Abstract:
Abstract
Background.
Magnesium sulfate is used
widely to prevent eclamptic seizures in pregnant women
with hypertension, but few studies have compared the efficacy
of magnesium sulfate with that of other drugs. Anticonvulsant
prophylaxis with phenytoin for eclampsia has
been recommended, but there are virtually no data to
support its efficacy. Our objective was to compare magnesium
sulfate with phenytoin in preventing seizures in
hypertensive women during labor.
Methods.
We randomly assigned women with hypertension
who were admitted for delivery to receive either
magnesium sulfate or phenytoin. The magnesium sulfate
regimen consisted of a 10-g intramuscular loading dose
followed by a maintenance dose of 5 g given intramuscularly
every four hours. For women with severe preeclampsia,
an additional 4-g loading dose was given intravenouslyThe phenytoin regimen included a 1000-mg loading
dose infused over a period of 1 hour, followed by a 500-
mg oral dose 10 hours later. With either regimen, anticonvulsant
therapy was continued for 24 hours post partum.
Results.
Ten of 1089 women randomly assigned to
the phenytoin regimen had eclamptic convulsions, as
compared with none of 1049 women randomly assigned
to magnesium sulfate (P
0.004). There were no significant
differences in any risk factors for eclampsia between
the two study groups. Maternal and infant outcomes were
also similar in the two study groups.
Conclusions.
Magnesium sulfate is superior to phenytoin
for the prevention of eclampsia in hypertensive
pregnant women. These results validate the long-practiced
use of magnesium sulfate in the prevention of eclampsia.
