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BJOG. 2017 Nov;124(12):1883-1890. doi: 10.1111/1471-0528.14400. Epub 2016 Nov 24.

Clinical practice patterns on the use of magnesium sulphate for treatment of pre-eclampsia and eclampsia: a multi-country survey.

Author information

1
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
2
King Edward Memorial Hospital for Women, Perth, WA, Australia.
3
Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
4
Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
5
Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya.

Abstract

OBJECTIVE:

To characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO4 ) for eclampsia prevention and treatment in a multi-country network of health facilities and compare with international recommendations.

DESIGN:

Cross-sectional survey.

SETTING:

A total of 147 health facilities in 15 countries across Africa, Latin America and Asia.

POPULATION:

Heads of obstetric departments or maternity units.

METHODS:

Anonymous online and paper-based survey conducted in 2015.

MAIN OUTCOME MEASURES:

Availability and use of MgSO4 ; availability of a formal clinical protocol for MgSO4 administration; and MgSO4 dosing regimens for eclampsia prevention and treatment.

RESULTS:

Magnesium sulphate and a formal protocol for its administration were reported to be always available in 87.4% and 86.4% of all facilities, respectively. MgSO4 was used for the treatment of mild pre-eclampsia, severe pre-eclampsia and eclampsia in 24.3%, 93.5% and 96.4% of all facilities, respectively. Regarding the treatment of severe pre-eclampsia, 26.4% and 7.0% of all facilities reported using dosing regimens that were consistent with Zuspan and Pritchard regimens, respectively. Across regions, intramuscular maintenance regimens were more commonly used in the African region (45.7%) than in the Latin American (3.0%) and Asian (22.9%) regions, whereas intravenous maintenance regimens were more often used in the Latin American (94.0%) and Asian (60.0%) regions than in the African region (21.7%). Similar patterns were found for the treatment of eclampsia across regions.

CONCLUSIONS:

The reported clinical use of MgSO4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations.

TWEETABLE ABSTRACT:

MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.

KEYWORDS:

dosing regimen; eclampsia; low- and middle-income settings; magneisum sulphate; pre-eclampsia

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