Original Articles

Abbreviated 12-Hour Postpartum Magnesium Sulphate Therapy is Equally Effective and Safer Than Standard 24-Hour Therapy in Preeclampsia With Severe Features: Results From A Randomized Controlled Trial

Abstract

Objective: Eclampsia is a major life-threatening complication of preeclampsia with severe features leading to significant perinatal and maternal mortality and morbidity. Magnesium sulphate (MgSO4) is the first-line therapy for eclampsia prevention and treatment, however, its use is associated with serious adverse effects and there is no consensus on the optimal duration of its therapy. This study compares the efficacy and safety of abbreviated 12-hour versus standard 24-hour MgSO4 therapy during postpartum in patients having preeclampsia with severe features.
Materials and methods: Patients having preeclampsia with severe features were randomized 1:1 into the 12-hour and 24-hour groups. Modified Pritchard regimen was used. The primary outcome was the incidence of seizures. Secondary outcomes included serious maternal morbidity and other adverse effects associated with MgSO4 use. Perinatal outcomes were also recorded. Analyses were intention-to-treat.
Results: A total of 116 patients [57 (12-hour group) and 59 (24-hour group)] were included. The mean age was 25(±4) years, while the mean gestation period was 34 (±4) weeks. The incidence of seizures was comparable in the two groups [1 (2%), 3 (5%), p=0.62]. Patients in the 12-hour group [1 (2%)] had lesser postpartum drowsiness compared to the 24-hour group [15 (25%), p<0.001] and consequently, lesser problems in breastfeeding [1 (2%) versus 10 (17%), p=0.008]. There were no inter-group differences in other adverse effects including loss of reflexes, oliguria, respiratory depression, and proportion of patients requiring interruption of therapy. Perinatal outcomes were also similar.
Conclusion: In patients having preeclampsia with severe features, 12-hour postpartum MgSO4 therapy is equally effective in preventing eclampsia and has lesser postpartum drowsiness and problems with breast feeding compared to the standard 24-hour therapy.

1. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009, 33:130-7.
2. World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. (2011). Accessed: 29 May 2024: https://apps.who.int/iris/rest/bitstreams/53238/retrieve.
3. Adu-Bonsaffoh K, Oppong SA, Samuel OA. Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana. Int J Gynaecol Obstet. 2013, 123:110-3.
4. Acquah-Arhin R, Kwawukuwe EY. Trends in eclampsia at Korle BU Teaching Hospatal, Accra Ghana. Nigerian Journal of Clinical Practice. 2003, 6:1-4.
5. Narkhede AM, Karnad DR. Preeclampsia and Related Problems. Indian J Crit Care Med. 2021, 25(Suppl 3):S261-S266.
6. Pritchard JA, Cunningham FG, Pritchard SA. The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases. Am J Obstet Gynecol. 1984, 148:951-63.
7. Zuspan FP. Problems encountered in the treatment of pregnancy induced hypertension. A point of view. Am J Obstet Gynecol. 1978, 131:591-7.
8. Sibai BM, Lipshitz J, Anderson GD, Dilts PV Jr. Reassessment of intravenous MgSO4 therapy in preeclampsia-eclampsia. Obstet Gynecol. 1981 Feb;57(2):199-202.
9. Okonkwo M, Nash CM. Duration of Postpartum Magnesium Sulphate for the Prevention of Eclampsia: A Systematic Review and Meta-analysis. Obstet Gynecol. 2022, 139(4):521-528.
10. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013, 122(5):1122-1131.
11. Yifu P, Lei Y, Yujin G, Xingwang Z, Shaoming L. Shortened postpartum magnesium sulfate treatment vs traditional 24h for severe preeclampsia: a systematic review and meta-analysis of randomized trials. Hypertens Pregnancy. 2020, 39(2):186-195.
12. Smith JM, Lowe RF, Fullerton J, Currie SM, Harris L, Felker-Kantor. An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC Pregnancy Childbirth. 2013, 13:34:1-11.
13. Salvador DAC, Salvador FC. Single loading dose versus standard 24-hour magnesium sulfate in women with severe preeclampsia and eclampsia: A systematic review and metaanalysis. Philipp J Obstet Gynecol. 2018, 42(5):1-10.
14. Beyuo TK, Lawrence ER, Kobernik EK, Oppong SA. A novel 12-hour versus 24-hour magnesium sulfate regimen in the management of eclampsia and preeclampsia in Ghana (MOPEP Study): A randomized controlled trial. Int J Gynaecol Obstet. 2022, 159:
495-504.
15. Unwaha EA, Bello FA, Bello OO, Oladokun A. Intravenous magnesium sulfate in the management of severe pre-eclampsia: A randomized study of 12-hour versus 24-hour maintenance dose. Int J Gynaecol Obstet. 2020, 149:37-42.
16. Grillo EO, Awonuga DO, Dedeke IOF, Abiodun O, Imaralu JO, Sotunsa JO et al. Comparison of Zuspan regimen and its 12-hour modification in women with severe pre-eclampsia and eclampsia in two hospitals in Abeokuta. Pregnancy Hypertens. 2023, 32:22-27.
Files
IssueVol 19, No 1 (March 2025) QRcode
SectionOriginal Articles
Keywords
Eclampsia Magnesium Sulphate Pre-Eclampsia
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Saha P, Sheokand S, Dhaliwal L, Bagga R, Saha L. Abbreviated 12-Hour Postpartum Magnesium Sulphate Therapy is Equally Effective and Safer Than Standard 24-Hour Therapy in Preeclampsia With Severe Features: Results From A Randomized Controlled Trial. J Family Reprod Health. 2025;19(1):31-36.