title: Magnesium sulphate versus diazepam for eclampsia.
abstract: BACKGROUND
  Eclampsia, the occurrence of a seizure 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 Group's Trials Register (30 September 2010) and CENTRAL (2010, Issue 3).
  
  
  METHODS
  Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with diazepam for women with a clinical diagnosis of eclampsia.
  
  
  METHODS
  Two authors assessed and extracted data independently.
  
  
  RESULTS
  We have included seven trials, involving 1396 women. Three trials (1030 women) were good quality. Magnesium sulphate was associated with a reduction in maternal death (seven trials;1396 women; risk ratio (RR) 0.59, 95% confidence interval (CI) 0.38 to 0.92) and recurrence of seizures (seven trials;1390 women; RR 0.43, 95% CI 0.33 to 0.55) compared to diazepam. There were no clear differences in other measures of maternal morbidity.There was no clear difference in perinatal mortality (four trials; 788 infants; RR 1.04, 95% CI 0.81 to 1.34) or neonatal mortality (four trials; 759 infants; RR 1.18, 95% CI 0.75 to 1.84). In the magnesium sulphate group, fewer liveborn babies had an Apgar score less than seven at one minute (two trials; 597 babies; RR 0.75, 95% CI 0.65 to 0.87) or at five minutes (RR 0.70, 95% CI 0.54 to 0.90), and fewer appeared to need intubation at the place of birth (two trials; 591 infants; RR 0.67, 95% CI 0.45 to 1.00). There was no difference in admission to a special care nursery (four trials; 834 infants; RR 0.91, 95% CI 0.79 to 1.05), but fewer babies in the magnesium sulphate group had a length of stay more than seven days (three trials 631 babies; RR 0.66, 95% CI 0.46 to 0.96).
  
  
  CONCLUSIONS
  Magnesium sulphate for women with eclampsia reduces the risk ratio of maternal death and of recurrence of seizures, compared with diazepam.
authors.affiliation: Centre for Epidemiology and Biostatistics, University of Leeds, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire, UK, BD9 6RJ.
authors.forename: Lelia
authors.initials: L
authors.lastname: Duley
authors.forename: David J
authors.initials: DJ
authors.lastname: Henderson-Smart
authors.forename: Godfrey Ja
authors.initials: GJ
authors.lastname: Walker
authors.forename: Doris
authors.initials: D
authors.lastname: Chou
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D003975:Diazepam / Q000627:therapeutic use*; D004461:Eclampsia / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
chemical_list: D000927:Anticonvulsants; D008278:Magnesium Sulfate; D003975:Diazepam