Comparative study between magnesium sulfate and phenytoin for prevention of eclampsia in severely pre-eclamptic patients with acute kidney injury

Abstract

Introduction Pre-eclampsia is a pregnancy-specific, multisystem disorder that is characterized by the development of hypertension and proteinuria after 20 weeks of gestation. Acute kidney failure occurs in about 20% of patients with severe pre-eclampsia. Magnesium sulfate is the medication of choice for the prevention of eclamptic seizures in women with severe pre-eclampsia and for the treatment of women with eclamptic seizures. This medication is renally excreted and hence significant renal impairment can result in exaggerated toxicity. Phenytoin was specifically developed as an anticonvulsant and is the most widely prescribed drug for epilepsy worldwide. The aim of this study is to compare magnesium sulfate with phenytoin for prevention of eclampsia in severely pre-eclamptic patients with acute kidney injury. Patients and methods Forty pregnant women were enrolled in the study; all patients had American Society of Anesthesiologists (ASA) physical status of II or III and were proved to have severe pre-eclampsia with acute kidney injury. Patients were allocated randomly into one of two groups (20 patients each). Group A (magnesium sulfate group) included 20 patients who received magnesium sulfate for prophylaxis against eclampsia. Group B (phenytoin group) included 20 patients who received phenytoin for prophylaxis against eclampsia. For each patient, the following data were collected: age, gestational age, body weight, height, occurrence of magnesium or phenytoin toxicity, occurrence of fits, and fetal outcome. Results In terms of the occurrence of fits, we found a statistically significant difference between the magnesium group and the phenytoin group as five patients in the phenytoin group developed fits, whereas none of the patients in the magnesium group developed fits. In this study, we did not find a statistically significant difference between the magnesium group and the phenytoin group in the incidence of magnesium or phenytoin toxicity and fetal outcome. Conclusion The results of this study showed that prophylaxis against eclampsia in severely pre-eclamptic patients with acute kidney injury using magnesium sulfate (adjusted dose) resulted in no toxicity and no fetal effects besides fewer incidences of fits compared with phenytoin.