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

ObjectiveTo determine whether magnesium sulfate (MgSO₄) prophylaxis is needed for up to 24 hours postpartum in all patients with pre-eclampsia.MethodsIn 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 MgSO₄ and delivered at more than 20 weeks gestation were enrolled. After 6 hours postpartum, the participants were randomized to continue receiving (control group) or to discontinue (intervention group) MgSO₄, and outcomes were compared.ResultsAdministration of MgSO₄ 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 MgSO₄ 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).ConclusionFor women at low risk for postpartum eclampsia, a shortened (6-hour) MgSO₄ regime was as effective for seizure prophylaxis as the conventional 24-hour regime, with significant benefits in terms of cost and morbidity.