RHL Commentary by Álvaro Nagib Atallah
EVIDENCE SUMMARY
This commentary discusses three Cochrane Reviews comparing magnesium sulfate with diazepam, phenytoin and lytic cocktail. The findings of the first two reviews are largely derived from the Collaborative Eclampsia Trial,(1),which was conducted in a total of 25 centres in India, sub-Saharan Africa and Latin America while the lytic cocktail review is based on two trials in India with 198 women.
The use of magnesium sulfate for the care of women with eclampsia was associated with statistically and clinically significant reductions in the recurrence of convulsions compared with diazepam (RR: 0.44; 95% CI: 0.34 to 0.57), phenytoin (RR: 0.31; 95% CI: 0.20 to 0.47) and lytic cocktail (RR: 0.09; 0.03 to 0.24).
Magnesium sulfate is associated with clinically significant reductions in maternal death when compared to diazepam (RR: 0,59; 0,95% CI: 0.37 to 0.94), phenytoin (RR: 0.50; 0,95% CI: 0.24 to 1.05) and lyctic cocktail (RR: 0.25; 0,95% CI: 0.04 to 1.43). The latter comparison included two trials and a total of 198 women. Therefore the results have a wide confidence interval. Both intramuscular magnesium sulfate regimens(Pritchard) and intravenous (Zuspan) were effective. No adverse effects on the newborn were found.
The methodology of the reviews are sound. All adequately controlled trials that could be identified have been included and appropriately analysed. Two trials in the diazepam review and one trial in the phenytoin review have been included in the recent revision of these two reviews.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the results
Research
References
This document should be cited as: Álvaro Nagib Atallah. Anticonvulsant therapy for eclampsia: RHL commentary (last revised: 14 November 2003). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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