Postpartum magnesium sulfate prophylaxis: a prospective trial utilizing clinical parameters to indicate duration of therapy for hypertensive diseases of pregnancy

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 97; no. 4; p. S44
• Main Authors: Isler, Christy M., Barrilleaux, P.Scott, Rinehart, Brian K., Magann, Everett F., Martin, James N.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-05-2001; The American College of Obstetricians and Gynecologists
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(01)01248-0

Objective: To utilize patient clinical parameters to signal safe cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders.
Methods: A prospective trial using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100, spontaneous diuresis) was used to signal safe cessation of intravenous magnesium sulfate postpartum in gravidas with preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation.
Results: Five hundred three patients were enrolled and classified according to ACOG criteria for hypertensive disease. Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically significant among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups, with the average duration of therapy 7.04 ± 8.17 hours. No eclamptic seizures occurred after magnesium discontinuation.
Conclusion: Clinical criteria can be used successfully and safely to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders.