A shortened postpartum magnesium sulfate prophylaxis regime in pre-eclamptic women at low risk of eclampsia

To determine whether magnesium sulfate (MgSO(4)) prophylaxis is needed for up to 24 hours postpartum in all patients with pre-eclampsia.

In a randomized open clinical trial conducted in a tertiary health center in India between September 2008 and April 2010, 150 women with severe pre-eclampsia who received intrapartum MgSO(4) and delivered at more than 2 weeks gestation were enrolled. After 6hours postpartum, the participants were randomized to continue receiving (control group) or to discontinue (intervention group) MgSO(4), and outcomes were compared.

Administration of MgSO(4) had to be reinstituted for 1 woman in the intervention group. Under the current protocol in the institution, all 75 women in the intervention group would have received MgSO(4) for 24 hours postpartum. A significant reduction in time spent by the doctors (P<0.001) and nurses (P<0.001) was seen in the intervention group. The pain score in the intervention group was significantly less (P<0.001), and women in the intervention group were able to look after themselves better (P<0.001).

For women at low risk for postpartum eclampsia, a shortened (6-hour) MgSO(4) regime was as effective for seizure prophylaxis as the conventional 24-hour regime, with significant benefits in terms of cost and morbidity.