Preventing and treating eclamptic seizures

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Abstract
Ninety nine percent of all maternal deaths occur in developing countries. Pre-eclampsia or eclampsia is responsible for many of these, accounting for 50 000 deaths annually. Large randomised trials in developing countries and systematic reviews have shown the usefulness of magnesium sulphate in treating recurrent eclamptic seizures and in the prophylaxis of eclampsia.1–3 Despite this evidence magnesium sulphate remains underused. In 1995 the Eclampsia Trial Collaborative Group did an impressive study in developing countries and showed unequivocally that magnesium sulphate given intramuscularly or intravenously is superior to phenytoin or diazepam in reducing recurrent eclamptic seizures.1 Seizures were a half or a third less likely to recur after treatment with magnesium. Maternal mortality was also lower in women allocated magnesium rather than phenytoin or diazepam, although this did not achieve statistical significance. Recent Cochrane reviews, however, indicated a significant reduction in maternal mortality with magnesium.2 Magnesium was also associated with less maternal and neonatal morbidity than phenytoin. Recently the findings of this study were extended to indicate the …