Experience of a low-dose magnesium sulfate regimen for the management of eclampsia over a decade.

OBJECTIVE: To assess the safety and efficacy of a low-dose magnesium sulfate regimen for the management of eclampsia in Indian women. METHODS: A loading dose consisting of 3g of magnesium sulfate intravenously plus 5g intramuscularly (2.5g in each buttock) was followed by 2.5g intramuscularly every 4hours, for 24hours beyond the last seizure. In a first phase, which spanned 2001 and 2002, the regimen was evaluated prospectively with 554 women with eclampsia, and the results were compared with results from the Collaborative Eclampsia Trial. Regarding the second phase, which spanned the 9 following years, mortality was analyzed retrospectively for 2929 women treated by the same regimen at the same hospital. RESULTS: The mean±SD maternal weight and height were 41.7±5.3kg and 151±7cm, respectively. The low-dose regimen was associated with a lower seizure recurrence (6.1% vs 9.7%; P=0.02) and a slightly lower maternal mortality (2.7% vs 3.2%; P=0.6) compared with the Collaborative Eclampsia Trial. The overall case fatality rate for the second phase was 3.3%. CONCLUSION: The low-dose regimen was safe and effective for the management of eclampsia in a region where most women are of light weight.

Tranexamic acid used before caesarean section reduces blood loss based on pre- and postoperative haemoglobin level: a case-control study.

The objective of the study was to find out the efficacy and safety of tranexamic acid in reducing blood loss during and after the lower segment caesarean section based on pre- and postoperative haemoglobin level. A prospective randomised, case-control, study was conducted on 100 women undergoing lower segment caesarean section. Fifty of them were given tranexamic acid immediately before the surgery and compared with 50 others to whom tranexamic acid was not given. Blood loss was measured up to two days. Haemoglobin level was estimated before caesarean section and two days after. Urine analysis, liver and renal functions were tested in both the groups. In this study, it was found that tranexamic acid reduced the quantity of blood loss from placental delivery to 2 days postpartum: 990 ml in the study group versus 1004 ml in the control group. The fall of haemoglobin was significantly less in the study group (1.214 g/dl) in comparision to control (1.7256 g/dl) (p < 0.0001). No complications or side-effects were reported in either group. No adverse neonatal outcome was also noted. Therefore tranexamic acid significantly reduced the amount of blood loss during and after the lower segment caesarean section and its use was not associated with any side-effects or complications. Tranexamic acid can be used safely and effectively in women undergoing lower segment caesarean section.