Abbreviated 12-Hour Postpartum Magnesium Sulphate Therapy is Equally Effective and Safer Than Standard 24-Hour Therapy in Preeclampsia With Severe Features: Results From A Randomized Controlled Trial.

Abstract

Objective: Eclampsia is a major life-threatening complication of preeclampsia with severe features leading to significant perinatal and maternal mortality and morbidity. Magnesium sulphate (MgSO₄) is the first-line therapy for eclampsia prevention and treatment, however, its use is associated with serious adverse effects and there is no consensus on the optimal duration of its therapy. This study compares the efficacy and safety of abbreviated 12-hour versus standard 24-hour MgSO₄ therapy during postpartum in patients having preeclampsia with severe features.

Materials and methods: Patients having preeclampsia with severe features were randomized 1:1 into the 12-hour and 24-hour groups. Modified Pritchard regimen was used. The primary outcome was the incidence of seizures. Secondary outcomes included serious maternal morbidity and other adverse effects associated with MgSO₄ use. Perinatal outcomes were also recorded. Analyses were intention-to-treat.

Results: A total of 116 patients [57 (12-hour group) and 59 (24-hour group)] were included. The mean age was 25(±4) years, while the mean gestation period was 34 (±4) weeks. The incidence of seizures was comparable in the two groups [1 (2%), 3 (5%), p=0.62]. Patients in the 12-hour group [1 (2%)] had lesser postpartum drowsiness compared to the 24-hour group [15 (25%), p<0.001] and consequently, lesser problems in breastfeeding [1 (2%) versus 10 (17%), p=0.008]. There were no inter-group differences in other adverse effects including loss of reflexes, oliguria, respiratory depression, and proportion of patients requiring interruption of therapy. Perinatal outcomes were also similar.

Conclusion: In patients having preeclampsia with severe features, 12-hour postpartum MgSO₄ therapy is equally effective in preventing eclampsia and has lesser postpartum drowsiness and problems with breast feeding compared to the standard 24-hour therapy.