Re: Postpartum Eclampsia
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Aug 12 22:26:52 2004
Art - IMHO - it's still a 3 fold increase in seizures events - I don't
like my patients convulsing - and as he puts it - remains uncertain in
mild PIH - whatever that means -...
>At Wed, 11 Aug 2004, art fougner, md wrote:
>
>Apropos MgSO4 for mild pre-eclampsia
>
>Magnesium sulfate prophylaxis in preeclampsia: lessons learned from
>recent trials
>
>Baha M. Sibai, MD
>Abstract
>
>In the US, the routine use of magnesium sulfate for seizure prophylaxis
>in women with preeclampsia is an ingrained obstetric practice. During
>the past decade, several observational studies and randomized trials
>have described the use of various regimens of magnesium sulfate to
>prevent or reduce the rate of seizures and complications in women with
>preeclampsia. There are only 2 double-blind, placebo-controlled trials
>evaluating the use of magnesium sulfate in mild preeclampsia. There
>were no instances of eclampsia among 181 women assigned to placebo, and
>there were no differences in the percentage of women who progressed to
>severe preeclampsia (12.5% in magnesium group vs 13.8% in the placebo
>group, relative risk [RR] 0.90; 95% CI 0.52-1.54). However, the number
>of women enrolled in these trials is too limited to draw any valid
>conclusions. There are 4 randomized controlled trials that compare the
>use of no magnesium sulfate, or a placebo vs magnesium sulfate, to
>prevent convulsions in patients with severe preeclampsia. The rate of
>eclampsia was 0.6% among 6343 patients assigned to magnesium sulfate vs
>2.0 % among 6330 patients assigned to a placebo or control (RR 0.39; 95%
>CI 0.28-0.55). However, the reduction in the rate of eclampsia was not
>associated with a significant benefit in either maternal or perinatal
>outcome. In addition, there was a higher rate of maternal respiratory
>depression among those assigned magnesium sulfate (RR 2.06; 95% CI
>1.33-3.18). The evidence to date confirms the efficacy of magnesium
>sulfate in reduction of seizures in women with eclampsia and severe
>preeclampsia; however, this benefit does not affect overall maternal and
>perinatal mortality and morbidities. The evidence regarding the
>benefit-to-risk ratio of magnesium sulfate prophylaxis in mild
>preeclampsia remains uncertain, and does not justify its routine use for
>that purpose.
>
> - Am J Obstet Gynecol 2004 Jun;190(6):1520-6.
>
>art
>
>At Wed, 11 Aug 2004, DoctorJoe@aol.com wrote:
>>
>>In a message dated 8/10/04 22:43:53, Len2976@aol.com writes:
>>
>>> Obviously we are all reviewing our management of this patient. She did not
>>> have MgSO4 in labor. She left the hospital with normal B/Ps (for her at
>>> least) and labs. One question we had--would MgSO4 in labor have preven ed
>>> a seizure 4 days PP? Should she have been discharged on something ther than
>>> labetolol?
>>>
>>That's actually two questions, but who's counting.
>>
>>I'd say (1) no, and (2) no (assuming the labetolol kept her normotensive.
>>
>>One question I would pose: What's the BP limit you shoot for with therapy
>>like this - is 130-140s/70-80s okay, or too high? (would 146/88 be okay or ot?)
>>
>>Joe P.
>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
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