Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy.
OBJECTIVE
To use individual patient clinical parameters to signal cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders.


METHODS
This was a prospective study using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100 without need for acute antihypertensive therapy, spontaneous diuresis more than 100 mL per hour for no less than 2 hours) to signal cessation of intravenous magnesium sulfate postpartum in gravidas diagnosed with preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation.


RESULTS
Five hundred three patients were enrolled and classified according to American College of Obstetricians and Gynecologists criteria (mild preeclampsia, severe preeclampsia, chronic hypertension with superimposed preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome). Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically different among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups with the median duration of therapy 4 hours (range 2-77 hours). No eclamptic seizures occurred after magnesium discontinuation. Thirty-eight patients (7.6%) required reinstitution of magnesium therapy for 24 hours because of exacerbation of blood pressure (sustained blood pressure more than 160/110) associated with headache or visual changes.


CONCLUSIONS
Clinical criteria, when compared with arbitrary protocols, can be used successfully to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders.
Isler
Christy M
CM
Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Greenville, North Carolina 27858-4354, USA. islerc@mail.ecu.edu
Barrilleaux
P Scott
PS
Rinehart
Brian K
BK
Magann
Everett F
EF
Martin
James N
JN
D000328:Adult; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D053284:Polyunsaturated Alkamides; D011225:Pre-Eclampsia / Q000188:drug therapy; D011247:Pregnancy; D011422:Propionates / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000517:prevention & control*; D012640:Seizures / Q000517:prevention & control*
D053284:Polyunsaturated Alkamides; D011422:Propionates; D008278:Magnesium Sulfate; C037512:3,4-dichlorophenyl propenylisobutylamide