title: Blood loss at cesarean delivery in women on magnesium sulfate for preeclampsia.
abstract: OBJECTIVE
  To evaluate the effect of magnesium sulfate for prevention of eclampsia on blood loss at time of cesarean delivery (CD).
  
  
  METHODS
  We conducted an electronic based search using the following databases: MEDLINE, PUBMED and the Cochrane Library. The search terms were "magnesium sulfate", "preeclampsia" and "randomized". Inclusion criteria were randomized controlled trials of women with preeclampsia who delivered with or without magnesium sulfate therapy for seizure prophylaxis. Only trials with placebo or no treatment comparison groups were included. Primary outcome was postpartum hemorrhage. Secondary outcomes were estimated blood loss, change in hemoglobin, blood transfusion and eclampsia.
  
  
  RESULTS
  Five trials met inclusion criteria. The incidence of postpartum hemorrhage was similar between the two groups [magnesium sulfate: 754/4482 (17%); no magnesium sulfate: 775/4427 (18%); RR 0.97, 95% CI 0.88-1.06]. There was no statistical difference between any of the other blood loss outcomes reported in the included studies. The rate of eclampsia with magnesium sulfate was significantly lower than with placebo (42/5604, 0.7%, versus 107/5600, 1.9%; RR 0.40, 95% CI 0.28-0.57).
  
  
  CONCLUSIONS
  Magnesium sulfate does not appear to affect blood loss intrapartum and postpartum in women with preeclampsia. Magnesium sulfate, therefore, should be continued during CD, given the benefit of seizure prophylaxis without any increased risk of hemorrhage.
authors.affiliation: a Department of Obstetrics and Gynecology , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Nora M
authors.initials: NM
authors.lastname: Graham
authors.affiliation: a Department of Obstetrics and Gynecology , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Alexis C
authors.initials: AC
authors.lastname: Gimovsky
authors.affiliation: a Department of Obstetrics and Gynecology , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Roman
authors.affiliation: a Department of Obstetrics and Gynecology , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000009:adverse effects*; D006473:Postpartum Hemorrhage / Q000139:chemically induced*; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
chemical_list: D000927:Anticonvulsants; D008278:Magnesium Sulfate
keywords: Hemorrhage; magnesium sulfate; preeclampsia