title: Magnesium sulphate for the management of preeclampsia and eclampsia in low and middle income countries: a systematic review of tested dosing regimens.
abstract: OBJECTIVE
  To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment).
  
  
  METHODS
  We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications.
  
  
  METHODS
  Our search yielded 753 publications, of which 26 (10 randomized controlled trials and 16 observational studies) evaluated MgSO4 for preeclampsia and/or eclampsia in World Bank-classified LMICs.
  
  
  METHODS
  Independent, by two authors.
  
  
  RESULTS
  Twenty-five studies were conducted in hospital settings and one in the community. Rates of eclampsia were usually < 5% (median 3.0%, range 0.0% to 26.5%) even when MgSO4 was administered for eclampsia. When dosage varied from the standard Pritchard or Zuspan regimens, almost all (n = 22) reduced the dose or duration of treatment, most commonly because of concerns about maternal safety, cost, or resource availability. Four trials of a loading dose only (4 g IV + 10 g IM) versus loading plus maintenance dosing of 5 g/4 hr IM found no difference in eclampsia recurrence (RR 1.64; 95% CI 0.48 to 5.65, n = 396). One study documented less eclampsia recurrence associated with community administration of a MgSO4 loading dose before referral to a care facility versus treatment in a care facility (RR 0.23; 95% CI 0.11 to 0.49, n = 265).
  
  
  CONCLUSIONS
  Use of MgSO4 for eclampsia treatment and prevention has been well-studied in LMICs, but concern remains about potential toxicity. Further studies are needed to identify the minimum effective dosage of MgSO4 for management of preeclampsia and eclampsia and whether MgSO4 loading can be safely administered in the community.
authors: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors: Rebecca
authors: R
authors: Gordon
authors: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC.
authors: Laura A
authors: LA
authors: Magee
authors: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC.
authors: Beth
authors: B
authors: Payne
authors: Department of Medicine, University of British Columbia, Vancouver BC.
authors: Tabassum
authors: T
authors: Firoz
authors: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC.
authors: Diane
authors: D
authors: Sawchuck
authors: Child and Family Research Institute, University of British Columbia, Vancouver BC.
authors: Domena
authors: D
authors: Tu
authors: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors: Marianne
authors: M
authors: Vidler
authors: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors: Dane
authors: D
authors: de Silva
authors: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC.
authors: Peter
authors: P
authors: von Dadelszen
mesh_terms: D017954:Africa South of the Sahara; D001208:Asia; D004461:Eclampsia / Q000188:drug therapy* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007182:Income; D016239:MEDLINE; D008278:Magnesium Sulfate / Q000008:administration & dosage* / Q000009:adverse effects; D011203:Poverty; D011225:Pre-Eclampsia / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D008278:Magnesium Sulfate
keywords: anticonvulsants; developing countries; eclampsia; magnesium sulfate; preeclampsia