PROPHYLACTIC ANTICONVULSANT THERAPY IN HYPERTENSIVE CRISES OF PREGNANCY - THE NEED FOR A LARGE, RANDOMIZED TRIAL

Objective: To assess whether prophylactic anticonvulsants in hypertensive crises of pregnancy further reduce the risk of eclampsia and other complications over and above lowering high blood pressure alone. Design: Open randomized controlled trial. Setting: The labor ward of King Edward VIII Hospital, Durban, South Africa. Subjects: Two hundred and twenty-eight patients with severe hypertension requiring delivery were recruited to the study; 116 received antihypertensive therapy while 112 received MgSO4 in addition. Main Outcome Measure: The onset of convulsions and both maternal and fetal complications between the groups. Results: Only 1 patient in the MgSO4 group had a convulsion compared to none in the control group, and there were no differences in birthweights, Apgar scores, or maternal complications between the groups. Conclusion: The strength of the conclusions is limited by the small number of patients, and by the preadmission administration of phenobarbitone in many patients. It does appear, however, that patients with hypertensive crises can be managed safely by aggressively lowering high blood pressure only and effecting delivery expediously.