Management of eclampsia in Assiut University Hospital, 15 years experience

The aim of this study was to evaluate the protocol used for management of eclampsia in Assiut University Hospital. This study was carried out in the Department of Obstetrics and Gynecology and Intensive Care Unit [ICU], Department of Anaesthesia; Assiut University Hospital. A prospective cross-sectional study from January 1990 till January 2005, all patients with eclampsia were included [1332 patients]. Patients studied were 1032 ante partum eclampsia, 75 intrapartum, 16 intercurrent and 209 postpartum eclampsia. The regimen included the use of Nifedipine as an antihypertensive, Magnesium sulfate as anticonvulsant, rapid termination of pregnancy and admission to the intensive care unit. Magnesium sulfate was effective in controlling convulsions in 98.1% of the cases. Nifedipine initiated a smooth decline in blood pressure [P > 0.0001]. The dose of Nifedipine needed to control the blood pressure was variable in the different groups of patients. There are 55 cases of maternal deaths [4.12%]. Maternal morbidity occurred in about 23% of cases. Vaginal delivery occurred in 23.3% of cases [most of them were admitted postpartum]. Perinatal morality was variable in the four groups with the highest rate in the antepartum group [7.9%]. The incidence of low Apgar score at 5 minutes was higher in the antepartum group. Combination of Niftdipine as an antihypertensive drug, magnesium sulfate as an anticonvulsant, rapid termination of pregnancy and managing the patients in the intensive care unit resulted in marked improvement of the outcome for both the mother and fetus

Prospective controlled study of intravenous ritodrine terbutaline and magnesium sulfate bolus for treatment of acute intrapartum fetal, distress

Tocolytic agents had been used with variable results in the treatment of acute intrapartum fetal distress. We studied 121 cases in this prospective, randomized trial to evaulate the efficacy and mate-nial, fetal and neonatal outcome associated with tocolysis with intravenous bolus of either ritodrine [group A of 32 cases], terbutaline [group B of 30 cases] or magnesium sulfate [Group C of 31 cases]. Group D consited of 29 cases as a control and received no tocolytic therapy. Fetal distress was diagnosed according to abnormal external and internal cardiotocographic [CTG] results during intrapartum fetal monitoring. Recovery of the abnormal fetal heart rate was reported in 81.3%, 76.7% and 54.8% in groups A, B, and C respectively. Fetal and neonatal outcome were favorable with ritodrine and terbutaline use compared to magnesium sulfate and control groups difference was significant depending on neonatal umbilical vein pH and Apgar score. A lower incidence of cesarean section was noticed among women received tocolytic therapy compared to control [P<0.05]. Minor side-effects were reported. Beta-adrenergic agonists are recommended as effective, safe therapy, compared to magnesium sulfate which is less effective with higher fetal and neonatal acidosis and distress