Comparison of Loading Dose of MgSO4 Versus Standard Regimen in Severe Pre-Eclampsia in Pregnant Women from Swat, Pakistan: A Randomized Clinical Trial Loading Dose vs Standard MgSO4 in Severe Pre-Eclampsia

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Alveena Khan
Shima Algasim Abbas Alhindi
Aqsa Arbab Khan
Farhat Shireen
Surraya Halimi
Aysha Bibi

Abstract

Background: Pre-eclampsia is a serious hypertensive disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Magnesium sulfate (MgSO₄) is the standard treatment for seizure prevention in severe pre-eclampsia.
Objective: To compare the efficacy and safety of a single loading dose of MgSO₄ versus the standard regimen in patients with severe pre-eclampsia in Swat, Pakistan.
Methods: A randomized clinical trial was conducted on 248 pregnant women with severe pre-eclampsia at Saidu Group of Teaching Hospital, Swat. Participants were randomized into two groups: Group A received a single loading dose of 4 g intravenous MgSO₄ followed by 5 g intramuscularly, while Group B received the standard regimen of a loading dose followed by 1 g per hour intravenous infusion for 24 hours. Efficacy was assessed by the absence of seizure recurrence, and safety was evaluated based on complications like knee jerk reflex loss, low respiratory rate, and low urine output.
Results: Seizure recurrence occurred in 29.8% in Group A and 21.8% in Group B (p=0.147). Knee jerk reflex loss was significantly higher in Group A (48.4% vs. 24.2%; p=0.000), with no significant differences in low respiratory rate or urine output.
Conclusion: A single loading dose of MgSO₄ is as effective as the standard regimen for seizure prophylaxis in severe pre-eclampsia but is associated with higher knee jerk reflex loss.

Article Details

How to Cite
Alveena Khan, Shima Algasim Abbas Alhindi, Aqsa Arbab Khan, Farhat Shireen, Surraya Halimi, & Aysha Bibi. (2024). Comparison of Loading Dose of MgSO4 Versus Standard Regimen in Severe Pre-Eclampsia in Pregnant Women from Swat, Pakistan: A Randomized Clinical Trial: Loading Dose vs Standard MgSO4 in Severe Pre-Eclampsia. Journal of Health and Rehabilitation Research, 4(3). https://doi.org/10.61919/jhrr.v4i3.1509
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Author Biographies

Shima Algasim Abbas Alhindi, Senior House Officer, Obstetrics and Gynaecology, Letterkenny University Hospital, Ireland

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Farhat Shireen, Senior Registrar, Obstetrics and Gynaecology, Letterkenny University Hospital, Ireland

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References

Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on Pre-Eclampsia: A Pragmatic Guide for First-Trimester Screening and Prevention. Int J Gynecol Obstet. 2019;145(Suppl 1):1-33. doi: 10.1002/ijgo.12802.

Kvalvik LG, Wilcox AJ, Skjærven R, Østbye T, Harmon QE. Term Complications and Subsequent Risk of Preterm Birth: Registry-Based Study. BMJ. 2020;369. doi: 10.1136/bmj.m1007.

Pittara T, Vyrides A, Lamnisos D, Giannakou K. Pre-Eclampsia and Long-Term Health Outcomes for Mother and Infant: An Umbrella Review. BJOG. 2021;128(9):1471-83. doi: 10.1111/1471-0528.16683.

Davis EF, Lazdam M, Lewandowski AJ, Worton SA, Kelly B, Kenworthy Y, et al. Cardiovascular Risk Factors in Children and Young Adults Born to Preeclamptic Pregnancies: A Systematic Review. Pediatrics. 2012;129(6). doi: 10.1542/peds.2011-3093.

Ness RB, Roberts JM. Heterogeneous Causes Constituting the Single Syndrome of Preeclampsia: A Hypothesis and Its Implications. Am J Obstet Gynecol. 1996;175(5):1365-70. doi: 10.1016/S0002-9378(96)70056-X.

Von Dadelszen P, Magee LA, Roberts JM. Subclassification of Preeclampsia. Hypertens Pregnancy. 2003;22(2):143-8. doi: 10.1081/PRG-120021060.

Knuist M, Bonsel GJ, Zondervan HA, Treffers PE. Risk Factors for Preeclampsia in Nulliparous Women in Distinct Ethnic Groups: A Prospective Cohort Study. Obstet Gynecol. 1998;92(2):174-8. doi: 10.1016/S0029-7844(98)00143-4.

Masuyama H, Nobumoto E, Kyozuka H, Komiyama H, Shimokawa M, Kaneko H, et al. Different Profiles of Circulating Angiogenic Factors and Adipocytokines Between Early- and Late-Onset Pre-Eclampsia. BJOG. 2010;117(3):314-20. doi: 10.1111/j.1471-0528.2009.02453.x.

Chaemsaithong P, Sahota DS, Poon LC. First Trimester Preeclampsia Screening and Prediction. Am J Obstet Gynecol. 2022;226(2). doi: 10.1016/j.ajog.2020.07.020.

Papageorghiou AT, Yu CKH, Cicero S, Bower S, Nicolaides KH. Second-Trimester Uterine Artery Doppler Screening in Unselected Populations: A Review. J Matern Fetal Neonatal Med. 2002;12(2):78-88. doi: 10.1080/JMF.12.2.78.88.

Papageorghiou AT, Yu CKH, Bindra R, Pandis G, Nicolaides KH. Multicenter Screening for Pre-Eclampsia and Fetal Growth Restriction by Transvaginal Uterine Artery Doppler at 23 Weeks of Gestation. Ultrasound Obstet Gynecol. 2001;18(5):441-9. doi: 10.1046/j.0960-7692.2001.00572.x.

Aardema MW, Oosterhof H, Timmer A, Van Rooy I, Aarnoudse JG. Uterine Artery Doppler Flow and Uteroplacental Vascular Pathology in Normal Pregnancies and Pregnancies Complicated by Pre-Eclampsia and Small for Gestational Age Fetuses. Placenta. 2001;22(5):405-11. doi: 10.1053/plac.2001.0676.

Voigt HJ, Becker V. Doppler Flow Measurements and Histomorphology of the Placental Bed in Uteroplacental Insufficiency. J Perinat Med. 1992;20(2):139-45. doi: 10.1515/jpme.1992.20.2.139.

Espinoza J, Chaiworapongsa T, Romero R, Kim YM, Kim MR, Yoshimatsu J, et al. Normal and Abnormal Transformation of the Spiral Arteries During Pregnancy. J Perinat Med. 2006;34(6):447-58. doi: 10.1515/JPM.2006.089.

Duley L, Gulmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium Sulphate and Other Anticonvulsants for Women with Pre-Eclampsia. Cochrane Database Syst Rev. 2010;(11). doi: 10.1002/14651858.CD000025.pub2.

Simon J, Gray A, Duley L. Cost-Effectiveness of Prophylactic Magnesium Sulphate for 9996 Women with Pre-Eclampsia from 33 Countries: Economic Evaluation of the Magpie Trial. BJOG. 2006;113(2):144-51. doi: 10.1111/j.1471-0528.2005.00785.x.

Duley L. Maternal Mortality Associated with Hypertensive Disorders of Pregnancy in Africa, Asia, Latin America and the Caribbean. BJOG. 1992;99(7):547-53. doi: 10.1111/j.1471-0528.1992.tb13818.x.

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO Analysis of Causes of Maternal Death: A Systematic Review. Lancet. 2006;367(9516):1066-74. doi: 10.1016/S0140-6736(06)68397-9.

Arulkumaran N, Lightstone L. Severe Pre-Eclampsia and Hypertensive Crises. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):877-84. doi: 10.1016/j.bpobgyn.2013.07.003.

Bigdeli M, Zafar S, Assad H, Ghaffar A. Health System Barriers to Access and Use of Magnesium Sulfate for Women with Severe Pre-Eclampsia and Eclampsia in Pakistan: Evidence for Policy and Practice. PLoS One. 2013;8(3). doi: 10.1371/journal.pone.0059158.

Rimal SP, Rijal P, Bhatt R, Thapa K. Loading Dose Only Versus Standard Dose Magnesium Sulfate Seizure Prophylaxis in Severe Pre-Eclamptic Women. J Nepal Med Assoc. 2017;56(208):343-7. doi: 10.31729/jnma.3431.

Shoaib T, Khan S, Javed I, Bhutta SZ. Loading Dose of Magnesium Sulphate Versus Standard Regime for Prophylaxis of Pre-Eclampsia. J Coll Physicians Surg Pak. 2009;19(1):30-3. doi: 01.2009/JCPSP.3033.

Dasgupta S, Saha SK, Bhowal J, Ganguly R. Single Loading Dose of Magnesium Sulphate in Severe Preeclampsia and Eclampsia-Is It Effective? A Randomized Prospective Study. Obstet Gynecol Int J. 2015;2(6):00059. doi: 10.15406/ogij.2015.02.00059.

Sharma A, Gupta K, Nigam A, Pathania K. Comparison of Low Dose Dhaka Regimen of Magnesium Sulphate with Standard Pritchard Regimen in Eclampsia. Int J Reprod Contracept Obstet Gynecol. 2016;5(9):3044-9. doi: 10.18203/2320-1770.ijrcog20163870.

Kanti V, Bhowmik S, Ganguli D, Ghosh D. Comparison Between Intramuscular and Intravenous Regimen of Magnesium Sulfate in Management of Severe Pre-Eclampsia and Eclampsia. Int J Reprod Contracept Obstet Gynecol. 2015;4(1):1-6. doi: 10.5455/2320-1770.ijrcog20150235.