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Magnesium sulphate versus diazepam for eclampsia.

BACKGROUND
A number of different anticonvulsants are used to control eclamptic fits and to prevent future seizures.


OBJECTIVES
The objective of this review was to assess the effects of magnesium sulphate compared with diazepam when used for the care of women with eclampsia. Magnesium sulphate is compared with phenytoin and with lytic cocktail (in preparation) in other Cochrane reviews.


SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials Register, 1999 Issue 3.


SELECTION CRITERIA
Randomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with diazepam for women with a clinical diagnosis of eclampsia.


DATA COLLECTION AND ANALYSIS
Trial quality was assessed and data extraction was done by the two reviewers.


MAIN RESULTS
Five trials involving 1236 women were included. Most of these trials were of good quality. Magnesium sulphate was associated with a substantial reduction in the recurrence of convulsions, when compared to diazepam (relative risk 0.45, 95% confidence interval 0.35 to 0.58). Maternal mortality was also reduced, although this difference was borderline for statistical significance (relative risk 0.60, 95% CI 0.36-1.00). There are no differences in any other measures of outcome, except for fewer Apgar scores <7 at five minutes (relative risk 0.72, 95% CI 0.55-0.94) and in length of stay in SCBU >7 days (relative risk 0. 66, 95% CI 0.46-0.95) associated with magnesium sulphate.


REVIEWER'S CONCLUSIONS
Magnesium sulphate appears to be substantially more effective than diazepam for treatment of eclampsia.