Table 7 Impact of magnesium sulphate in treatment of pre-eclampsia/eclampsia and threatened pre-term labour on stillbirth and perinatal mortality

Duley 2003 [108]

Bangladesh, South Africa, USA, Malaysia.

Meta-analysis (Cochrane). 5 RCTs included (N = 9,961 women).

To assess the effects of magnesium sulphate for pre-eclampsia (intervention) vs. placebo or no anti-convulsant (controls) on the women and their children.

SBR: RR = 0.99 (95% CI: 0.87 – 1.12) [NS].

[424/5003 vs. 426/4958 in intervention and control groups, respectively].

PMR: RR = 0.98 (95% CI: 0.88 – 1.10) [NS].

[538/4655 vs. 541/4604 in intervention and control groups, respectively].

Duley et al. 2000 [109]

India.

Meta-analysis (Cochrane). 2 RCTs included (N = 177 women).

To compare the effects of magnesium sulphate (intervention) vs. those of lytic cocktail (controls) when used for the care of women with eclampsia.

SBR: RR = 0.55 (95% CI: 0.26 – 1.16) [NS].

[9/89 vs. 16/88 in intervention and control groups, respectively].

NMR: RR = 0.39 (95% CI: 0.14 – 1.06) [NS].

[5/90 vs. 13/93 in intervention and control groups, respectively].

Duley et al. 2003 [104]

South Africa, India.

Meta-analysis (Cochrane). 2 RCTs included (N = 665 women).

To assess the effects of magnesium sulphate (intervention) vs. phenytoin (controls) when used for the care of women with eclampsia.

SBR: RR = 0.83 (95% CI: 0.61 – 1.13) [NS].

[57/325 vs. 72/340 in intervention and control groups, respectively].

PMR: RR = 0.85 (95% CI: 0.67 – 1.09) [NS].

[84/325 vs. 103/340 in intervention and control groups, respectively].

NMR: RR = 0.95 (95% CI: 0.59 – 1.53) [NS].

[29/325 vs. 32/340 in intervention and control groups, respectively].

Duley et al. 2003 [103]

Malaysia, Zimbabwe, Africa, Asia and South America.

Meta-analysis (Cochrane). 4 RCTs included (N = 756 women).

To assess the effects of magnesium sulphate (intervention) vs. diazepam (controls) when used for the care of women with eclampsia.

SBR: RR = 0.89 (95% CI: 0.63 – 1.26) [NS].

[51/385 vs. 55/371 in intervention and control groups, respectively].

PMR: RR = 1.04 (95% CI: 0.80 – 1.36) [NS].

[87/379 vs. 80/366 in intervention and control groups, respectively].

NMR: RR = 1.34 (95% CI: 0.84 – 2.14) [NS].

[38/364 vs. 27/352 in intervention and control groups, respectively].

Magnesium sulphate for threatened pre-term labour.

Reviews and meta-analyses

Crowther et al. 2002 [105]

USA.

Meta-analyses (Cochrane). 7 RCTs included (N = 635 women).

To assess the effectiveness and safety of magnesium sulphate therapy (intervention) vs. placebo, no placebo or alternative tocolytic therapy (controls) given to women in threatened pre-term labour with the aim of preventing pre-term birth and its sequelae.

Fetal deaths (miscarriage+SB): RR = 5.70 (95% CI: 0.28 – 116.87) [NS].

[2/293 vs. 0/342 in intervention and control groups, respectively].

Crowther and Moore 1998 [111]

USA.

Cochrane review. 1 RCT included (N = 50 women).

To assess the effects of magnesium maintenance therapy (intervention) vs. placebo/no treatment (controls) on preventing pre-term birth after threatened pre-term labour.

Death before hosp discharge: RR = 5.00 (95% CI: 0.25 – 99.16) [NS].

[2/25 vs. 0/25 in intervention and control groups, respectively].

Doyle et al. 2007 [110]

Australia, New Zealand, France, USA.

Meta-analysis (Cochrane). 4 RCTs included (N = 3,701 women).

To assess the effectiveness and safety of magnesium sulphate as a neuroprotective agent (intervention) vs. placebo or no placebo (controls) when given to women considered at risk of pre-term birth.

Fetal death (miscarriage + SB): RR = 0.98 (95% CI: 0.78 – 1.24) [NS].

[123/1864 vs. 125/1837 in intervention and control groups, respectively].

Intervention studies

Rouse et al. 2008 [112]

USA. Multicentre.

RCT. N = 2241 women 24–31 weeks of gestation deemed at high risk of pre-term labour.

Compared the impact of IV magnesium sulphate (a loading dose of 6 g infused for 20 to 30 minutes, followed by a maintenance infusion of 2 g per hour) (intervention) with identical-appearing placebo (controls).

SBR+IMR): RR = 1.12 (95% CI: 0.85 – 1.47); P = 0.41 [NS].

[99/1041 (9.5%) vs. 93/1095 (8.5%) in intervention and control groups, respectively].

Moderate or severe cerebral palsy: RR = 0.55 (95% CI: 0.32–0.95); P = 0.03.

[20/1041 (1.9%) vs. 38/1095 (3.5%) in intervention and control groups, respectively].