Magnesium sulphate regimens for

women with pre-eclampsia and eclampsia

For more than 75 years the anticonvulsant agent for treating
eclampsia and whether to use an anti-convulsant or not for
women with pre-eclampsia have been controversial.

This situation changed with two recent

multicentre trials:

Eclampsia Trial Collaborative Group.

Which anticonvulsant for women with eclampsia?
Evidence from the Collaborative Eclampsia Trial.
Lancet 1995;345:1455-1463
Do women with pre-eclampsia, and their babies,
benefit from magnesium sulphate?
The Magpie trial: a randomised placebo-controlled trial.
Lancet 2002;1:359(9321):1877-1890

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 Magnesium sulphate Boxes

Treatment packs in cardboard boxes containing

magnesium sulphate for the loading dose, 24h maintenance
therapy and treatment of one (recurrent) convulsion as well as
syringes, swabs, drip sets and fluids make the application of
magnesium sulphate treatment quick and easy in emergencies.

Magnesium
sulphate
BOX

Source: Duley L. Magnesium Sulphate regimens for women with Eclampsia: Messages from the
Collaborative Eclampsia Trial. British Journal of Obstetrics and Gynaecology. 1996;103:103-105
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 The treatments packs

Contents of the magnesium sulphate

pack (intramuscular regimen)

IV infusion set Magnesium sulphate

500 ml normal saline 14 g (for loading dose)
Drip set (tubes) 5 x 5 g (for maintenance
ampoules Intravenous cannula therapy)
Tape (to secure cannula) 5 g (for recurrent
syringes Swab (to clean skin for convulsions)
and needles cannula)
Syringes and needles Calcium gluconate
(For loading, maintenance 1 g (for toxicity)
doses and calcium
A flow chart gluconate)
summarising
how to administer Protocol Charts
magnesium Summary flow chart Fluid balance
sulphate (on lid of the box) Observations
Detailed regimen
Guidelines for other
aspects of care Next slide
 The intravenous (IV)
magnesium sulphate regimen

Magnesium sulphate Slow intravenous

(4g) injection over a period
INTRAVENOUS not less than 5 minutes
preferably 10-15
LOADING DOSE
minutes

Magnesium sulphate Rate of infusion 1g per

(10g) hour
in 1000 ml normal
Saline IV infusion

MAINTENANCE Continue for 24 hours

THERAPY after last convulsion, or
delivery

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 The intramuscular magnesium
sulphate regimen
Magnesium sulphate Slow intravenous
(4g) injection over a period
INTRAVENOUS not less than 5 minutes

LOADING DOSE
Magnesium sulphate Deep intramuscular
(10g) injection, 5g in each
INTRAMUSCULAR buttock

Deep intramuscular
injection, 2.5g in each
MAINTENANCE Magnesium sulphate buttock every 4 hours.
THERAPY (5g) Continue for 24 hours
INTRAMUSCULAR after last convulsion, or
delivery
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 Recurrent convulsions

Magnesium sulphate 2-4 g IV

over 5 minutes

Give lower dose (2g) if the

patient is small and/ or weight
is less than 70 kgs

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 Monitoring during magnesium
sulphate therapy

Continue with IV infusion or give the next IM

dose only if:
Respiratory rate >16/min
Urine output >25 ml/h (or >100 ml in 4h)

With IV regimen monitor more frequently in the

first 2 hours

Consider reducing the dose if renal function

is impaired

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 In case of magnesium toxicity
Respiratory arrest Absent patellar reflexes

-Stop magnesium sulphate -If respiration rate

treatment abnormal, withhold further
-Intubate and ensure magnesium sulphate
ventilation
-1g IV calcium gluconate

Respiratory depression Urine output < 100 ml in 4h

-Stop magnesium -If there are no respiratory or

sulphate treatment patellar signs mentioned
-Oxygen by mask reduce the dose by half
-1g IV calcium gluconate (IV infusion 0.5g/1h, IM
2.5g 4 hourly)
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 For more information go to Cochrane Reviews and
Commentaries on prevention and treatment of eclampsia
in WHO Reproductive Health Library

Magnesium sulphate versus diazepam for eclampsia

Magnesium sulphate versus phenytoin for eclampsia

Magnesium sulphate versus lytic cocktail for eclampsia

Drugs for rapid treatment of very high blood pressure
during pregnancy
Antihypertensive drug therapy for mild to moderate
hypertension during pregnancy

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 For more information, please see
Cochrane Reviews and Commentaries in RHL