Magnesium sulphate in clinical practice: an obstetrician's viewpoint

The management of eclampsia by obstetric anaesthetists in UK: a postal survey

Eclampsia and pre-eclampsia are major causes of morbidity and mortality in the obstetric population. The latest triennial report on Confidential Enquiries into Maternal Deaths found hypertensive disorders of pregnancy to be the second most common cause of maternal deaths directly attributable to pregnancy. The management of eclampsia includes the control and prevention of further convulsions by pharmacological methods but the choice of drugs may vary. Current evidence supports the use of magnesium sulphate as the drug of first choice for treating eclampsia. Until recently, UK clinicians used other anticonvulsants for this purpose. Questionnaire studies conducted amongst UK obstetricians published in 1991 and 1998 showed that magnesium sulphate was used in the management of severe pre-eclampsia by 2% and 40% of clinicians respectively. We conducted a survey among lead obstetric anaesthetists in 264 obstetric units in the UK to examine their current practice. We also asked how magnesium was used and included a question on the use of nimodipine. The response rate was 86%. Our results show that magnesium sulphate is used for the treatment of eclampsia in 90% of units and for severe pre-eclampsia in 68%. Most administered magnesium for 24-48 h while nimodipine was used by very few units.