|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: Mg for preeclampsiaFrom: ainsron (ainsron@sbcglobal.net)Thu May 17 16:19:40 2007
I think this review answers your question Ronald E. Ainsworth, MD Selective Magnesium Sulfate Prophylaxis for the Prevention of Eclampsia in Women With Gestational Hypertension. Alexander JM, McIntire DD, et al: Obstet Gynecol; 2006; 108 (October): 826-832 Take-Home Pearl: Since eclampsia is also associated with an increased risk of maternal morbidity and neonatal morbidity, one should be cautious about the selective use of magnesium sulfate prophylaxis. Objective: To determine the incidence of eclampsia in patients with severe gestational hypertension treated with magnesium sulfate prophylaxis compared to patients with mild gestational hypertension without treatment. Methods: This population-based, observational study was performed over a 4.5-year period. Patients with severe gestational hypertension received intravenous magnesium sulfate prophylaxis and those with nonsevere hypertension received no magnesium sulfate. The criteria for the magnesium sulfate included a blood pressure of at least 140/90, 2+ proteinuria or greater, serum creatinine >1.2 mg/dL, platelet count of <100,000, elevated liver enzymes, and persistent right upper quadrant pain. Both obstetric and neonatal outcomes were evaluated with specific attention paid toward the incidence of eclampsia. Results: During this 4.5-year period, 72,004 women were delivered. There were 87 patients with eclampsia for an incidence of 1 in 828; 65,573 patients did not have gestational hypertension. In this group, there were 49 cases of eclampsia for an incidence of 1 in 1338. Of these 49 cases, 32 patients had eclampsia while hospitalized and in 17 had eclampsia occur at home. Of 6431 patients with gestational hypertension, there were 38 cases of eclampsia for an incidence of 1 in 169. In this group with gestational hypertension, 3935 women received magnesium sulfate prophylaxis. There were 11 eclamptic seizures in this group for an incidence of 1 in 358. A total of 2496 women with nonsevere hypertension did not receive magnesium sulfate prophylaxis; 27 had subsequent eclamptic seizures for an incidence of 1 in 92. Women with eclampsia were also more likely to have received general anesthesia for an emergency cesarean section (23% vs 4%). There were no other differences in morbidity. In 12 patients with eclampsia, there had been an increase in blood pressure of the systolic pressure of 30 and of the diastolic pressure of 15 mm Hg; although, the blood pressure was not >140/90 mm Hg. Adverse neonatal outcomes were seen more commonly when the mothers had eclamptic seizures compared to those with just hypertension without eclampsia (12% vs 1%). The incidence of eclampsia during this study period was 1 in 828, a 50% increase from the 5 years previous when magnesium sulfate was used in all patients with gestational hypertension. Before selective administration of magnesium sulfate, the incidence was 1 in 1678 cases. Conclusions: Selective use of magnesium sulfate prophylaxis is associated with an increased incidence of eclampsia secondary to an increase in the frequency of eclamptic seizures with nonsevere gestational hypertension not treated with magnesium sulfate. Reviewer's Comments: If there is selective administration of magnesium sulfate only in patients with severe hypertensive disease, then the rate of eclampsia will increase. Since eclampsia is also associated with an increased risk of maternal morbidity and neonatal morbidity, one should be cautious about the selective use of magnesium sulfate prophylaxis. (Reviewer-Thomas N. Tabb, MD -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew Folley Sent: Thursday, May 17, 2007 5:37 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Mg for preeclampsia Given 1000 moms with severe toxemia by traditional criteria verses 1000 moms with mild toxemeia: How many in each group will go on to seizure if neither gets mgso4? ie is it worth giving mg to moms with mild toxemia? andrew n_HM_mini_outlook_0507
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Jul 2 04:46:42 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.