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Individually determined postpartum magnesium sulfate therapy with clinical parameters to safely and cost-effectively
M H Ascarelli1, V Johnson, W L May
1Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
Objective:
The purpose of this study was to investigate the safety of treating pre-eclampsia with magnesium sulfate, with clinical determinants used for drug discontinuation.
Study Design:
One hundred sixty-eight patients were enrolled. After delivery, women with mild pre-eclampsia received a minimum of 6 hours of intravenous magnesium sulfate, whereas women with severe pre-eclampsia received a minimum of 12 hours. Magnesium sulfate was discontinued in the absence of clinical symptoms associated with spontaneous diuresis, minimal protein by urinary dipstick, and satisfaction of predetermined blood pressure criteria.
Results:
Patients with mild pre-eclampsia required significantly less magnesium sulfate (mean 9.5 +/- 4.2 hours) than did those with severe pre-eclampsia alone (mean 16 +/- 5.9 hours); pre-eclampsia superimposed on chronic hypertension (mean 16 +/- 5.8 hours); or hemolysis, elevated liver enzyme, and low platelet count syndrome (mean 20 +/- 6.7 hours). With this protocol there was no eclampsia, and recovery room time was reduced by 50%.
Conclusion:
Individual determination of postpartum magnesium sulfate therapy for pre-eclampsia appears to be a safe approach that carries minimal risk of eclampsia.