A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use
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BACKGROUND: Evidence from RCTs shows that magnesium sulfate reduces the risk of seizures and mortality for women with pre-eclampsia/eclampsia. However, it has been argued that outcomes within trials may not reflect real-world outcomes with the same intervention. OBJECTIVE: To assess whether outcomes for women with pre-eclampsia/eclampsia who received magnesium sulfate in the real world were comparable to those in RCTs. SEARCH STRATEGY: EMBASE and MEDLINE were searched (January 1990-July 2010). SELECTION CRITERIA: Cohort, before-and-after, and serial cross-sectional studies were included. Participants were women with eclampsia who received magnesium sulfate or another anticonvulsant, and women with pre-eclampsia who received magnesium sulfate or no anticonvulsant. Primary outcomes were death (maternal, fetal, neonatal) or recurrent seizures. DATA COLLECTION AND ANALYSIS: Data were extracted independently by 2 reviewers. MAIN RESULTS: Six studies (1831 women with eclampsia) were included, from academic centers in Bangladesh, India, Pakistan, and Nigeria, together with 2 population-based UK studies. Magnesium sulfate for eclampsia was associated with lower risks of maternal death, recurrent seizure, and major morbidity; for pre-eclampsia, it was associated with lower risks of eclampsia. CONCLUSION: Improvements in maternal outcome with magnesium sulfate for pre-eclampsia/eclampsia in real-world use are comparable to those reported in RCTs.