Intervention Review

Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia

  1. Lelia Duley1,*,
  2. Hosam E Matar2,
  3. Muhammad Qutayba Almerie3,
  4. David R Hall4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 4 AUG 2010

Assessed as up-to-date: 4 JUL 2010

DOI: 10.1002/14651858.CD007388.pub2

Database Title

Additional Information

How to Cite

Duley L, Matar HE, Almerie MQ, Hall DR. Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD007388. DOI: 10.1002/14651858.CD007388.pub2.

Author Information

  1. 1

    University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, UK

  2. 2

    North Middlesex University Hospital Foundation Trust, North Central Thames Foundation School, London, UK

  3. 3

    National Collaborating Centre for Women's & Children's Health, London, UK

  4. 4

    Stellenbosch University and Tygerberg Hospital, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Tygerberg, Western Cape, South Africa

*Lelia Duley, Nottingham Clinical Trials Unit, University of Nottingham, B39, Medical School, Queen's Medical Centre Campus, Nottingham, NG7 2UH, UK. lelia.duley@nottingham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 4 AUG 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen
  5. 摘要

Background

Magnesium sulphate remains the drug of choice for both prevention and treatment of women with eclampsia. Regimens for administration of this drug have evolved over the years, but have not yet been formally evaluated.

Objectives

To assess the comparative effects of alternative regimens for the administration of magnesium sulphate when used for the care of women with pre-eclampsia or eclampsia, or both.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2010).

Selection criteria

Randomised trials comparing different regimens for administration of magnesium sulphate used for the care of women with pre-eclampsia or eclampsia, or both.

Data collection and analysis

All four review authors assessed trial quality and extracted data independently.

Main results

We identified 17 studies of which six (866 women) met the inclusion criteria: two trials (451 women) compared regimens for women with eclampsia and four (415 women) for women with pre-eclampsia.

Treatment of eclampsia: one trial compared loading dose alone with loading dose plus maintenance therapy for 24 hours (401 women). There was no clear difference between the groups in the risk ratio (RR) of recurrence of convulsions (RR 1.13, 95% confidence interval (CI) 0.42 to 3.05) or stillbirth (RR 1.13, 95% CI 0.66 to 1.92), and the CIs are wide. One trial compared a low dose regimen with a standard dose regimen over 24 hours (50 women). This study was too small for any reliable conclusions about the comparative effects.

Prevention of eclampsia: one trial compared intravenous with intramuscular maintenance regimen for 24 hours (17 women). This trial was too small for any reliable conclusions. Three trials compared short maintenance regimens postpartum with continuing for 24 hours after the birth (398 women), even taken together these trials were too small for any reliable conclusions.

Authors' conclusions

Although strong evidence supports the use of magnesium sulphate for prevention and treatment of eclampsia, trials comparing alternative treatment regimens are too small for reliable conclusions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen
  5. 摘要

Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia

This review found that not enough research has been carried out to show what is the best dose for magnesium sulphate for women with pre-eclampsia or eclampsia, and how best to give it.

Pre-eclampsia (or toxaemia) is a disorder that is usually associated with raised blood pressure (hypertension) and protein in the urine. It can occur at any time during the second half of pregnancy or in the first few weeks after delivery. Magnesium sulphate is effective in preventing eclampsia (a fit or seizure) in women who have pre-eclampsia, and for treating women who experience an eclamptic convulsion. The review authors included six trials (866 women). Two of the trials (451 women) recruited women with eclampsia and four trials (415 women) recruited women with pre-eclampsia. These randomised trials are too small to give reliable guidance on the advantages or disadvantages of the different regimens used. The included studies were carried out in both high-income and low-income countries.

 

Resumen

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  2. Abstract
  3. Plain language summary
  4. Resumen
  5. 摘要

Antecedentes

Regímenes alternativos de sulfato de magnesio para mujeres con preeclampsia y eclampsia

El sulfato de magnesio sigue siendo el fármaco preferido, tanto para la prevención como para el tratamiento en mujeres con eclampsia. Los regímenes para la administración de este fármaco han evolucionado con el transcurso de los años, aunque todavía no se han evaluado formalmente.

Objetivos

Evaluar los efectos comparativos de los regímenes alternativos para la administración de sulfato de magnesio al utilizarlo para la atención de las mujeres con preeclampsia o eclampsia, o ambas.

Estrategia de búsqueda

Se hicieron búsquedas en el registro de ensayos del Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group) (junio 2010).

Criterios de selección

Ensayos aleatorios que compararan diferentes regímenes para la administración de sulfato de magnesio para la atención de las mujeres con preeclampsia o eclampsia, o ambas.

Obtención y análisis de los datos

Los cuatro autores de la revisión evaluaron la calidad de los ensayos y extrajeron los datos de forma independiente.

Resultados principales

Se identificaron 17 estudios de los cuales seis (866 mujeres) cumplieron los criterios de inclusión: dos ensayos (451 mujeres) compararon los regímenes para las mujeres con eclampsia y cuatro (415 mujeres) para las mujeres con preeclampsia.

Tratamiento de la eclampsia: un ensayo comparó la dosis de inicio sola con la dosis de inicio más tratamiento de mantenimiento durante 24 horas (401 mujeres). No hubo una diferencia clara entre los grupos en el cociente de riesgos (CR) de la recurrencia de las convulsiones (CR 1,13; intervalo de confianza [IC] del 95%: 0,42 a 3,05) o la mortinatalidad (CR 1,13; IC del 95%: 0,66 a 1,92), y los IC son amplios. Un ensayo comparó un régimen de dosis baja con un régimen de dosis estándar durante 24 horas (50 mujeres). Este estudio fue demasiado pequeño para establecer cualquier conclusión fiable acerca de los efectos comparativos.

Prevención de la eclampsia: un ensayo comparó un régimen de mantenimiento intravenoso versus intramuscular durante 24 horas (17 mujeres). Este ensayo fue demasiado pequeño para establecer conclusiones fiables. Tres ensayos compararon regímenes cortos de mantenimiento posparto con regímenes durante 24 horas después del parto (398 mujeres); incluso al considerar estos ensayos juntos, fueron demasiado pequeños para establecer conclusiones fiables.

Conclusiones de los autores

Aunque existen pruebas sólidas que apoyan el uso de sulfato de magnesio para la prevención y el tratamiento de la eclampsia, los ensayos que comparan los regímenes alternativos de tratamiento son demasiado pequeños para establecer conclusiones fiables.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen
  5. 摘要

背景

硫酸鎂於子癇前症和子癇症女性的給藥選擇方案

硫酸鎂一直是預防與治療子癇症孕婦的藥物之一，它的給藥方式隨著時代不斷演變，卻仍未正式地被審視。

目標

評估硫酸鎂給藥的選擇方案，在照護子癇前症或子癇症 (或兩者同時) 孕婦的相對效果。

搜尋策略

我們搜尋了截至2010年6月的Cochrane Pregnancy and Childbirth Group's Trials Register。

選擇標準

比較硫酸鎂用於照護子癇前症或子癇症 (或兩者同時) 孕婦時的給藥方式之隨機對照試驗。

資料收集與分析

四位作者獨立地評估試驗的品質並擷取資料。

主要結論

我們共找到17篇研究，其中6篇 (866位孕婦) 符合選取標準，有2個試驗的治療對象是子癇症孕婦 (451人) ，另外4個試驗則是子癇前症孕婦 (415人) 。就治療子癇症而言，有一個試驗 (401人) 比較了單獨負載劑量和負載劑量加上24小時維持性治療，發現兩組在痙攣復發 (相對危險性RR = 1.13，95% 信賴區間CI: 0.42 – 3.05) 或死產 (RR = 1.13，95% CI: 0.66 – 1.92) 的相對危險性皆沒有明顯差別，且信賴區間都很寬；另一個試驗 (50人) 則比較低劑量與標準劑量給藥經24小時的差別，但此研究的規模太小，無法就相對效果做出可靠的結論。就預防子癇症而言，有一個試驗比較靜脈注射和肌肉注射24小時維持性治療，但規模太小無法提供可靠結論；三個試驗 (398人) 比較了產後24小時短期維持性治療，即使將三個試驗的人數加起來，規模仍小因而無法得出可靠結論。

作者結論

僅管支持以硫酸鎂預防和治療子癇症的證據非常強，比較不同給藥方案的試驗規模都太小，不足以獲得可靠的結論。

翻譯人

本摘要由劉家毓翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

硫酸鎂於子癇前症和子癇症女性的給藥選擇方案：本篇回顧發現，目前的研究還不足以了解硫酸鎂治療子癇前症或子癇症孕婦的最佳劑量和最佳途徑。子癇前症 (或稱妊娠毒血症) 的症狀通常為血壓升高和尿液中出現蛋白，它可能發生在懷孕後半期的任何時刻，或是在生產後的頭幾週。硫酸鎂能有效地預防子癇前症孕婦的子癇發作，以及治療發生子癇痙攣的女性。本回顧的作者共搜選了6個試驗 (866名女性) ，其中2個試驗 (451人) 的受試者為子癇症孕婦，另外4個 (415) 則是子癇前症孕婦。這些隨機對照試驗的規模都太小，因而無法就不同給藥方式的優缺點提供可靠的指引。本回顧選取的研究涵蓋了高所得和低所得國家。

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