Magnesium sulphate versus diazepam for eclampsia.
BACKGROUND
Eclampsia, the occurrence of a convulsion in association with pre-eclampsia, remains a rare but serious complication of pregnancy. A number of different anticonvulsants are used to control eclamptic fits and to prevent further fits.


OBJECTIVE
The objective of this review was to assess the effects of magnesium sulphate compared with diazepam when used for the care of women with eclampsia. Magnesium sulphate is compared with phenytoin and with lytic cocktail in other Cochrane reviews.


METHODS
We searched the Cochrane Pregnancy and Childbirth trials register (28 November 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002).


METHODS
Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with diazepam for women with a clinical diagnosis of eclampsia.


METHODS
Both reviewers assessed and extracted data.


RESULTS
Seven trials involving 1441 women are included. Most of the data are from trials of good quality. Magnesium sulphate is associated with a reduction in maternal death when compared to diazepam (six trials 1336 women; relative risk (RR) 0.59, 95% confidence interval (CI) 0.37 to 0.94). There is also a substantial reduction in the risk recurrence of further fits (seven trials 1441 women; RR 0.44, 95% CI 0.34 to 0.57). There were few differences in any other measures of outcome, except for fewer Apgar scores less than seven at five minutes (two trials 597 babies; RR 0.72, 95% CI 0.55 to 0.94) and fewer babies with a length of stay in special care baby unit more than seven days (three trials 631 babies; RR 0.66, 95% CI 0.46 to 0.95) associated with magnesium sulphate.


CONCLUSIONS
Magnesium sulphate appears to be substantially more effective than diazepam for treatment of eclampsia.
Duley
L
L
Resource Centre for Randomised Trials, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF. lelia.duley@ndm.ox.ac.uk
Henderson-Smart
D
D
D000927:Anticonvulsants / Q000627:therapeutic use*; D003975:Diazepam / Q000627:therapeutic use*; D004461:Eclampsia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D000927:Anticonvulsants; D008278:Magnesium Sulfate; D003975:Diazepam