MagnesiumsulphateintheManagementofEclampsiain.docx

Magnesium sulphate in the Management of Eclampsia in Malawi Dr. Chisale Mhango FRCOG 1 NPC Training in MNH Objectives of Use of MgSO4 in the Eclampsia Management To prevent severe pre-eclampsia progressing to eclampsia (life-threatening convulsions). To stop the convulsions of eclampsia. 2 NPC Training in MNH Evidence of Effectiveness of Magnesium sulphate In a series of 300 consecutive cases, of eclampsia, Pritchard in Texas USA achieved 100% survival A 1998 review concluded that it is effective in preventing convulsions in women who have severe pre-eclampsia and in stopping convulsions in eclamptic women. (Obstetrics and Gynaecology, Vol. 92, pp. 883-889). 3 NPC Training in MNH Local guidelines on use of magnesium sulphate Health Centre All pre-eclampsia and eclampsia patients shall be referred to the hospital immediately after admission. Give first dose (correct loading dose) to prevent progression of severe pre-eclampsia to eclampsia or stop fits and then refer to hospital. On the way to hospital patient must be accompanied by an experienced clinician to stabilise patient during transit. Hospital Give MgSO4 to prevent progression of severe pre-eclampsia to eclampsia as per national guidelines depending on whether or not the patient already has a loading dose at source. Follow national protocol for the management of the eclamptic patient 4 NPC Training in MNH Use of Valium NB MgSO4 is the drug of choice in all circumstances – it should always be available at both health centre and hospital levels Give diazepam 10 mg (2 ml) over 2 minutes if Convulsions recur after giving MgSO4 Convulsions occur early in pregnancy There is MgSO4 toxicity MgSO4 is not available 5 NPC Training in MNH Administration of magnesium sulphate Health Centre Loading dose: 4 grams IV (over 5-15 min) plus 10 grams IM, 5 grams IM in each buttock: deep intramuscular injection with 1ml 2% lignocaine or 2ml 1% lignocaine Rationale: Pre-eclampsia can quickly develop into eclampsia Shaking dur