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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.


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

IV infusion set Magnesium sulphate

500 ml normal saline 14 g (for loading dose)
Drip set (tubes) 5 x 5 g (for maintenance
ampoules Contents of the
Intravenous magnesium
cannula sulphate
Tape (to secure cannula) 5 g (for recurrent
pack (intramuscular
Swab (to clean skin for regimen)
and needles cannula)

Syringes and needles Calcium gluconate

(For loading, maintenance 1 g (for toxicity)
doses and calcium
A flow chart gluconate)
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

Rate of infusion 1g per

Magnesium sulphate
in 1000 ml normal
Saline IV infusion
The intramuscular magnesium
sulphate regimen
Magnesium sulphate Slow intravenous
(4g) injection over a period
INTRAVENOUS not less than 5 minutes


Magnesium sulphate Deep intramuscular

(10g) injection, 5g in each
MAINTENANCE Magnesium sulphate
buttock every 4 hours.
THERAPY (5g) Continue for 24 hours
INTRAMUSCULAR after last convulsion, or
Deep intramuscular Next slide
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

-If respiration rate

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

Respiratory depression
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