A shortened postpartum magnesium sulfate prophylaxis regime in pre-eclamptic women at low risk of eclampsia

Objective: To determine whether magnesium sulfate (MgSO4) prophylaxis is needed for up to 24 hours postpartum in all patients with pre-eclampsia. Methods: In a randomized open clinical trial conducted in a tertiary health center in India between September 2008 and April 2010, 150 women with severe pre-eclampsia who received intrapartum MgSO4 and delivered at more than 20 weeks gestation were enrolled. After 6 hours postpartum, the participants were randomized to continue receiving (control group) or to discontinue (intervention group) MgSO4, and outcomes were compared. Results: Administration of MgSO4 had to be reinstituted for 1 woman in the intervention group. Under the current protocol in the institution, all 75 women in the intervention group would have received MgSO4 for 24 hours postpartum. A significant reduction in time spent by the doctors (P<0.001) and nurses (P<0.001) was seen in the intervention group. The pain score in the intervention group was significantly less (P<0.001), and women in the intervention group were able to look after themselves better (P<0.001). Conclusion: For women at low risk for postpartum eclampsia, a shortened (6-hour) MgSO4 regime was as effective for seizure prophylaxis as the conventional 24-hour regime, with significant benefits in terms of cost and morbidity. (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.