FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 333:201-206 July 27, 1995 Number 4 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Magnesium sulfate is used widely to prevent eclamptic seizures in pregnant women with hypertension, but few studies have compared the efficacy of magnesium sulfate with that of other drugs. Anticonvulsant prophylaxis with phenytoin for eclampsia has been recommended, but there are virtually no data to support its efficacy. Our objective was to compare magnesium sulfate with phenytoin in preventing seizures in hypertensive women during labor.

Methods We randomly assigned women with hypertension who were admitted for delivery to receive either magnesium sulfate or phenytoin. The magnesium sulfate regimen consisted of a 10-g intramuscular loading dose followed by a maintenance dose of 5 g given intramuscularly every four hours. For women with severe preeclampsia, an additional 4-g loading dose was given intravenously. The phenytoin regimen included a 1000-mg loading dose infused over a period of 1 hour, followed by a 500-mg oral dose 10 hours later. With either regimen, anticonvulsant therapy was continued for 24 hours post partum.

Results Ten of 1089 women randomly assigned to the phenytoin regimen had eclamptic convulsions, as compared with none of 1049 women randomly assigned to magnesium sulfate (P = 0.004). There were no significant differences in any risk factors for eclampsia between the two study groups. Maternal and infant outcomes were also similar in the two study groups.

Conclusions Magnesium sulfate is superior to phenytoin for the prevention of eclampsia in hypertensive pregnant women. These results validate the long-practiced use of magnesium sulfate in the prevention of eclampsia.

Source Information

From the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235-9032, where reprint requests should be addressed to Dr. Lucas.

Full Text of this Article

Related Letters:

Magnesium Sulfate versus Phenytoin for the Prevention of Eclampsia
Sankar R., Licht E. A., Friedman M. N., Duggan K., Macdonald G., Lucas M. J., Leveno K. J., Cunningham F. G.
Extract | Full Text  
N Engl J Med 1995; 333:1638-1639, Dec 14, 1995. Correspondence

This article has been cited by other articles:

• Euser, A. G., Cipolla, M. J. (2009). Magnesium Sulfate for the Treatment of Eclampsia: A Brief Review. Stroke 40: 1169-1175 [Abstract] [Full Text]  
• Wen, S. W. MB PhD, Zhou, J. MB MSc, Yang, Q. MD PhD, Fraser, W. MD MSc, Olatunbosun, O. MD, Walker, M. MSc MD (2008). Maternal exposure to folic acid antagonists and placenta-mediated adverse pregnancy outcomes. CMAJ 179: 1263-1268 [Abstract] [Full Text]  
• Touyz, R. M. (2008). Transient receptor potential melastatin 6 and 7 channels, magnesium transport, and vascular biology: implications in hypertension. Am. J. Physiol. Heart Circ. Physiol. 294: H1103-H1118 [Abstract] [Full Text]  
• Marik, P. E., Varon, J. (2007). Hypertensive Crises: Challenges and Management. Chest 131: 1949-1962 [Abstract] [Full Text]  
• Briggs, G. G., Wan, S. R. (2006). Drug therapy during labor and delivery, part 2.. Am J Health Syst Pharm 63: 1131-1139 [Abstract] [Full Text]  
• Wong, G. K.C., Boet, R., Poon, W.S., Chan, M. T.V., van den Bergh, W., Rinkel, G., Algra, A., On behalf of the MASH Study group, (2005). Trial Design in "Magnesium Sulphate in Aneurysmal Subarachnoid Hemorrhage: A Randomized Controlled Trial" * Response:. Stroke 36: 2530-2532 [Full Text]  
• Rynn, K. O., Hughes, F. L., Faley, B. (2005). An Emergency Department Approach to Drug Treatment of Hypertensive Urgency and Emergency. Journal of Pharmacy Practice 18: 363-376 [Abstract]  
• Euser, A. G., Cipolla, M. J. (2005). Resistance artery vasodilation to magnesium sulfate during pregnancy and the postpartum state. Am. J. Physiol. Heart Circ. Physiol. 288: H1521-H1525 [Abstract] [Full Text]  
• Tatum, W. O. IV, Liporace, J., Benbadis, S. R., Kaplan, P. W. (2004). Updates on the Treatment of Epilepsy in Women. Arch Intern Med 164: 137-145 [Abstract] [Full Text]  
• Greene, M. F. (2003). Magnesium Sulfate for Preeclampsia. NEJM 348: 275-276 [Full Text]  
• Belfort, M. A., Anthony, J., Saade, G. R., Allen, J. C. Jr., the Nimodipine Study Group, (2003). A Comparison of Magnesium Sulfate and Nimodipine for the Prevention of Eclampsia. NEJM 348: 304-311 [Abstract] [Full Text]  
• Schwartz, R. B., Feske, S. K., Polak, J. F., DeGirolami, U., Iaia, A., Beckner, K. M., Bravo, S. M., Klufas, R. A., Chai, R. Y. C., Repke, J. T. (2000). Preeclampsia-Eclampsia: Clinical and Neuroradiographic Correlates and Insights into the Pathogenesis of Hypertensive Encephalopathy. Radiology 217: 371-376 [Abstract] [Full Text]  
• Varon, J., Marik, P. E. (2000). The Diagnosis and Management of Hypertensive Crises. Chest 118: 214-227 [Abstract] [Full Text]  
• Norwitz, E. R., Repke, J. T. (2000). Preeclampsia Prevention and Management. Reproductive Sciences 7: 21-36 [Abstract]  
• Munro, P. T (2000). Management of eclampsia in the accident and emergency department. Emerg. Med. J. 17: 7-11 [Abstract] [Full Text]  
• Duley, L., Neilson, J. P (1999). Magnesium sulphate and pre-eclampsia. BMJ 319: 3-4 [Full Text]  
• Sawle, G. V, Ramsay, M. M (1998). The neurology of pregnancy. J. Neurol. Neurosurg. Psychiatry 64: 717-725 [Full Text]  
• Muir, K. W., Lees, K. R. (1998). Dose Optimization of Intravenous Magnesium Sulfate After Acute Stroke. Stroke 29: 918-923 [Abstract] [Full Text]  
• Nelson, K. B. (1996). Magnesium Sulfate and Risk of Cerebral Palsy in Very Low-Birth-Weight Infants. JAMA 276: 1843-1844 [Abstract]  
• Qureshi, A. I., Frankel, M. R., Ottenlips, J. R., Stern, B. J. (1996). Cerebral Hemodynamics in Preeclampsia and Eclampsia. Arch Neurol 53: 1226-1231 [Abstract]  
• Sibai, B. M. (1996). Treatment of Hypertension in Pregnant Women. NEJM 335: 257-265 [Full Text]  
• Sheth, R. D, Riggs, J. E. (1996). Eclamptic Seizures, Magnesium, and Semantics. Arch Neurol 53: 122-122 [Abstract]  
• Hachinski, V. (1996). Eclamptic Seizures, Magnesium, and Semantics-Reply. Arch Neurol 53: 122-122 [Abstract]  
• Sankar, R., Licht, E. A., Friedman, M. N., Duggan, K., Macdonald, G., Lucas, M. J., Leveno, K. J., Cunningham, F. G. (1995). Magnesium Sulfate versus Phenytoin for the Prevention of Eclampsia. NEJM 333: 1638-1639 [Full Text]  
• (1995). Paper to change practice: Magnesium sulphate for eclampsia. DTB 33: 80-80 [Full Text]  
• Neilson, J. P (1995). Magnesium sulphate: the drug of choice in eclampsia. BMJ 311: 702-703 [Full Text]  
• (1995). MAGNESIUM VS. PHENYTOIN TO PREVENT ECLAMPSIA. JWatch General 1995: 5-5 [Full Text]  
• Roberts, J. M. (1995). Magnesium for Preeclampsia and Eclampsia. NEJM 333: 250-251 [Full Text]