Tara Haelle

February 07, 2017

 

LAS VEGAS — Women with severe pre-eclampsia who received magnesium sulfate before delivery don't need it again later to reduce the risk for eclampsia, according to a large multicenter trial.

Women walked and breast-fed sooner without postpartum magnesium sulfate than with it, and there was no increased risk for other complications in these mothers, according to the randomized controlled open-label trial presented here at the Society for Maternal-Fetal Medicine 2017 Annual Pregnancy Meeting.

An estimated 1% to 3% of mothers with severe pre-eclampsia go on to develop eclampsia, and it remains a major cause of maternal death in Latin America. Current recommendations advise that magnesium sulfate be administered during labor and during the first 12 to 24 hours after delivery for women with severe pre-eclampsia.

The Magpie trial showed a 58% reduction in the risk for eclampsia with postpartum magnesium sulfate (Lancet. 2002;359:1877-1890). However, Magpie was not designed to examine outcomes in women with severe pre-eclampsia who received the drug for 8 hours before delivery, explained Jack Ludmir, MD, from the University of Pennsylvania in Philadelphia.

His team conducted their trial at nine maternity hospitals in five Latin American countries. The primary end point was postpartum eclampsia in the first 24 hours after delivery in mothers who had severe pre-eclampsia and who had received at least 8 g (1 g/h) of magnesium sulfate before delivery.

The 1113 women involved in the study had a blood pressure of at least 140/90 mm Hg, proteinuria of at least 0.3 g, and were at more than 20 weeks of gestation. They also had one of the following symptoms: systolic blood pressure of at least 160 mm Hg, diastolic blood pressure of at least 110 mm Hg, central nervous system symptoms, severe epigastric pain, or laboratory abnormalities other than those related to HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count).

Strict Bed Rest vs Movement

The 555 women who received postpartum magnesium sulfate had a Foley catheter and remained on strict bed rest. The 558 women who did not receive postpartum magnesium sulfate could ambulate and breast-feed when they were ready if they were stable.

Hydralazine or intravenous labetalol was administered as needed in women with a systolic pressure of at least 160 mm Hg or a diastolic pressure of at least 110 mm Hg.

In the first 24 hours, one woman who received postpartum magnesium sulfate and two women who did not developed eclampsia. Each of these women experienced one convulsion after delivery. None of the mothers died and there were no other complications.

The women who did not receive postpartum magnesium sulfate were able to walk an average of 6.3 hours sooner than those who did, and began lactation an average of 7 hours sooner.

"The use of postpartum magnesium sulfate in patients with severe pre-eclampsia who have received at least 8 hours of magnesium sulfate prior to delivery does not seem justified," Dr Ludmir concluded.

Dr Ludmir has disclosed no relevant financial relationships.

Society for Maternal-Fetal Medicine (SMFM) 2017 Annual Pregnancy Meeting: Abstract 4. Presented January 26, 2017.

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