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.