Magnesium sulphate versus Phenytoin in eclampsia - Maternal and Foetal outcome – A comparative study
Jayeeta Roy, Jayanta Kumar Mitra, Arnab Pal
Abstract
Background
Eclampsia manifests as seizures and is unique to the pregnant state. It remains an important cause of maternal mortality especially in resource-challenged countries that lack access to prenatal care.
Aims
The aim of our study was to compare maternal and foetal outcomes in mothers with eclampsia with the administration of either magnesium sulphate or phenytoin in a resource- challenged situation.
Method
The work was conducted from January 2012 to December 2012. A total of 80 patients were assigned alternately to two groups – one group was treated with magnesium sulphate (Group-M; n=40), and the other treated with phenytoin (Group-P; n=40) (Figure 1). The magnesium sulphate was administered according to the Pritchard’s regimen; phenytoin administered according to Ryan’s regimen. With either regimen, anticonvulsant therapy was continued for 24 hours postpartum or 24 hours after the last convulsion, whichever was later.
Results
Fifty-four percent of patients regained consciousness within 8 hours of treatment onsetin Group-P compared to 5.3 percent in Group-M (p=0.0001, χ2=19.24). Seven patients in Group-P had recurrence of convulsions as compared to none of the 40 women assigned to Group-M (p=0.032, χ2=4.62). The incidence of Caesarean section was greater (62.5 per cent) in Group-M compared to Group-P (25 per cent; p=0.001, χ2= 9.96). No statistically significant differences were found in the foetal outcomes between the two groups.
Conclusion
Phenytoin use may be reconsidered in selective cases in low and middle income countries (LMIC) as it has been found simpler to use, has several benefits and also curtails treatment cost. Magnesium sulphate is substantially more effective than phenytoin with regard to recurrence of convulsions. Proper training in the management of eclampsia should be given to all health care workers to ensure appropriate management of eclamptic mothers. Thus, the treatment of this disease calls for more research work especially in the resource challenged settings.
Full Text:
Eclampsia manifests as seizures and is unique to the pregnant state. It remains an important cause of maternal mortality especially in resource-challenged countries that lack access to prenatal care.
Aims
The aim of our study was to compare maternal and foetal outcomes in mothers with eclampsia with the administration of either magnesium sulphate or phenytoin in a resource- challenged situation.
Method
The work was conducted from January 2012 to December 2012. A total of 80 patients were assigned alternately to two groups – one group was treated with magnesium sulphate (Group-M; n=40), and the other treated with phenytoin (Group-P; n=40) (Figure 1). The magnesium sulphate was administered according to the Pritchard’s regimen; phenytoin administered according to Ryan’s regimen. With either regimen, anticonvulsant therapy was continued for 24 hours postpartum or 24 hours after the last convulsion, whichever was later.
Results
Fifty-four percent of patients regained consciousness within 8 hours of treatment onsetin Group-P compared to 5.3 percent in Group-M (p=0.0001, χ2=19.24). Seven patients in Group-P had recurrence of convulsions as compared to none of the 40 women assigned to Group-M (p=0.032, χ2=4.62). The incidence of Caesarean section was greater (62.5 per cent) in Group-M compared to Group-P (25 per cent; p=0.001, χ2= 9.96). No statistically significant differences were found in the foetal outcomes between the two groups.
Conclusion
Phenytoin use may be reconsidered in selective cases in low and middle income countries (LMIC) as it has been found simpler to use, has several benefits and also curtails treatment cost. Magnesium sulphate is substantially more effective than phenytoin with regard to recurrence of convulsions. Proper training in the management of eclampsia should be given to all health care workers to ensure appropriate management of eclamptic mothers. Thus, the treatment of this disease calls for more research work especially in the resource challenged settings.
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