title: Situational analysis of facilitators and barriers to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil.
abstract: Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive disorders, including timely access to magnesium sulfate. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system.
  
  
  
  A situational analysis was conducted with two components: a documental analysis on information available at the official websites on the policy, regulation and availability of the medication, plus a cross sectional study with field analysis and interviews with local managers of public obstetric health services in Campinas, in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations using specific questionnaires.
  
  
  
  There was no access to magnesium sulfate in primary care facilities, obstetric care was excluded from urgency services and clinical protocols for professional guidance on the adequate use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals.
  
  
  
  The lack of processes that promote the integration between urgency/emergency care and specialized obstetric care possibly favors the untimely use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates.
authors: Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil.
authors: Fátima Aparecida
authors: FA
authors: Lotufo
authors: Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil. parpinelli@caism.unicamp.br.
authors: Mary Angela
authors: MA
authors: Parpinelli
authors: Sociologist and Full Professor of the Postgraduate Program on Obstetrics and Gynecology, University of Campinas School of Medicine, Campinas, Brazil.
authors: Maria José
authors: MJ
authors: Osis
authors: Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil.
authors: Fernanda Garanhani
authors: FG
authors: Surita
authors: Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil.
authors: Maria Laura
authors: ML
authors: Costa
authors: Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil.
authors: José Guilherme
authors: JG
authors: Cecatti
mesh_terms: D001938:Brazil; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D004461:Eclampsia / Q000188:drug therapy*; D004632:Emergency Medical Services; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006771:Hospitals, Maternity; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D000072440:Public Health Systems Research; D015149:Tocolytic Agents / Q000627:therapeutic use*
chemical_list: D015149:Tocolytic Agents; D008278:Magnesium Sulfate
keywords: Cause-effect diagram; Eclampsia; Magnesium sulfate; Quality of care; Severe preeclampsia