Magnesium sulfate an overview sciencedirect topics. The magpie trial is an international randomised trial comparing magnesium sulphate with placebo for women with preeclampsia. Evidence supported magnesium sulphate as the drug to evaluate. The use of magnesium sulphate for the treatment of severe. Women diagnosed with preeclampsia were excluded from the magnet trial to avoid confounding. A randomized trial comparing the pharmacology of magnesium. Magnesium sulfate mgso 4, the preferred pharmacological intervention for treatment of eclamptic seizures, has been shown to have greater efficacy and fewer complications than treatment with diazepam or phenytoin. Therapeutic magnesium concentrations in maternal plasma have been deduced from empiric studies. The median time from 35 magnesium sulfate administration to birth was reported in only two of the trials that generated the evidence 1 hour 38 minutes and 3. The aim of this study was to assess longterm effects for women following the use of magnesium sulphate for preeclampsia.
Magpie magpie trial followup study collaborative group, 2007 the magpie trial. Ii rct n 10, 141 the antenatal magnesium sulphate for neuroprotection guideline development panel antenatal magnesium sulphate prior to preterm birth for neuroprotection of the fetus, infant and child. Outcome for children at 18 months prospective rct conducted at 175 hospitals in 33 countries. The magpie trial is comparing magnesium sulphate with placebo for treatment of women with preeclampsia. Primary measures of outcome are eclampsia and death of the baby. Pdf on jan 1, 2002, the magpie trial collaborative group and others published do women with preeclampsia, and their babies, benefit from magnesium sulphate. Magnesium sulfate for neuroprotection of prematurity. Uk medical research council, department for international. The magpie trial12 included 10,110 women with preeclampsia and was conducted in 175 hospitals in 33 countries with considerable heterogeneity of clinical.
Magnesium sulfate administration for the prevention and treatment of eclampsia condition. Between 1998 and 2001, 10 141 women were recruited to the magpie trial at 175 hospitals in 33 countries. There did not appear to be any substantive harmful. This trial tests whether magnesium sulfate given to a woman in labor with a premature fetus 24 to 31 weeks out of 40 will reduce the rate of death or moderate to severe cp in the children at 2 years. Antenatal magnesium sulphate mgso4 for fetal neuro. A randomized, controlled trial of magnesium sulfate for.
Magpie trial, concluded that the lower risk of eclampsia following prophylaxis with mgso4 was not associated with a clear. The magpie trial compared magnesium sulphate with placebo for women with preeclampsia. Strengthening the use of magnesium sulphate for management of spee 3 i. Altman d, carroli g, duley l, farrell b, moodley j, neilson j, smith d. Primary outcomes are eclampsia and death of the baby. Magnesium sulfate, the most commonly used drug in the us to stop premature labor, may prevent cp. Magnesium sulfate is the drug of choice for treatment of seizures in eclampsia oettinger 1993. Outcome for women at 2 years magpie trial followup study collaborative group. Women administered magnesium sulfate had a 52 and 67 percent lower rate of convulsions than those treated with diazepam and phenytoin, respectively. Magnesium sulfate for the treatment of eclampsia stroke. Stop magnesium sulfate infusionadministration fetal assessment administer calcium gluconate 10 ml of 10% solution over 10. Neonatal serum magnesium concentrations are determined by. Capitals indicate lifethreatening, underlines indicate most frequent. Assessment at 23 years after delivery for women recruited to the magpie trial recruitment in 19982001, isrctn 86938761, which compared magnesium sulphate with placebo for preeclampsia.
Magnesium sulfate has been demonstrated to both prevent. Nevertheless, the unexpected paediatric complications in our tocolytic magnesium trial led us to scrutinise the magpie data set, enquiring about possible adverse paediatric effects when magnesium sulphate was used instead for the prevention of eclampsia. Magnesium sulphate neuroprotection of preterm infants. Abbreviated postpartum magnesium sulfate therapy for women with mild preeclampsia. Magnesium sulphate for neuroprotection in preterm births magpie trial follow up study management group. The magpie trial magnesium sulphate mgso 4 was first introduced to control convulsions in 1925, but it was the collaborative eclampsia trial in 1995 that confirmed the efficacy of mgso 4 in the treatment of severe preeclampsia and eclampsia. Implementation of an antenatal magnesium sulfate protocol. The trial is coordinated from oxford, and in the uk women are entered into the study by telephoning a randomisation service. Eclampsia is commonly defined as new onset of seizure activity andor unexplained coma during pregnancy or postpartum in a woman with signs or symptoms of preeclampsia hypertension with proteinuria. Additionally, magnesium sulfate may also protect the bloodbrain barrier and limit cerebral edema formation, or it may act through a central anticonvulsant action. Introduction purpose this report summarizes the activities and results from a focused intervention to strengthen the use of evidencebased practice for management of severe preeclampsia and eclampsia spee with magnesium sulphate in 22 health facilities across nepal.
Findings demonstrate that magnesium sulfate meaningfully reduces the risk of eclamptic seizures among women with preeclampsia. In 89% 7281 of cases, the magnesium sulfate protocol was ordered by the oncall obstetrician and in another 6 cases 7. Design assessment at 18 months of age for children whose mothers were recruited to the magpie trial recruitment 19982001 isrctn 86938761, which compared magnesium sulphate with placebo. Originally included 8804 women with preeclampsia randomized to mgso4 or placebo. Overall, 9024 children were included in the analysis of outcome at discharge from hospital. Magnesium sulfate, although not actually an antihypertensive, has proven valuable in the treatment of preeclampsia.
The most concerning major side effect of magnesium sulfate is respiratory depression. In the magnesium sulphate for prevention of eclampsia magpie trial, researchers randomized women with preeclampsia in labor to receive magnesium sulfate or placebo and assessed rates of eclampsia. Individually determined postpartum magnesium sulfate therapy with clinical parameters to safely and costeffectively shorten treatment for preeclampsia. Objective to assess the longterm effects of in utero exposure to magnesium sulphate for children whose mothers had preeclampsia. Beneficial effects of antenatal magnesium sulfate beam. In the magpie trial, magnesium sulfate administration was associated with a reduction in the incidence of eclampsia of approximately 56% placebo. The trial also called magpie trial was a randomized, placebo.
Randomized controlled trials evaluating the effects of magnesium sulfate on. Magnesium sulfate for neuroprotection should only be given if preterm birth is likely within the next 24 hours. Mgso 4 is also superior to placebo and nimodipine for prevention of eclampsia in women diagnosed with preeclampsia. Magnesium sulfate may act as a vasodilator, with actions in the peripheral vasculature or the cerebrovasculature, to decrease peripheral vascular resistance or relieve vasoconstriction. Manual for the bayley scales of infant development, 2nd edn. The results of the magpie trial june 1, p 18771 confirm claims that magnesium sulphate given during labour and for at least 24 h post partum will reduce the risk of seizures in women with severe preeclampsia or imminent eclampsia. Do women with preeclampsia, and their babies, benefit. Judicious use of magnesium sulfate for eclampsia mdedge. Magnesium sulphate more than halved the risk of eclampsia, and probably reduced the risk of maternal death. In this multicenter, placebocontrolled, randomized trial of intravenous magnesium sulfate in women at imminent risk for delivery between 24 and 31 weeks of gestation, magnesium sulfate did not sig. Who recommendation on the use of magnesium sulfate for. Magpie trial multicenter international trial 10,141 randomized.