Obstetric outcome of eclamptic patients managed with diazepam compared with patients managed with magnesium sulphate at Muhimbili National Hospital

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

Vll 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.

V III 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