Magnesium Sulphate Prophylaxis in Severe Preeclampsialessons Learnt from Recent Trials Conducted in Low-MiddleIncome-Countries: A Systematic Review

Abstract

Aim and background:Searching is ongoing to find an alternative prophylactic magnesium sulphate regimen for severe preeclampsia despite 24 hours recommendation of the World Health Organization (WHO). This review finds the provision of any such substitute prophylactic instead of the recommended ones searching through the recently published trials. Objectives: To endorse any alternative prophylactic magnesium sulphate regimen effective for severe preeclampsia. Methods: Data sources: Studies are retrieved from the bibliographic databases of PubMed, Scopus, and Cochrane Library. Eligibility Criteria, Participants, and Interventions: Included studies are recently published trials intended to compare the efficacy of different modified regimens of magnesium sulphate prophylaxis for women with severe preeclampsia in contrast to the standard regimen. Results: Out of a total of fifteen, eight studies evaluated different abbreviated regimens of magnesium sulphate prophylaxis. A lower maintenance dose of magnesium sulphate as preeclampsia-prophylaxis was assessed by two. In addition, four studies evaluated the efficacy of only loading doses of magnesium sulphate as prophylaxis. Finally, one study estimated a placebo in the postpartum period compared to the standard regimen. No incidence of eclampsia was reported in any group of eight studies. Even in the rest seven studies, eclampsia incidences did not appear significantly higher in the study group allocated for either abbreviated or low dose or loading-dose regimens. However, a statistically significant number of women in the study groups needed extension/reinstitution of prophylaxis. Low-dose and loading dose prophylaxis are found unsuitable for a recommendation. Apart from the established safety potential, abbreviated/short-course prophylaxes of magnesium sulphate have been found to generate different secondary benefits. Conclusions: The abbreviated postpartum regimen of magnesium sulphate can be recommended as prophylaxis for severe preeclampsia instead of recommended schedule if applied judicially.