Prise En Charge Des Manifestations Neurologiques De La Pre- Eclampsie Severe Et De L\'eclampsie Par Le Sulfate De Magnesium A Cotonou

Le sulfate de magnesium(MgSO4) utilise depuis des decennies aux USA est reconnu plus efficace que le diazepam ou les phenytoines dans la prevention et le traitements des crises d\'eclampsie, responsables d\'une mortalite elevee. Objectif Evaluer l\'efficacite et la tolerance du MgSO4 en milieu africain a Cotonou(BENIN) ou la frequence et la letalite dues a l\'eclampsie demeurent des plus elevees. Materiel et methode Il s\'agissait d\'une etude a la fois retrospective et prospective a visee descriptive et analytique menee pendant 30 mois a l\'Hopital de la Mere et Enfant Lagune(HOMEL) de Cotonou. L\'echantillon etait constitue de patientes presentant une pre- eclampsie severe ou une eclampsie et qui etaient traitees par MgSO4 en dose d\'attaque et d\'entretien. L\'administration du produit etait rigoureusement surveillee afin de diagnostiquer un surdosage. L\'efficacite de MgSO4 etait evaluee sur l\'amendement des signes neurologiques, le score d\'APGAR a 1 et 5 mn de vie, la morbidite et la mortalite maternelles et neonatales etant comparees a celles rapportees dans une serie de 2001a l\'HOMEL. Resultats 760 cas sur 17.753 accouchements etaient colliges (4,28% des accouchements ) ; 211 (âge moyen 24,74 ans) etaient traites par du MgSO4. Les pressions arterielles systolique et diastolique etaient comprises respectivement entre 160- 200 et 110- 120 mm Hg dans 83 et 86% des cas, accompagnees de crises convulsives(63%), d\'obnubilation et de coma (13 et 12% respectivement) • L\'efficacite du MgSO4 etait nette en termes d\'amendement complet des crises convulsives (54% des cas) des l\'administration de la dose d\'attaque. Le score d\'APGAR etait satisfaisant a la 1ere et 5eme mn de vie respectivement chez 69 et 84% des nouveaux- nes. La mortalite neonatale et la letalite maternelle (de 4 et 0,94% respectivement) etaient ameliorees par rapport aux taux d\'une serie de 2001 (de 20,8 et 8,05% respectivement) a l\'HOMEL de Cotonou avant l\'introduction du MgSO4. Conclusion Le sulfate de magnesium sous reserve d\'une surveillance clinique rigoureuse etait reellement efficace sur les manifestations neurologiques de la pre- eclampsie severe et de l\'eclampsie. The sulphate of magnesium(MgSO4) used since decades in USA is recognized more efficient than diazepam or phenytoins in the prevention and the treatment of the eclampsia seizures, responsible of an elevated mortality. Objectif To Value the efficiency and the tolerance of MgSO4 in African environment in Cotonou(BENIN) where the frequency and the lethality due to eclampsia stay of the most elevated. Material and method It was a retrospective and prospective, analytic and descriptive survey achieved during 30 months in the Mother and Child Hospital Lagoon(HOMEL) of Cotonou. The sample was constituted of patients presenting preeclampsia and eclampsia neurological symptoms and who were treated by MgSO4 in attack and maintenance dose. The treatment was supervised to diagnose overdose. The efficiency of MgSO4 was valued on the neurological sign amendment, the score of APGAR at 1 and 5 min. of life, the maternal and neonatal morbidity and mortality and neonatales being compared to those returned in a set of 2001at the HOMEL. Results 760 cases on 17.753 childbirths were collected (4,28% of the childbirths); 211 (middle age of 24,74 years) were treated by MgSO4. Systolic and diastolic arterial blood pressures were consisted respectively between 160 - 200 and 110 - 120 Hgs mm in 83 and 86% of the cases, accompanied by seizures(63%), obnubilation and coma (13 and 12% respectively). The efficiency of MgSO4 was clean in terms of complete amendment of the seizures (54%) since the administration of the attack dose. The score of APGAR was satisfactory at the 1st and 5th minites of life respectively at 69 and 84% of the new - born. The neonatal mortality and the maternal lethality (of 4 and 0,94% respectively) were improven in relation to the rates of a set of 2001 (of 20,8 and 8,05% respectively) at the HOMEL of Cotonou before the introduction of MgSO4. Conclusion MgSO4 subject to a rigorous clinic follow up was really efficient on the neurological manifestations of the preeclampsia and eclampsia . Keywords : neurological manifestations - Preeclampsia - Eclampsia - MgSO4 - BENIN. African Journal of Neurological Sciences Vol. 25 (1) 2006: pp. 41-49