Magnesium sulphate versus lytic cocktail for eclampsia.
BACKGROUND
Eclampsia, the occurrence of a seizure in association with pre-eclampsia, is a rare but serious complication of pregnancy. A number of different anticonvulsants have been used to control eclamptic fits and to prevent further seizures.


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


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010) and the Cochrane Central Register of Trials (The Cochrane Library 2010, Issue 2).


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


METHODS
Two review authors (L Duley and D Chou) assessed trial quality and extracted data.


RESULTS
We included three small trials (total 397 women) of average quality in the review. Magnesium sulphate was associated with fewer maternal deaths (risk ratio (RR) 0.14, 95% confidence interval (CI) 0.03 to 0.59; 3 trials, 397 women) and was better at preventing further seizures (RR 0.06, 95% CI 0.03 to 0.12; 3 trials, 397 women) than lytic cocktail. Magnesium sulphate was also associated with less respiratory depression (RR 0.12, 95% CI 0.02 to 0.91; 2 trials, 198 women), less coma (RR 0.04, 95% CI 0.00 to 0.74; 1 trial, 108 women), and less pneumonia (RR 0.20, 95% CI 0.06 to 0.67; 2 trials, 307 women). There was no clear difference in the RR for any death of the baby (RR 0.35, 95% CI 0.05 to 2.38, random effects; 2 trials, 177 babies).


CONCLUSIONS
Magnesium sulphate, rather than lytic cocktail, for women with eclampsia reduces the RR of maternal death, of further seizures and of serious maternal morbidity (respiratory depression, coma, pneumonia). Magnesium sulphate is the anticonvulsant of choice for women with eclampsia; the use of lytic cocktail should be abandoned.
Duley
Lelia
L
Centre for Epidemiology and Biostatistics, University of Leeds, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire, UK, BD9 6RJ.
Gülmezoglu
A Metin
AM
Chou
Doris
D
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002746:Chlorpromazine / Q000008:administration & dosage; D004338:Drug Combinations; D004461:Eclampsia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D008614:Meperidine / Q000008:administration & dosage; D011247:Pregnancy; D011398:Promethazine / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic
D000927:Anticonvulsants; D004338:Drug Combinations; D008278:Magnesium Sulfate; D008614:Meperidine; D011398:Promethazine; D002746:Chlorpromazine
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