Magnesium sulphate and other anticonvulsants for women with pre-eclampsia

被引:264
作者
Duley, Lelia [1 ]
Guelmezoglu, A. Metin [2 ]
Henderson-Smart, David J. [3 ]
Chou, Doris [2 ]
机构
[1] Univ Leeds, Bradford Royal Infirm, Bradford Inst Hlth Res, Ctr Biostat & Epidemiol, Bradford BD9 6RJ, W Yorkshire, England
[2] WHO, Dept Reprod Hlth & Res, UNDP,UNFPA, World Bank Special Programme Res Dev & Res Traini, CH-1211 Geneva, Switzerland
[3] Queen Elizabeth II Res Inst, NSW Ctr Perinatal Hlth Serv Res, Sydney, NSW, Australia
来源
COCHRANE DATABASE OF SYSTEMATIC REVIEWS | 2010年 / 11期
基金
英国医学研究理事会;
关键词
PREGNANCY-INDUCED HYPERTENSION; RANDOMIZED CONTROLLED-TRIAL; MILD PREECLAMPSIA; BLOOD-PRESSURE; DOUBLE-BLIND; ECLAMPSIA; PLACEBO; MANAGEMENT; THERAPY; PHENYTOIN;
D O I
10.1002/14651858.CD000025.pub2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Eclampsia, the occurrence of a seizure (fit) in association with pre-eclampsia,is rare but potentially life-threatening. Magnesium sulphate is the drug of choice for treating eclampsia. This review assesses its use for preventing eclampsia. Objectives To assess the effects of magnesium sulphate, and other anticonvulsants, for prevention of eclampsia. Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (4 June 2010), and the Cochrane Central Register of Controlled Trials Register (The Cochrane Library 2010, Issue 3). Selection criteria Randomised trials comparing anticonvulsants with placebo or no anticonvulsant, or comparisons of different drugs, for pre-eclampsia. Data collection and analysis Two authors assessed trial quality and extracted data independently. Main results We included 15 trials. Six (11,444 women) compared magnesium sulphate with placebo or no anticonvulsant: magnesium sulphate more than a halved the risk of eclampsia (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.29 to 0.58; number needed to treat for an additional beneficial outcome (NNTB) 100, 95% CI 50 to 100), with a non-significant reduction in maternal death (RR 0.54, 95% CI 0.26 to 1.10) but no clear difference in serious maternal morbidity (RR 1.08, 95% CI 0.89 to 1.32). It reduced the risk of placental abruption (RR 0.64, 95% CI 0.50 to 0.83; NNTB 100, 95% CI 50 to 1000), and increased caesarean section (RR 1.05, 95% CI 1.01 to 1.10). There was no clear difference in stillbirth or neonatal death (RR 1.04, 95% CI 0.93 to 1.15). Side effects, primarily flushing, were more common with magnesium sulphate (24% versus 5%; RR 5.26, 95% CI 4.59 to 6.03; number need to treat for an additional harmful outcome (NNTH) 6, 95% CI 5 to 6). Follow-up was reported by one trial comparing magnesium sulphate with placebo: for 3375 women there was no clear difference in death (RR 1.79, 95% CI 0.71 to 4.53) or morbidity potentially related to pre-eclampsia (RR 0.84, 95% CI 0.55 to 1.26) (median follow-up 26 months); for 3283 children exposed in utero there was no clear difference in death (RR 1.02, 95% CI 0.57 to 1.84) or neurosensory disability (RR 0.77, 95% CI 0.38 to 1.58) at age 18 months. Magnesium sulphate reduced eclampsia compared to phenytoin (three trials, 2291 women; RR 0.08, 95% CI 0.01 to 0.60) and nimodipine (one trial, 1650 women; RR 0.33, 95% CI 0.14 to 0.77). Authors' conclusions Magnesium sulphate more than halves the risk of eclampsia, and probably reduces maternal death. There is no clear effect on outcome after discharge from hospital. A quarter of women report side effects with magnesium sulphate.
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页数:100
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