Clinical practice patterns on the use of magnesium sulphate for treatment of pre-eclampsia and eclampsia: a multi-country survey.
OBJECTIVE:To characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO4 ) for eclampsia prevention and treatment in a multi-country network of health facilities and compare with international recommendations. DESIGN:Cross-sectional survey. SETTING:A total of 147 health facilities in 15 countries across Africa, Latin America and Asia. POPULATION:Heads of obstetric departments or maternity units. METHODS:Anonymous online and paper-based survey conducted in 2015. MAIN OUTCOME MEASURES:Availability and use of MgSO4 ; availability of a formal clinical protocol for MgSO4 administration; and MgSO4 dosing regimens for eclampsia prevention and treatment. RESULTS:Magnesium sulphate and a formal protocol for its administration were reported to be always available in 87.4% and 86.4% of all facilities, respectively. MgSO4 was used for the treatment of mild pre-eclampsia, severe pre-eclampsia and eclampsia in 24.3%, 93.5% and 96.4% of all facilities, respectively. Regarding the treatment of severe pre-eclampsia, 26.4% and 7.0% of all facilities reported using dosing regimens that were consistent with Zuspan and Pritchard regimens, respectively. Across regions, intramuscular maintenance regimens were more commonly used in the African region (45.7%) than in the Latin American (3.0%) and Asian (22.9%) regions, whereas intravenous maintenance regimens were more often used in the Latin American (94.0%) and Asian (60.0%) regions than in the African region (21.7%). Similar patterns were found for the treatment of eclampsia across regions. CONCLUSIONS:The reported clinical use of MgSO4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations. TWEETABLE ABSTRACT:MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.
Long, Q; Oladapo, OT; Leathersich, S; Vogel, JP; Carroli, G; Lumbiganon, P; Qureshi, Z; Gülmezoglu, AM; WHO Multicountry Survey on Maternal and Newborn Health Research Network,
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