JOURNAL

READING
A shortened postpartum magnesium sulfate
prophylaxis regime in pre-eclamptic women at low
risk of eclampsia
Lalthakimi Darngawn, Rubi Jose, Anni Regi , Ramandeep Bansal, Laxmanan Jeyaseelan

Agnia Rahmani 1507101030xxx

Ressi Maulina 1507101030xxx
Winda Nurjanah 1507101030057

Supervisor:
Niken Asri Utami,
dr.OBSGYN

INTRODUCTION
Pre-eclampsia is a
pregnancy-specific
multisystem disorder, is
characterized
by the development of
hypertension and
proteinuria after 20 weeks
of gestation

BACKGROUND

MgSO4
optimal drug
for seizure
prophylaxis

The primary aim of

treatment in
preeclampsia is to
prevent eclamptic
seizures, and resultant
morbidity and
mortality

Traditionally,
seizure
prophylaxis is continued
postpartum, usually for
1224 hours, because
25%
of
eclamptic
seizures occur during
the
postpartum
period with greatest risk
in the first 12 to 24 hours

INTRODUCTION
muscle
weakness
flushing

flushing

MgSO
dizziness
irritation
at the
injection
site

nausea
and
vomiting

feeling of
warmth

In BACKGROUND
1998, Ascarelli
Isler et al. evaluated an
et al. suggested
individualized protocol for
an
individually
postpartum MgSO4 therapy
determined
in 495 women based on
postpartum
blood pressure, use of anti
MgSO4
protocol
hypertensive
drugs,
based on clinical
diuresis,
and
maternal
parameters
for
symptoms.
treating patients
The resultant limited
withshorter preduration of MgSO4
eclampsia.
stay in
the
labor
and
delivery
unit.

exposure, costsavings, and

decreased patient
discomfort and
inconvenience

BACKGROUND
to see
AIM

complain
of
minor
adverse
efects,

whether all
such
women
need
MgSO4 for
24
hours ????
Intensive
monitoring
takes up the
time of
doctors and
nursing staf

stopping the
drug for
selected
women
without
putting them
at an
ncreased risk
of eclampsia
Reduced
adverse
efects
and
save
resources.

METHODOLOGY

PLACE

randomized open clinical trial conducted in

a tertiary care center in Vellore, India

TIME

between September 1, 2008, and April 20, 2010

150 women with pre-eclampsia were randomized eit

to continue or to discontinue postpartum MgSO4 fo
RESPONDEN
seizure prophylaxis.

METHODOLOGY

INCLUSION

EXCLUSION

Women with severe PE

More than 20 weeks
Received intrapartum
and postpartum MgSO4
After 6 hours :
BP 150/100 mm Hg,
Proteinuria +1,
No symptoms of
impending eclampsia

All women gave

written informed
consent, then deny
to be participant in
this study

METHODOLOGY
Intervention Group

Control Group
MgSO4 continuation
group for 24 hours
Urinary catheter was
put in place
The WongBaker pain
scale to assess pain
at the injection site
Monitoring of MgSO4
toxicity

MgSO4 discontinu
after 6 hours of
delivery
Urinary catheter was
left in place
The WongBaker pain
scale to assess pain
at the injection site
Monitoring of MgSO4
toxicity

RESULTS

RESULTS

DISKUSI
In this study, MgSO4 was reinstituted for only
1 out of 75 women (1.3%) in the intervention
group (P<0.001).
Regarding the secondary outcomes, no
eclampsia occurred in either group
The time that doctors spent monitoring the
women was
significantly less in the intervention group
than in the control group (P<0.001)
Time spent by the nurses in giving MgSO4
injections and care thereafter was significantly
less in the intervention group (P<0.001)

DISKUSI
Intramuscular injections are associated with a
lot of pain at the injection site; thus, it is our
standard practice to mix MgSO4 with 2%
xylocaine. The resultant 10 mL of preparation
can cause abscesses
Pain felt by the women due to MgSO4 injection
was found to be significantly less in the
intervention group than in the control group
(P<0.001), and women in the intervention
group were better able to look after
themselves
By not administering postpartum MgSO4 to
women in the intervention group, US $7 was
saved per patient. This finding is consistent
with those of Ascarelli et al. Who reported
cost savings of US $480 per patient with a
shortened regime of postpartum MgSO4 in
their study at the University of Mississippi
Medical Center, USA.

SUMMARY
A shortened (6-hour) regime of postpartum
MgSO4 for seizure prophylaxis is a suitable
alternative to the 24-hour regime, and is
feasible for women at low risk for postpartum
eclampsia.
However, a larger number of women with preeclampsia should be studied to come to a
robust conclusion about a shortened
postpartum MgSO4 regime.

THANK YOU