E-drug: Magnesium sulphate for pre-eclampsia
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Magnesium sulphate is a safe and cheap drug that has long been used for
pre-eclampsia. However, it seems to be overlooked sometimes when new
national Standard Drug Lists and Treatment Guidelines are being formulated.
The latest issue of the Lancet provides the results of a very large trial
and a commentary that validate its continuing use.
[Don't forget to check the URLs for wrapping. BS]
Lancet 2002; 359(9321): 1877-90 (1 June)
Article: Do women with pre-eclampsia, and their babies, benefit from
magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial
The Magpie Trial Collaborative Group*
http://www.thelancet.com/journal/vol/iss/full/llan.359.9321.original_researc
h.21240.1
Summary
Background Anticonvulsants are used for pre-eclampsia in the belief they
prevent eclamptic convulsions, and so improve outcome. Evidence supported
magnesium sulphate as the drug to evaluate.
Methods Eligible women (n=10 141) had not given birth or were 24 h or less
postpartum; blood pressure of 140/90 mm Hg or more, and proteinuria of 1+
(30 mg/dL) or more; and there was clinical uncertainty about magnesium
sulphate. Women were randomised in 33 countries to either magnesium sulphate
(n=5071) or placebo (n=5070). Primary outcomes were eclampsia and, for women
randomised before delivery, death of the baby. Follow up was until discharge
from hospital after delivery. Analyses were by intention to treat.
Findings Follow-up data were available for 10 110 (99�7%) women, 9992 (99%)
of whom received the allocated treatment. 1201 of 4999 (24%) women given
magnesium sulphate reported side-effects versus 228 of 4993 (5%) given
placebo. Women allocated magnesium sulphate had a 58% lower risk of
eclampsia (95% CI 40-71) than those allocated placebo (40, 0�8%, vs 96,
1�9%; 11 fewer women with eclampsia per 1000 women). Maternal mortality was
also lower among women allocated magnesium sulphate (relative risk 0�55,
0�26-1�14). For women randomised before delivery, there was no clear
difference in the risk of the baby dying (576, 12�7%, vs 558, 12�4%;
relative risk 1�02, 99% CI 0�92-1�14). The only notable difference in
maternal or neonatal morbidity was for placental abruption (relative risk
0�67, 99% CI 0�45-0�89).
Interpretation Magnesium sulphate halves the risk of eclampsia, and probably
reduces the risk of maternal death. There do not appear to be substantive
harmful effects to mother or baby in the short term.
Lancet 2002; 359(9321): 1872 (1 June)
Commentary: Magnesium for preventing and treating eclampsia: time for
international action
*Shirish S Sheth, Iain Chalmers
http://www.thelancet.com/journal/vol/iss/full/llan.359.9321.editorial_and_re
view.21307.1
best wishes
Beverley Snell
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Beverley Snell
Centre for International Health
Macfarlane Burnet Institute for Medical Research & Public Health
P O Box 254 Fairfield Vic Australia 3078
Telephone 613 9282 2115 / 9282 2275
Fax 613 9482 3123
Time zone: 10 hours ahead of GMT.
email <bev@burnet.edu.au>
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