Publication:

Comparison of low dose Dhaka regimen of magnesium sulphate with standard pritchard regimen in eclampsia

Background The purpose of this study was to determine the effects of altitude on severe preeclampsia and eclampsia and subsequent perinatal outcome.

Methods This prospective study was carried out during 1st March 2011 to 29th February 2012 in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla situated at a height of 2200m from sea level. All the subjects with severe preeclampsia or eclampsia were included in the study and their perinatal outcome was noted.

Results There were a total of 5897 deliveries. There were 423 cases of PIH making an incidence of severe preeclampsia and eclampsia 15.4% and 7.3% among PIH, respectively. Majority of cases (60.4%) belonged to age group 18-25 year with mean systolic blood pressure in eclampsia was 184.3±18.6 mm of Hg and in severe preeclampsia was 171.5±13.9 mm of Hg. Mean diastolic blood pressure was 125.8±12.6 mm of Hg in eclampsia and 118.6±4.3 mm of Hg in severe preeclampsia. Various other complications in eclampsia and severe preeclampsia cases included IUGR (35.1%) cases, abruptio placentae (15.9%), HELLP syndrome (9.6%) cases, spontaneous preterm labour (21.3%) and intrauterine death (6.4%). Live births were 85.1%; fresh still births were 8.5%. Mean birth weight was 2192.5±572grams. Respiratory distress syndrome was seen in 21.3% neonates, Hyperbilirubinemia was seen in 26.2% neonates intracranial bleeding was seen in 7.5% neonates. Perinatal mortality was 27.7% which constitute14.9% still birth neonatal deaths.

Conclusions Efficacy of MgSO4 in prevention and treatment of eclamptic convulsions is time tested and supported with a variety of studies. Since its narrow therapeutic and toxicity is major concern, the use of low dose MgSO4 protocols is a viable alternative to standard dose therapy. However, because of small study design further studies on the larger scale are required to support routine clinical use of low dose protocols.