Sipra Singh 1 , Rakesh Kumar Singh 2
BACKGROUND Hypertensive disorder of pregnancy is the foremost cause of maternal deaths in developed countries and the third most common cause of death in developing countries. Eclampsia alone accounts for 50,000 maternal deaths worldwide, annually. Collaborative trial in 1995 conclusively proved that Magnesium Sulphate is the preferred treatment for eclamptic fits. Commonly used regimens are the IM MgSO4 regimen popularized by Pritchard and, the IV MgSO4 regimen popularized by Zuspan. The present study was done with an aim to compare IM Magnesium Sulphate regimen with IV Magnesium Sulphate regimen with regard to prevention of recurrence of seizure and maternal and fetal outcome. MATERIAL AND METHODS After institutional ethical committee approval and obtaining informed consent from patients, 100 patients presenting with eclamptic fits reporting to our centre were included in the study and were randomly allocated to one of the following groups. Group I. M.: Received a loading dose of 4 gm IV MgSO4 over 5-10 minutes +5 gm MgSO4 deep intramuscular injection in each buttock and a maintenance dose of 5 gm MgSO4 deep intramuscular injection in alternate buttock every 4 hourly. Group I.V.: Received MgSO4 4gm slow IV over 5-10 minutes as loading dose and 1 gm MgSO4 per hour as continuous intravenous maintenance infusion. RESULTS Both the treatment regimens were comparable with regard to recurrence of convulsions. 3 (6%) patients in Group IM and 2 (4%) patients in Group IV developed convulsions after initiation of treatment, p value 0.646. Incidence of loss of knee jerk was significantly higher in Group IM as compared to group IV; 7 (14%) in Group IM versus 1 (2%) in Group IV, p value 0.027. Incidence of other parameters of toxicity were comparable between the groups. Maternal and fetal outcome were poor in both the groups but were comparable and no significant differences were observed between the groups. CONCLUSION Both IM and IV regimen are equally effective in controlling the recurrence of eclamptic fits. IM Magnesium Sulphate is associated with a higher incidence of toxicity as evidenced by significantly higher incidence of loss of knee jerk reflux.
