Alternative Magnesium Sulphate Regimen for Women with Severe Pre-Eclampsia in Elgadarif Maternity Hospital from January 2016 to January 2017

Dr Fatima .B. A. Basheer¹, Dr Ashwag. A. A .Hamad², Dr Tabareh. S .A .Awadelkrem³

 

*Correspondence to: Dr Fatima .B. A. Basheer.

Copyright     

© 2024 Dr Fatima .B. A. Basheer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 25 October 2024

Published: 26 November 2024

DOI: https://doi.org/10.5281/zenodo.14221884

Introduction

Many women are still dying from complications of pregnancy despite global efforts to reduce the maternal death by 75% by 2015. It was estimated that 287000 women died in 2010, a 47% reduction in maternal mortality rate which is far from the 75% target, Ninety nine percent of these deaths occurred in developing countries , whith sub-sahara A frica alone contributing to 56% ( 161000 daeths ) (1) , the major causes of maternal death remaine the same and they include obstetric hemorrhage , sepsis,

 

Risk factors

According to Cunningham FG et al (13) , in etiology pf pre=eclampsia include : maternal immunological intolerance , cardiovascular and inflammatory changes , abnormal implantation. In addition, environmental , geneyics and nutritional.

 

Complications

•           Premature birth, low birth weight, or placental abruption

•           Fluid in the lungs, heart failure, or bleeding from the liver

•           Seizures, stroke, or reversible blindness

•           Liver or kidney damage, or low platelet count

•           Fetal growth restriction or death of the mother or the baby of Mgso4 in pre-eclampsia

 

Justification

Study design: Prospective , interventional cross sectional hospital base study

Study area: Algadaref maternity hospital regarded the referral hospital in al gadaref state, with capacity of 200 bed , with average of as 8,894/ year deliveries, eclampsia patients seen are estimated as( 5/1,000)

 

Objectives

To compare the use of mgso4 for 12 hrs versus 24 hrs in women with severe preeclampsia.

Methodology

Study Period : the study was conducted during the period from Jan 2016 to December 2016.

Study Population: all women in Algadarif maternity hospital and diagnosed with severe pre eclampsia during the study period.

 

Inclusion criteria :

Severe-pre eclampsia

the women who agree to join the study

Exclusion criteria

Women who refused to join the study

Sample size and sampling technique: All patients was diagnosed as sever pre-eclampsia antenatally, intrapartum or post partum with high pressures.

Data variables : demographic characteristics , parity , GA , mode of delivery , magnesium sulfate dose.

 

Method and data collection :

The data was collected by using a questionnaire from the patients, hospital records or staff interviews. In which the selection of the patient was by randomized selection method included all patient that presented to the labor room , ER and out patient clink . concent was given explaining the method of the treatment either 24 hrs. or 12 hrs.

The patient were admitted in the HDU , catheterized and the mgso4 was given by the rate of 1 g/hr for 24 hr or 12 hrs accordingly by an infusion pump.

 

Data analysis:

The data was analyzed by computerized program ;statistical package for social sciences (SPSS version 19 ). result presented in tables and graphs. The test of significance was calculated by P value of (0,05) and 05% confidence interval .

 

Results

Please click here to view all images

 

Discussion

A systemic review has compared the pregnancy outcome in the case of MgSO4 presentation in deferent countries and showed that MgSO4 could reduce the maternal mortality and occurrence of convulsions , repeating convulsions and major morbidities in all of these countries.

In this prospective trial we have found that a12 hrs MgSO4 in the cases of svere pre eclampsia is associated with clinical course similer to that of traditional 24 hrs of planned treatment , significantly reducing the duration of MgSO4 exposure and the need for intensive nursing care.

In the present study , MgSO4 administration for duration of 12 hrs after delivery was effective in preventing convulsions in 49 women with severe preeclampsia except one. Shorting of the duration of MgSO4 prescription after delivery in cases of severe pre eclampsia and eclampsia can reduce the risk of magnesium sulfate toxicity and it is adverse effect and as well it is economically beneficial specially in developing countries.

Therefore, it seem necessary to perform studies for the finding mimum duration and dosage of MgSO4 in order to prevent convulsions after delivery .

Using various regimen of MgSO4, prescription has been studied during past year ; however up to now there is no consensus on optimal duration of administration after delivery and changing the present policy from 24 hrs to 12 hrs

In 2006 two methods of 12 hrs VS 24 hrs admenstration of MgSO4 after delivery were compaired in cases with mild pre eclampsia and no cases of serious complication was reported in the 12 hrs group (68)

•Also in another study (70) , using MgSO4 for 12 hrs after delivery in cases of stable severe preeclampsia was evaluated and was compaired with standered metod of 42 hrs duration . Clinical outcomes were similer between the two groups of 12 hrs and 24 hrs .

•No cases of eclampsia were reported and there was no necessary to restart MgSO4 but In three patint sout of 60 patients there was necessary to administer MgSO4 FOR 24 HR S

•In the present study , one of 50 patients had convulsion and we continue the MgSO4 for another 24 hrs according to the MgO4 intrnatunal protocol ( continue for 24 hrs after delivery or the convulsion whatever the last ) but at the same time 49 women have no serious complications compaired with whome recived 24 hrs MgSO4 .

• Notice that this number of convulsion can occure in the 24 hrs duration of MgSO4 as well .

With respect to the previous studies , and paucity of researches about the MgSO4 administration after delivery in the caese of severe pre eclampsia , it seem necessary to perform mor studies in order to find exact criteria to differentiate which patient need 24 hrs duration of MgSO4 administration and in whc=ich cases there is no need to continue

 

Also it has to be studies that for which group of patients it is harmful to discontinue Mgso4 in shorter duration

The sample size is small to make a definite conclusion about safty of discontinuing MgSO4 at 12 therefore mor studies wit bigger sample size shoul be berformaed in order to reach definite conclusion

 

Conclusion

Abbreviated MgSO4 in patient with severe pre eclampsia was associated with less drug exposure , similar outcome , and benefits such as reduction in the time that the mother can start to handle her baby, decrease time of HDU admission and monitoring as well as decrease the staff exhaustion, insure early mobilization and removal of the catheter and decrees time and cost for hospital stay

 

Recommendations

1. Further studies are needed to establish this regimen to be safely conducted in the hospitals.

2. MgSO4 it could be the leading cause of deathin some cases specially in developing countries so more studies regarding the ways that can decrees it is complication should be performed.

 

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