Abstract:
Background: Eclamptic seizures in association with the syndrome of
pre-eclampsia remain an important cause of maternal and perinatal
deaths. Diazepam, from among other drugs, has remained the main
drug in use for many years in the management of eclampsia at the MNH
and in other medical facilities throughout Tanzania. Magnesium
sulphate has been reintroduced more recently at the MNH. Systematic
documentation on the obstetric outcome either of the use of diazepam or
Mgso4 in the treatment of eclampsia has not been documented and was
clearly needed.
Objectives: To compare Obstetric outcome of patients with eclampsia
managed with diazepam and those managed after introducing
magnesium sulphate. The obstetric outcome variables included;
Recurrences of seizures, maternal deaths, fetal Apgar scores and
duration of maternal stay under intensive care.
Design: Retrospective cohort study.
Setting: MNH, Dar Es Salaam, Tanzania.
Patients: To select patients for participation in the study the files of
patients were reviewed. Out of a total of 945 pregnant women with
eclampsia who were admitted at MNH during the two study periods, 630
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met the criteria for inclusion in the study. 312 were on diazepam from
January to October 2000 and 318 were on Mgso4 from January to
October 2001.
Methodology: The author compared the observed obstetric variables in
318 patient files that were given MgSo4 with 312 who were given
diazepam. The instructions for loading doses, 24 hours maintenance
therapy and treatment of additional convulsions were according to the
well-defined treatment protocols.
Results: Use of MgSo4 resulted into fewer recurrences of convulsions
than diazepam (14.5% vs. 45.2%, P < 0.01). {The absolute risk reduction
(ARR) of 30.7% converts to a number of eclamptic women who need to
be treated with MgSo4 rather than diazepam to prevent 1 recurrent
convulsion}. A trend toward lower maternal mortality was noted after
introducing MgSo4 than when diazepam was used (3.1% vs. 5.1%, P =
0.21. There was a significant differences in the number of asphyxiated
babies with Apgar scores < 7 at 5 minutes and had less serious infant
morbidity and mortality i.e. (10.5% MgSo4 versus 29.6% diazepam), p
=0.00. Mothers stayed less time under intensive care facilities (65.2
%Mgso4 vs. 37.0 %diazepam), P = 0.00.
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Conclusions: MgSo4 was more effective than diazepam for reducing
)
recurrent convulsions. The use of Mgso4 showed a trend towards
reduced maternal mortality, less stay time under 'intensive care and
better fetal outcome in terms of Apgar score at 5 minutes when it was
used.
Recommendations: Since Mgso4 is more effective and cheaper than
diazepam, should be adopted in places not in use in the management of
eclamptic fits in Tanzania
