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MgSO4 in preeclampsia (was Preeclampsia Lab Package)From: Malcolm Griffiths (Malcolm@MGRIFF22.demon.co.uk)Sun Jun 28 03:16:30 1998
In message <199806280525.PAA07782@ariel.ucs.unimelb.EDU.AU>, Peter Wein <p.wein@obsgyn-mercy.unimelb.EDU.AU> writes >At 04:08 PM 27/06/98 -0500, you wrote: > >>You are quite wrong! >> >>The Lancet paper established that MgSO4 was superior to phenytoin and >>diazepam in secondary prophylaxis of eclampsia. That is they showed >>MgSO4 was the best way to stop a woman who'd fitted from having another >>fit. There are one or two of my colleagues who would even quibble about >>that (my favourite sceptic feels it may be wrong to extrapolate from the >>setting of the study to our own unit). >> >>No study to date has really established that MgSO4 is superior to >>placebo in pre-eclamptic women. Nor has any study established what level >>of pre-eclampsia needs MgSO4. MAGPIE is an RCT which aims to do this. It >>is being run by the same coordinator as the Lancet paper had (Lelia >>Duley). >>> >Malcolm - there are trials which in the setting of women who have not yet >fitted show that MgSO4 is clearly effective in prevention of eclampsia - in >units which I am sure are not dissimilar to yours - not in South America or >India. It is true that it is not clear which specific women will benefit, >but the agent is clearly effective. > Peter - if you are familar with the Lancet/Duley paper you will be aware that the main outcomes measured were death and serious co-morbidity. As far as I am aware (I stand to be corrected) no study to date has addressed these significant end-points or determined the level of disease severity at which MgSO4 is indicated. If there have been such stuies then they should quickly be brought to the attention of Duley's group and the UK-MRC who are funding her trial - if there are such studies then time and money is being wasted. Duley also intends to look at neonatal outcomes, particularly cerebral palsy and develpoment at 4 years. My personal feeling is that having a single eclamptic fit whilst in the intensive care environment of a properly staffed and run delivery suite is not the worst crisis of preeclampsia, and that the incidence of fits in even the most severe population of preeclamptics is only ~0.5%. Giving a few hundred women potentially hazardous medication to prevent one having a "relatively benign" fit may need some justification. As for the problem of extrapolating from other settings to my own, it tried to make clear that I didn't have a problem with that about MgSO4, but rather that a colleague (who would win a gold medal if scepticism was an Olympic sport) was! Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997])
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