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A study on the effect of a low-dose magnesium sulfate regimen for the management of eclampsia

Background Magnesium sulfate is the anticonvulsant of choice for eclampsia, but the standard Pritchard regimen uses repeated intramuscular injections and requires careful toxicity monitoring. This study compared a half-dose regimen with the standard Pritchard regimen.

Methods In this prospective randomized study, 50 women with eclampsia were allocated equally to a low-dose group or a standard Pritchard group. The low-dose regimen comprised 2 g intravenous and 5 g intramuscular loading doses, followed by 2.5 g intramuscularly every four hours for 24 hours after delivery or the last seizure. The primary outcome was control of convulsions. Repeat dosing, treatment failure, clinical toxicity, perinatal outcome, injection-site discomfort, ambulation, magnesium sulfate use, and cost were assessed. Categorical data were compared using Fisher's exact test or the chi-square test.

Results Convulsions were controlled in 25/25 women (100%) in the low-dose group and 24/25 (96%) in the Pritchard group (p=1.000). Repeat doses were required in 3/25 (12%) and 2/25 (8%), respectively (p=1.000). No treatment failure occurred with the low-dose regimen; one failure occurred in the Pritchard group in a woman with hepatic capsule rupture. No clinical evidence of magnesium toxicity was observed in the low-dose group. Live-birth rates were 88% and 92%, respectively (p=1.000). The low-dose regimen used half the magnesium sulfate and reduced the calculated drug cost by 50%.

Conclusions The low-dose regimen achieved seizure control comparable to the standard regimen in this small study and reduced drug use and cost. Larger multicentre non-inferiority trials are required before routine substitution.