of magnesium sulphate versus standard regime for prophylaxis of pre-eclampsia

To determine the efficacy of single dose of magnesium sulphate versus the standard Pritchard regime in the management of pre-eclampsia. Quasi-experimental study. Jinnah postgraduate Medical Centre, Karachi from January 2004 to January 2006. All women with severe pre-eclampsia and impending eclampsia were included in the study. Patients with pregnancy induced hypertension and mild to moderate pre-eclampsia were excluded. From the 100 women included in the study, after matching for age, parity and gestational age, 50 were given only bolus dose of magnesium sulphate and 50 were given the standard regime. They were observed for one week for the number of convulsions. Fisher's exact test and Chi-square test were used to analyze results. There was no significant difference in the two groups in term of occurrence of seizures, one patient developed fit with Pritchard regimen. The rate of caesarean section was lower in group A, 12% versus 30% in group B [p=0.05]. There was no significant difference in prenatal outcome in either group [82% live births in group A versus 72% amongst group B [p=0.2]. Few side effects like vomiting, dizziness and irritation at the site of injection were observed when standard treatment was used. Single dose treatment was also found to be cost-effective costing Pak Rs. 45 [US $ 0.56] as compare to Pak Rs. 195 [US $ 2.4] in control group. No maternal death was observed in either group. Having the equal effectiveness, ease of monitoring and cost effectiveness, single loading dose of magnesium sulphate is preferable over the standard regime in the management of pre-eclampsia as a prophylactic measure for prevention of seizure

Magnesium sulphate prophylaxis in pre-eclampsia

To determine the efficacy of magnesium sulphate in the management of preeclampsia. Ward 8, Department of Obstetrics and Gynaecology, Jinnah Post Graduate Medical Center [JPMC] Karachi, from January 2004 to December 2004. A study was done using non random purposive sampling. Study population consisted of 100 pre-eclamptic women. All women with severe pre-eclampsia and impending eclampsia were recruited in the study with blood pressure more than 140/100 mm Hg, proteinuria + + on dipstick or signs and symptoms of impending eclampsia like epigastric pain, nausea, vomiting, headache associated with sever hypertension. Fifty patients had magnesium sulpahte prophylaxis and 50 [control group] without any anticonvulsant. Before giving magnesium sulphate, the clinician checked that knee and other tendon reflexes were present, respiratory rate was normal [more than 16 breaths per minute] and urine output more than 100 ml in last four hours or greater than 25 ml in last four hours. The average age of patients with magnesium sulphate prophylaxis was 28.06 +/- 5.5 years and for controls, it was 27.88 +/- 5.46 years. A significant reduction in the rate of eclampsia in women assigned to magnesium sulphate 2% versus 12% [p<0.05, OR 0.15] was noted. However there was no significant reduction in the rate of abruptio placentae in either group, 6% versus 8% [p>0.5]. The rate of caesarean section was lower in women given magnesium prophylaxis 6% versus 17% [p=0.01]. There was no significant difference inperinatal outcome in either group, 41% live births in study versus 38% amongst controls [p=0. 91]. No maternal death was observed in either group. Magnesium sulphate minimizes the risk of eclampsia and decreases the morbidity and mortality related to eclampsia but at the same time it does not prevent the progression of pre-eclampsia and therefore maternal and fetal surveillance should be continued irrespective of magnesium sulphate prophylaxis

Therapeutic termination of second trimester pregnancies with low dose misoprostol

To determine the effectiveness of 50micro g misoprostol for midtrimester termination of pregnancies. Experimental, cross-sectional study. Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005. The study subjects were 54 pregnant women admitted during the 2nd trimester [14-26 weeks] of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder [hypertension or diabetes] or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50micro g misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 [range 4-48 hours]. Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4 +/- 15.9 hours in alive fetuses [t -value:1.9, p: 0.05]. Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 micro g misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect