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Loading dose vs standard regime of magnesium sulphate in the management of eclampsia — A randomized trial
TUESDAY, SEPTEMBER 5 case at 29 weeks, a HELLP syndrome was treated with corticoid during 17 days. In a second group of 14 cases the gestationnal age was > 34 weeks. For these an aggressive management was undergone. The average prolongation was 1.8 days. Conclusion: The expectant management of HELLP syndrome before 34 weeks can be tested in only 60% of cases. Fifty per cent of extraction indications were of f&al origin. The pregnancy prolongation does not seem to be influenced by neither the gestationnal age nor the extraction indication.
FC2.14.07 LOADING DOSE VS STANDARD REGIME OF MAGNESIUM SULPHATE IN THE MANAGEMENT OF ECLAMPSIA - A RANDOMIZED TRIAL A. Beeum, Dept. OB/GYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh., R. Begum, Dept. OB/GYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh. Objectives: Our purpose was to determine whether only loading dose of magnesium sulphate is effective in controlling convulsion in eclampsia. Study Methods: This prospective study was conducted in Dhaka Medical College and Hospital, Bangladesh between July and November 1999. Eclamptic patients who were eligible for Mg SO, therapy were randomly assigned by lottery to receive either only loading dose (n= 202) or standard regime (n= 199). Besides anticonvulsant, patients of both the groups were managed by same protocol for eclampsia management prepared by Eclampsia Working Group Bangladesh. Efficacy of both the regime were assessed by measuring the rate of recurrent convulsion. Results were expressed as mean f SD and proportion. Statistical analysis used Z test and Chi-square test when applicable. A p value of co.05 was considered significant. Results: At the time of randomization there were no significant difference between the two groups in terms of age (22.40 f 4.21 vs 22.49 f 4.67 years), parity (72.77% vs 70.35% primi), type of eclampsia (84.65% vs 85.42% APE), no of convulsion (5.30 f 3.26 vs 5.48 f 3.32 times), gestational age (35.65 f 3.37 vs 35.13 f 3.26 weeks), systolic blood pressure (153.19 f 20.91 vs 154.17 f 22.32 mmHg), diastolic blood pressure (106.23 f 13.84 vs 105.60 mmHg), proteinuria (70.79% vs 72.36% had >+ protienuria) and GCS (73.26% had score E-15 and 26.73% had <8 vs 75.88% had score E-15 and 23.11% had ~8) for the loading dose and standard regime group. There were also no difference between the two groups in mean fit and treatment interval (6.88 f 5.26 vs 7.12 f 4.29 hours), fit and delivery interval (11.35 f 10.22 vs ilk 6.69 hours) and regain of consciousness (10.94 f 8.29 vs 11.24 f 8.37 hours) for the loading and standard regime group. Recurrent convulsion rate was almost same in both the groups (3.96% in loading vs 3.51% in standard regime, p>O.O5). Case fatality rate was 4.45% and 5.02% in loading and standard regime respectively (p>O.O5). Conclusion: Only loading dose of magnesium sulphate can control convulsion in eclampsia and it is as effective as standard regime.
FC2.14.08 THE MAGPIE TRIAL: MAGNESIUM SULPHATE VERSUS PLACEBO FOR WOMEN WITH PRE-ECLAMPSIA n on behalf of the Magpie Trial Collaborative Group Magpie Trial Co-ordinating Centre, Institute of Health Sciences, Oxford, UK. Introduction: Magnesium sulphate is now the anticonvulsant of choice for treatment of eclampsia. However, anticonvulsant prophylaxis in preeclampsia is controversial. A recent systematic review of relevant trials concluded there is promising evidence that magnesium sulphate may reduce the risk of developing eclampsia, but with little information about safety or possible effects on other important outcomes. Objectives: The aim of the Magpie Trial is to compare magnesium sulphate with placebo for women with pre-eclampsia and to evaluate the effects for women and their children. Design and methods: The Magpie Trial is a large international randomised trial co-ordinated from Oxford, UK. There are also regional co-ordinating centres in South Africa and Argentina. A woman is eligible for trial entry if there is uncertainty about whether she should receive magnesium sulphate, she is undelivered or less than 24 hours
47 postpartum, and she has blood pressure zz140/9OmHg, and proteinuria >l+. Trial treatment is given as a loading dose plus 24 hours maintenance therapy. Primary outcomes are eclampsia and, for women recruited before delivery, death of the baby. The estimated sample size is 14,000 women. Progress: Following a pilot study in South Africa, recruitment began in July 1998. By January 2000 more than 3000 women have been recruited from 105 hospitals in 26 countries. Conclusions: The results from this trial will provide reliable data about the benefits and hazards of magnesium sulphate when used for women with pre-eclampsia. This information will help to improve care for women in the future, and to maximise the efficiency of the available health service resources.
FC2.14.09 USE OF MAGNESIUM SULPHATE AMONG ECLAMPSIA CASES AT COMMUNITY LEVEL BEFORE REFERRAL TO TERTIARY HOSPITALS L. Shamsuddin (l), S. Roof (2), P. Fatema (l), S. Khatun (l), K. Rma (1) (1) Dept. OB/GYN, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. (2) Dhaka Medical College Hospital, Dhaka, Bangladesh. Objectives: Use of injection Magnesium Sulphate among eclampsia patients at community level before referral to tertiary hospitals can prevent recurrence of convulsion. Study Methods: It was a case control intervention study. 86 cases of eclampsia from 20 slum of Mirpur, Dhaka, Bangladesh, were selected by one stage cluster sampling during July-December 1999. Cases were given loading doses of injection Magnesium Sulphate (1Ogm) in the community. Results: There was no gross differences in the age, type of eclampsia, or gestational age between the study and control group. Recurrence of fit was nil among the study group whereas 22.8% of the patients had recurrence of convulsion in the control group (P -0.05). Mean time taken to control convulsion was 2.5 and 4.8 hours in the study and control group respectively (P -0.05). 88.4% of the patients in the study group remained conscious. Mean time taken to regain consciousness was 5.3 and 10.7 hours in the study and control group respectively (P X1.05). Case fatality was nil in the study group and 11.1% in the control group. 29% of the control group and 2.3% of the study group developed complications. Conclusions: From the study it reveals that injection of Magnesium Sulphate can safely be administered in the community level before referral to the hospital to decrease maternal mortality from eclampsia.
FC2.15 VIOLENCE
AGAINST
WOMEN
FC2.15.01 FEMALE CIRCUMCISION, SEXUALITY AND MARRIAGE A7TITUDES AND EXPERIENCES OF YOUNG, SINGLE SOMALIS IN LONDON w S Dirir’, J Warsamez, A Dirir’, S Elm?, ‘London School of Hygiene and Tropical Medicine, London WClE 7HT, UK ‘London Black Womens’ Health Action Project, 82 Russia Lane, London E2 9LU, UK Objectives: To understand the role of sexuality and marriage in the dynamics of continuation of female circumcision in an ethnic minority group which practises the most severe form of circumcision: infibulation. Study Methods: Snowball sampling with starting points within different parts of Greater London was used to identify 94 single, female and 82 single, male Somalis aged 16-22 for completion of a detailed questionnaire. In addition 10 females and 10 males gave in-depth interviews. Data collected included circumcision experience (females), sexual experience and attitudes to marriage and circumcision of daughters. Results: 70% of females were circumcised (253% infibulated), with 13% of operations performed in UK. During in-depth interviews females described the trauma of the operation and it’s negative effects on their lives. Both males and females described sexual problems caused by infibulation. The survey showed that a third of males wanted a circumcised wife to ‘ensure’ virginity. 18% females and 42% males intended to circumcise any daughters they had. Longer residence in UK was associated with lower risk of circumcision (females) and less favourable attitudes to female
FC2.14.07 LOADING DOSE VS STANDARD REGIME OF MAGNESIUM SULPHATE IN THE MANAGEMENT OF ECLAMPSIA - A RANDOMIZED TRIAL A. Beeum, Dept. OB/GYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh., R. Begum, Dept. OB/GYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh. Objectives: Our purpose was to determine whether only loading dose of magnesium sulphate is effective in controlling convulsion in eclampsia. Study Methods: This prospective study was conducted in Dhaka Medical College and Hospital, Bangladesh between July and November 1999. Eclamptic patients who were eligible for Mg SO, therapy were randomly assigned by lottery to receive either only loading dose (n= 202) or standard regime (n= 199). Besides anticonvulsant, patients of both the groups were managed by same protocol for eclampsia management prepared by Eclampsia Working Group Bangladesh. Efficacy of both the regime were assessed by measuring the rate of recurrent convulsion. Results were expressed as mean f SD and proportion. Statistical analysis used Z test and Chi-square test when applicable. A p value of co.05 was considered significant. Results: At the time of randomization there were no significant difference between the two groups in terms of age (22.40 f 4.21 vs 22.49 f 4.67 years), parity (72.77% vs 70.35% primi), type of eclampsia (84.65% vs 85.42% APE), no of convulsion (5.30 f 3.26 vs 5.48 f 3.32 times), gestational age (35.65 f 3.37 vs 35.13 f 3.26 weeks), systolic blood pressure (153.19 f 20.91 vs 154.17 f 22.32 mmHg), diastolic blood pressure (106.23 f 13.84 vs 105.60 mmHg), proteinuria (70.79% vs 72.36% had >+ protienuria) and GCS (73.26% had score E-15 and 26.73% had <8 vs 75.88% had score E-15 and 23.11% had ~8) for the loading dose and standard regime group. There were also no difference between the two groups in mean fit and treatment interval (6.88 f 5.26 vs 7.12 f 4.29 hours), fit and delivery interval (11.35 f 10.22 vs ilk 6.69 hours) and regain of consciousness (10.94 f 8.29 vs 11.24 f 8.37 hours) for the loading and standard regime group. Recurrent convulsion rate was almost same in both the groups (3.96% in loading vs 3.51% in standard regime, p>O.O5). Case fatality rate was 4.45% and 5.02% in loading and standard regime respectively (p>O.O5). Conclusion: Only loading dose of magnesium sulphate can control convulsion in eclampsia and it is as effective as standard regime.
FC2.14.08 THE MAGPIE TRIAL: MAGNESIUM SULPHATE VERSUS PLACEBO FOR WOMEN WITH PRE-ECLAMPSIA n on behalf of the Magpie Trial Collaborative Group Magpie Trial Co-ordinating Centre, Institute of Health Sciences, Oxford, UK. Introduction: Magnesium sulphate is now the anticonvulsant of choice for treatment of eclampsia. However, anticonvulsant prophylaxis in preeclampsia is controversial. A recent systematic review of relevant trials concluded there is promising evidence that magnesium sulphate may reduce the risk of developing eclampsia, but with little information about safety or possible effects on other important outcomes. Objectives: The aim of the Magpie Trial is to compare magnesium sulphate with placebo for women with pre-eclampsia and to evaluate the effects for women and their children. Design and methods: The Magpie Trial is a large international randomised trial co-ordinated from Oxford, UK. There are also regional co-ordinating centres in South Africa and Argentina. A woman is eligible for trial entry if there is uncertainty about whether she should receive magnesium sulphate, she is undelivered or less than 24 hours
47 postpartum, and she has blood pressure zz140/9OmHg, and proteinuria >l+. Trial treatment is given as a loading dose plus 24 hours maintenance therapy. Primary outcomes are eclampsia and, for women recruited before delivery, death of the baby. The estimated sample size is 14,000 women. Progress: Following a pilot study in South Africa, recruitment began in July 1998. By January 2000 more than 3000 women have been recruited from 105 hospitals in 26 countries. Conclusions: The results from this trial will provide reliable data about the benefits and hazards of magnesium sulphate when used for women with pre-eclampsia. This information will help to improve care for women in the future, and to maximise the efficiency of the available health service resources.
FC2.14.09 USE OF MAGNESIUM SULPHATE AMONG ECLAMPSIA CASES AT COMMUNITY LEVEL BEFORE REFERRAL TO TERTIARY HOSPITALS L. Shamsuddin (l), S. Roof (2), P. Fatema (l), S. Khatun (l), K. Rma (1) (1) Dept. OB/GYN, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. (2) Dhaka Medical College Hospital, Dhaka, Bangladesh. Objectives: Use of injection Magnesium Sulphate among eclampsia patients at community level before referral to tertiary hospitals can prevent recurrence of convulsion. Study Methods: It was a case control intervention study. 86 cases of eclampsia from 20 slum of Mirpur, Dhaka, Bangladesh, were selected by one stage cluster sampling during July-December 1999. Cases were given loading doses of injection Magnesium Sulphate (1Ogm) in the community. Results: There was no gross differences in the age, type of eclampsia, or gestational age between the study and control group. Recurrence of fit was nil among the study group whereas 22.8% of the patients had recurrence of convulsion in the control group (P -0.05). Mean time taken to control convulsion was 2.5 and 4.8 hours in the study and control group respectively (P -0.05). 88.4% of the patients in the study group remained conscious. Mean time taken to regain consciousness was 5.3 and 10.7 hours in the study and control group respectively (P X1.05). Case fatality was nil in the study group and 11.1% in the control group. 29% of the control group and 2.3% of the study group developed complications. Conclusions: From the study it reveals that injection of Magnesium Sulphate can safely be administered in the community level before referral to the hospital to decrease maternal mortality from eclampsia.
FC2.15 VIOLENCE
AGAINST
WOMEN
FC2.15.01 FEMALE CIRCUMCISION, SEXUALITY AND MARRIAGE A7TITUDES AND EXPERIENCES OF YOUNG, SINGLE SOMALIS IN LONDON w S Dirir’, J Warsamez, A Dirir’, S Elm?, ‘London School of Hygiene and Tropical Medicine, London WClE 7HT, UK ‘London Black Womens’ Health Action Project, 82 Russia Lane, London E2 9LU, UK Objectives: To understand the role of sexuality and marriage in the dynamics of continuation of female circumcision in an ethnic minority group which practises the most severe form of circumcision: infibulation. Study Methods: Snowball sampling with starting points within different parts of Greater London was used to identify 94 single, female and 82 single, male Somalis aged 16-22 for completion of a detailed questionnaire. In addition 10 females and 10 males gave in-depth interviews. Data collected included circumcision experience (females), sexual experience and attitudes to marriage and circumcision of daughters. Results: 70% of females were circumcised (253% infibulated), with 13% of operations performed in UK. During in-depth interviews females described the trauma of the operation and it’s negative effects on their lives. Both males and females described sexual problems caused by infibulation. The survey showed that a third of males wanted a circumcised wife to ‘ensure’ virginity. 18% females and 42% males intended to circumcise any daughters they had. Longer residence in UK was associated with lower risk of circumcision (females) and less favourable attitudes to female