Pre-eclampsia and eclampsia
Pregnancy complications with hypertension, proteinuria, and multi-organ dysfunction (pre-eclampsia) or seizures (eclampsia). Seizure prophylaxis in severe pre-eclampsia relies on intravenous magnesium sulphate.
ICD-10 O14/O152 drugs
Also known as: Severe gestational hypertension with proteinuria
Drugs used for this condition
- AMagnesium (oral salts: citrate, glycinate, oxide, sulfate)First line · Mineral supplements. MacromineralsIntravenous magnesium sulphate is the standard for seizure prophylaxis and treatment in severe pre-eclampsia and eclampsia. The multicentre Magpie trial (Lancet 2002, more than 10,000 women) showed a 58% reduction in eclampsia risk. ACOG 2020 and Russian Ministry of Health guidelines include magnesium sulphate as a required component of severe pre-eclampsia management. Oral forms are not used in this indication.
- AMagnesium sulfateFirst line · Magnesium salt: intravenous solution and oral saline laxativeEclampsia sits among the indications of the AEMPS Sulfato de Magnesio Altan label. Magnesium goes in intravenously and works not as an antihypertensive but as an anticonvulsant: it stops a fit under way and keeps it from returning. The 2010 Cochrane review compared magnesium with diazepam and phenytoin and found fewer recurrent seizures on magnesium, and in severe pre-eclampsia half as many progressions to eclampsia. Blood pressure is brought down by separate drugs. During the infusion knee reflexes, respiratory rate and urine output are watched: their fading precedes respiratory arrest. The antidote in overdose is intravenous calcium gluconate, which the label states outright. With impaired renal function the dose drops and serum magnesium is checked more often.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit