Eclampsia
Michael J. O’Dowd in The History of Medications for Women, 2020
Alexander Hamilton of Edinburgh, usually gains the credit for being one of the first writers in English to use the term but according to Fleetwood Churchill of Dublin, it was Carl Braun of Vienna who introduced the term (uremic) eclampsia in the mid-nineteenth century. Although Denman and Dewees were very influential and their opinions held sway for a time, the management of eclampsia suffered from the introduction of anesthesia in 1847 and the re-application of ‘accouchement force’ which it allowed. In eclampsia, moreover, an effect is necessary both on the sensory centers and the convulsive center. The best agent for the former is morphine; for the latter chloral’. The results of the Collaborative Eclampsia Trial, which found in favor of magnesium sulfate over diazepam and/or phenytoin, meant that magnesium sulfate, the humble Epsom salt, was to become the drug treatment of choice in eclampsia.
Magnesium in obstetrics
Kupetsky A. Erine in Magnesium, 2019
Magnesium sulfate is one of the most commonly administered intravenous medications in pregnancy. The high frequency of usage arises from the fact that it has multiple indications including seizure prophylaxis in a mother with pre-eclampsia and the prevention of cerebral palsy in a fetus that is delivered prematurely. Pre-eclampsia is a disease that is unique to pregnant women and remains a mysterious disorder despite significant recent basic science advances. While magnesium is being administered, patients should be monitored closely for adverse effects and signs of toxicity, including assessment of respiratory rate, patellar reflexes, neurologic status, and urine output. Intravenous magnesium has a long and complicated history of clinical use in obstetrics. Its predominant role is in neuronal stabilization and the prevention of neurologic injury including both eclamptic seizures in the mother and cerebral palsy after preterm delivery in the neonate.
Magnesium Sulfate
Louis A. Pagliaro, Ann Marie Pagliaro in PNDR: Psychologists’ Neuropsychotropic Drug Reference, 2020
Generally, it is recommended that intravenous magnesium sulfate pharmacotherapy be restricted to hospitalized patients who can be monitored appropriately (including blood pressure, electrocardiogram, and respiratory function) and for whom magnesium blood concentrations can be obtained easily and rapidly. An intravenous formulation of calcium gluconate should be readily available to reverse the adverse drug reactions or toxicity associated with magnesium sulfate pharmacotherapy. Magnesium sulfate is incompatible with alkali carbonates, alkali hydroxides, and salicylates. Concurrent magnesium sulfate pharmacotherapy and pharmacotherapy with opiate analgesics, sedative-hypnotics, or other drugs that produce CNS depression may result in additive CNS depression. Magnesium sulfate pharmacotherapy generally is well tolerated.
The effect of magnesium sulfate on gene expression in maternal microvascular endothelial cells
Published in Hypertension in Pregnancy, 2018
Dennis K. Lee, Anindita Sengupta, Ori Nevo
Preeclampsia is a severe complication of pregnancy associated with maternal and fetal morbidity and mortality. To date, magnesium sulfate remains the preferred method of treatment used to reduce the development of eclampsia. Our aim was to investigate the effects of magnesium sulfate on the expression of genes involved with endothelial function in maternal microvascular endothelial cells from both normal and preeclamptic pregnancies. Primary cells from normal pregnancies treated with 80 mg/L magnesium sulfate for 6 h revealed an overall trend of increased expression of angiogenic and vasopressor-related factors by qPCR analyses. Primary cells from preeclamptic pregnancies revealed an overall trend of decreased expression, with significantly lowered levels for vascular endothelial growth factor receptor 2, endothelin, and vascular cell adhesion protein-1. A comparison of treated cells revealed significantly increased levels for endoglin, vascular endothelial growth factor receptor 2, soluble fms-like tyrosine kinase-1, prostacyclin synthase, tumor necrosis factor α, tumor necrosis factor receptor 1, and endothelin in normal versus preeclamptic cells following treatment. These results reveal disparate activation of overall expression activity by magnesium sulfate in maternal endothelial cells from normal pregnancies over preeclamptic pregnancies.
A novel protocol for postpartum magnesium sulphate in severe pre-eclampsia: a randomized controlled pilot trial
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2016
Waleed El-Khayat, Adel Atef, Sahar Abdelatty, Ali El-semary
Objective: Magnesium sulphate is the preferred anticonvulsant used to prevent the development of fits in severe pre-eclampsia; we aim to compare between three different protocols of postpartum magnesium sulphate in the effectiveness of preventing the development of fits in severe pre-eclampsia. Methods: Double-blind randomized controlled pilot trial, done in Cairo university hospital, Cairo, Egypt during 2013–2014, on 240 women with severe pre-eclampsia. Magnesium sulphate intravenous infusion was given in the postpartum period to all the patients, women were randomly allocated to group I (Single loading dose only), group II (12 h abbreviated protocol) or group III (24 h standard protocol) (n = 80 in each group). Results: There were no significant difference between the three groups as regards the incidence of eclampsia, elevated liver enzymes and low platelets syndrome, maternal ICU admission and; however The incidence of flushing was significantly higher in group III than group II and I (24 [30%] versus 12 [15%] versus 4 [5%]; p
Magnesium sulphate can prolong pregnancy in patients with severe early-onset preeclampsia
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2016
Akihiko Ueda, Eiji Kondoh, Kaoru Kawasaki, Haruta Mogami, Yoshitsugu Chigusa, Ikuo Konishi
Objective: To assess whether long-term use of magnesium sulphate prolongs pregnancy in patients with severe early-onset preeclampsia. Methods: Retrospective cohort study included all singleton pregnancies with severe early-onset preeclampsia, expectantly managed in our institution between 2005 and 2013. Obstetric and perinatal outcomes were compared between patients managed using a current protocol that tolerates long-term (over 48 h) use of magnesium sulphate (long-term group, n = 26) and a historical control group (control group, n = 15) that underwent conventional treatment (up to 48 h use of magnesium sulphate). Results: Long-term group showed significant prolongation of pregnancy compared with the control group (9.2 ± 7.9 versus 16.6 ± 9.3 d, log-rank test, p = 0.021), which was also observed in patients with severe preeclampsia occurring before 28 weeks’ gestation (n = 11, 4.5 ± 5.2 versus 13.2 ± 6.8 d, log-rank test, p = 0.035). In contrast to a progressive decrease of platelet count in patients managed without magnesium sulphate, administration of magnesium sulphate for 7 d prevented the decrease of platelet count (p = 0.001). Thirty two percent of patients (13/41) experienced a major complication irrespective of duration of magnesium sulphate use. Conclusions: Long-term use of magnesium sulphate prolonged pregnancy in patients with severe early-onset preeclampsia and can help alleviate progression of preeclampsia.
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