Magnesium sulphate therapy in women with pre-eclampsia and eclampsia in Kuwait

ABSTRACT

To evaluate the outcome of the use of MgSO4 therapy in women with severe pre-eclampsia in Kuwait from January 2002 to December 2004. The study involved 450 women managed at the Maternity Hospital in Kuwait with a blood pressure of 160/110 mm Hg and proteinuria of >0.3-5 g/24 h. A loading dose of 4 g MgSO4 was administered intravenously over 20 min and then the maintenance dose continued at 1 g/h for 24 h postpartum. Magnesium sulphate toxicity was monitored by urine output, deep tendon reflexes and serum magnesium levels and managed with an infusion of 10 ml of 10% calcium gluconate and cessation of magnesium infusion. Adjunct therapy included intravenous hydralazine 10 mg and labetalol 100 mg. The mode of delivery was determined after stabilizing the patient. The women included Kuwaitis [n = 200, 44.4%], Asians [n = 129, 28.7%] and other Arabs [n = 116, 25.8%] with a mean age of 29.7 +/- 6.7 years [primigravida n = 233, 51.8%; other parities n = 217, 48.2%]. Antenatal complications included intra-uterine growth restriction [n = 136, 30.2%], oliguria [n = 39, 8.7%], haemolysis, elevated liver enzymes and low platelet count syndrome [n = 30, 6.6%], abruptio placentae [n = 20, 4.4%], eclampsia [n = 15, 3.3%], and preterm birth [n = 253, 55.2%]. Caesarean section [n = 241, 53.6%] was the main mode of delivery. The perinatal mortality rate was 27 per 1,000. Magnesium sulphate toxicity observed as reduced tendon reflexes occurred in 14 [3.1%] patients and flushing, nausea and vomiting and blocked nostrils in 86 [19.1%]. There was no association between adverse outcomes and maternal serum magnesium concentrations and no maternal mortality occurred. Magnesium sulphate was effective in preventing recurrence of eclamptic fits and safe for both mother and fetus