Efficacy and safety of 12 hours versus 24 hours maintenance therapy of magnesium sulphate in patients with severe pre eclampsia

ABSTRACT

To determine the efficacy and safety of 12 hour magnesium sulphate maintenance therapy in management of severe pre eclampsia by comparing it with 24 hours standard magnesium sulphate maintenance therapy. Randomized control trial. MCH Centre PIMS from November 2011 to April 2012. All patients with severe preeclampsia [blood pressure of 160/110 mm of Hg or more, proteinuria 2+ on dipstick] or signs and symptoms of impending eclampsia were included in the study. After receiving the loading dose, patients were randomly assigned to 12 hours maintenance therapy of magnesium sulphate in group A versus 24 hours therapy in group B.The main Outcomes measures included frequency of occurrence of fits, side effects of magnesium sulphate [major and minor], degree of rise in serum uric acid, SGOT and proteinuria, maternal complications and neonatal outcomes. Of 104 patients 52 patients were assigned to each group. Both groups were comparable with regards to maternal age, parity and gestational age. In group A [12 hours regimen] had higher baseline levels of S.uricacid, SGOT, proteinuria versus 24 hours of administration of magnesium sulphate [p=0.15]. Regarding outcome, none of patients in either group had eclamptic fit, conveying that 12 hour magnesium sulphate therapy was equally effective in term of prevention of eclampsia as 24 hours magnesium sulphate therapy. On the other hand group B had significantly higher frequency of minor side effects of magnesium sulphate [nausea, flushing] [p=0.09], compared with 12hours regime. No difference was found among 2 groups in terms of major side effects of magnesium sulphate [respiratory depression, renal failure],occurrence of eclamptic fits, maternal complications and neonatal outcomes. 12 hours maintenance therapy is equally effective in prophylaxis of eclamptic fits and maternal complications, as 24 hours maintenance therapy in patients with severe pre eclampsia and is associated with lesser side effects than 24 hours regime. Large scale studies are however required for generalization of results.