Magnesium sulphate effective for eclampsia

Clinical question: 
How effective is magnesium sulphate for eclampsia?
Bottom line: 
Compared to phenytoin, magnesium sulphate significantly reduced the risk of recurrence of seizures, decreased pneumonia, ventilation and admission to an intensive care unit, probably reduced the risk of maternal death, and improved outcomes for the baby (fewer admissions to a special care baby unit [SCBU], fewer deaths, and fewer babies spending more than seven days in a SCBU). Magnesium sulphate also appeared to be safer for the baby. The use of phenytoin should be abandoned.
Caveat: 
Recruitment to trials in this review was primarily from hospitals in low- and middle-income countries, which is where 99% of maternal deaths occur. None of the trials were conducted at primary care level, and none included evaluation of care during transfer to a higher level of care.
Context: 
Eclampsia is rare: in high-income countries it affects 2 to 3 in every 10,000 pregnant women, and in low- and middle-income countries 16 to 69 in every 10,000. However, 15% of maternal deaths are associated with eclampsia.
Review CD#: 
CD000128
PEARLS No: 
298
Date: 
January, 2011
Authored by: 
Brian R McAvoy