Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound

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Abstract
Objective To assess maternal middle cerebral artery flow velocity patterns as measured by transcranial Doppler ultrasound (TCD) in eclampsia and to investigate the effect of the anticonvulsants magnesium sulphate (MgSO4) and phenytoin on cerebral circulation. Design Prospective randomised study. Setting High care obstetric unit, King Edward VIII Hospital, Durban, South Africa. Participants Twenty‐four eclamptic patients: 13 received MgSO, and 11 phenytoin. Intervention Middle cerebral artery flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach in eclamptic patients, before and 15 minutes after the loading dose of anticonvulsant. Results Magnesium sulphate significantly reduced the pulsatility index (P= 0.002) and mean flow velocity (P= 0.02) in the middle cerebral artery, whereas phenytoin failed to produce any statistically significant effect. However, differences between groups were not statistically significant. Systolic and diastolic blood pressures were reduced in both the MgSO, and phenytoin groups. Conclusion These findings provide firm evidence that MgSO, relieves cerebral vasospasm, compared with phenytoin, and may therefore be the better drug for the prevention of eclamptic convulsion.