OUTCOME OF LOW MAINTENANCE DOSE MGSO4 IN ECLAMPSIA PATIENTS OF A TERTIARY CARE HOSPITAL OF GUJARAT, INDIA- A PROSPECTIVE STUDY

Abstract

Background: Eclamptic convulsions are life-threatening emergencies and require proper treatment to decrease maternal morbidity and mortality. Amongst the principles of management of eclampsia, the first and foremost is the control of convulsions. In the last decade researchers in developing countries (like India) are constantly striving to steadily decrease the doses of MgSo4 regimes in view of decrease the toxicity of MgSo4 therapy.

Methodology: Present study was a prospective interventional study and hdsanalysed all antenatal, intranatal and postnatal cases diagnosed as eclampsia and admitted to Obstetric ward, HDU, ICU (medical and surgical), IMC of Shree Krishna Hospital and Pramukhswami Medical college, Karamsad. All patients of Eclampsia admitted in the hospital during the study period were included in the study. Patients fulfilling the inclusion criteria, MgSo4 4gm was administered slowly intravenously over 10-15 minutes as loading dose and maintenance dose 0.5g/hr continue up to 24 hrs of delivery or 24hrs after convulsions whichever was later. Those patient were developed recurrent convulsion, they were given 2g MgSo4i.v. stat and maintenance dose was converted in standard dose 1g/hr.

Results: In the present study we could achieve the average serum magnesium level around 3.3-3.4 mEq/L. These were below therapeutic range for eclampsia but within the range of normal blood level. Even serum magnesium level in subtherapeutic range, 89.2%patients had not developed recurrent convulsions. 33(71.73%) patients delivered Vaginally and 13(28.26%) were delivered by LSCS. Most common indicationsfor LSCS were fetal distress in 1^st stage of labour followed by severe oligohydroamniosis and failure of induction of labour.

Conclusion: Low maintenance dose of magnesium sulphate therapy is effective for controlling convulsion in cases of eclampsia. The toxicity is reduced to nil. There was no maternal complication due to recurrent convulsions because patient was under close monitoring and immediately the stepping up of dose was enough.