Eclampsia is defined as the occurrence of a tonic- clonic seizure in association with a diagnosis of preeclampsia. It is an obstetric emergency and occurs in 1 in 2000 pregnancies and alone accounts for 50,000 maternal deaths worldwide, annually. 50% cases occur postpartum, 25% after 48 hours but it may occur up to 10 days after delivery. Magnesium Sulphate is the drug of choice both for control of fits and preventing further seizures. Commonly used regimens are the IM MgSO4 regimen by Pritchard and, the IV MgSO4 regimen by Zuspan. The present study was done with an aim to compare the efficacy of IM Magnesium Sulphate regimen with IV Magnesium Sulphate regimen for prevention of recurrence of seizure and maternal and fetal outcome.
Material and Methods
The present study was carried out in Katihar medical college and hospital.100 patients presenting with eclamptic fits were included in the study and were randomly allocated to one of the following groups.
Group A:A loading dose of 4 gm IV MgSO4 was given over 5-10 minutes followed by 5 gm MgSO4 deep intramuscular injection in each buttock and a maintenance dose of 5 gm MgSO4 deep intramuscular injection in alternate buttock every 4 hourly.
Group B: A loading dose of MgSO4 4gm slow IV was given over 5-10 minutes followed by 1 gm MgSO4 per hour as continuous intravenous maintenance infusion.
The recurrence of convulsions was comparable in both the groups.. 4 patients in Group IM and 2 patients in Group IV developed convulsions after initiation of treatment.Incidence of loss of knee jerk was significantly higher in Group IM as compared to group IV. Incidence of other parameters of toxicity were comparable between the groups. Maternal and fetal outcome were poor in both the groups but were comparable and no significant differences were observed between the groups.
Both IM and IV regimen are equally effective in controlling the recurrence of eclamptic fits. IM Magnesium Sulphate is associated with a higher incidence of toxicity as evidenced by significantly higher incidence of loss of knee jerk reflux. Both IM and IV regimen are equally effective but IM Magnesium Sulphate is associated with a higher incidence of toxicity.