See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/233647399

Which Anticonvulsant for Women with Eclampsia – Evidence from the

Collaborative Eclampsia Trial

Article  in  International Journal of Gynecology & Obstetrics · February 1996

DOI: 10.1016/0020-7292(96)88075-1

CITATIONS READS

270 178

18 authors, including:

Lelia Duley Álvaro N. Atallah

University of Nottingham Universidade Federal de São Paulo
343 PUBLICATIONS   12,910 CITATIONS    84 PUBLICATIONS   687 CITATIONS   

SEE PROFILE SEE PROFILE

José M Belizán Kassam Mahomed

Institute for Clinical Effectiveness and Health Policy The University of Queensland
330 PUBLICATIONS   11,976 CITATIONS    132 PUBLICATIONS   3,063 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Third stage of labour and postpartum haemorrhage View project

The significance of the psychosocial factors influence in pathogenesis of cardiovascular disease. View project

All content following this page was uploaded by Godfrey J A Walker on 25 October 2018.

The user has requested enhancement of the downloaded file.

 Citations from the literature /International Journal of Gynecology & Obstetrics 52 (1996) 217-227
continuing and tubal) pregnancies with 87.6% sensitivity and
87.5% specificity. Conclusions - A single serum progesterone
measurementtaken in early pregnancy is valuable in the imme-
diate diagnosis of early pregnancy failure and the long term
prognosis of viability.
Fetoscopic her ablatioa of phcentd vesels in severe previable
twio-twiatmmfusioasyndmmc
De Lia J.E.; Kuhhnann R.S.; Ha&ad T.W.; Cruikshank D.P.
AM I OBSTET GYNECOL 1995 172’4 I(1202-1211)
Objective: We undertook a pilot study to determine the
feasibility and efficacy of fetoscopic laser occlusion of
chorioangiopagous vesselsin severe previable twin-twin trans-
fusion syndrome. Study design: A total of 35 patients were
referred to the investigators with ultrasonographic findings
consistent with twin-twin transfusion syndrome, posterior pla-
cental implantation, gestational age < 25 weeks, and clinical
hydramnios. Placental vessel occlusion was performed with a
rigid 2.9 x 3.85 mm dual-channel fetoscope and
neodymium:yttrium-aluminum-garnet laser light. Results: Of
the original 35 patients, 5 were eliminated preoperatively and
4 intraoperatively for various factors. The 26 treated patients
had a mean gestational age of 20.8 weeks (range 18 to 24) and
a mean fundal height of 36.I cm (range 29 to 44). One patient
has surviving triplets, 8 have surviving twins, 9 have a single
survivor (2 neonatal and 7 fetal deaths occurred in this group),
and 8 have no survivors (all had pregnancy loss within 3 weeks
of treatment), The cases with survivors were delivered for
obstetric indications at a mean of 32.2 weeks (range 26 to 37),
having gained a mean of 11.7 weeks (range 6 to 17) in utero.
Fifty-three percent (28/53) of the fetuses survived with 96%
(27/28) developing normally at a mean age of 35.8 months
(range 1 to 68). Thirty-three of 35 placentas were
monochorionic with chorioangiopagous vessels on gross and
microscopic evaluation. Conclusions: Fetoscopic laser occlu-
sion of chorioangiopagous vessels is technically feasible and
improves the course and outcome of severe twin-twin transfu-
sion syndrome in previabie fetuses.
Markers of acute and chronic asphyxia in infants with meconimn-
~amaiotkfhlid
Richey SD.; Ramin S.M.; Bawdon R.E.; Roberts S.W.; Dax J.;
Roberts J.; Gilstrap L.C.
AM J OBSTET GYNECOL 1995 172/41(1212-1215)
Objective: Cord blood pH, lactate, hypoxanthine, and
erythropoietin levels have all been used as markers of either
acute or chronic asphyxia. We sought to determine whether
theseindex values were significantly different in infants with or
without meconium-stained amniotic fluid. Study design: Fifty-
six pregnant women in spontaneous labor at term were divided
into two groups on the basis of the presence or absence of
meconium-stained amniotic fluid. All meconium-stained fluid
was centrifuged, and the volume percentage of particulate mat-
ter (i.e., meconium) was recorded. Umbilical artery blood and
mixed arterial and venous cord blood were obtained at each de-
livery. Lactate, hypoxanthine, and erythropoietin levels were
measured.Statistical analysis included Student t test and rank
221
sum statistics where appropriate. Normal and Spearman corre-
lation coefficients were also used.Results: There were no signif-
icant differencesin mean umbilical artery pH (7.26 f 0.06 vs.
7.25 + O.lO), lactate levels (32.8 * 10 mg/dl vs. 30.4 f 14.2
mg/dl), and hypoxanthine levels (13.4 f 6.7 mom vs.
14.0 * 6.0 mom) in newborns with meconium (n = 28) com-
pared with controls (II = 28). Erythropoietin levels were
significantly greater in newborns with meconium (median 39.5
mIU/ml vs. 26.8 mIU/ml, P = 0.039). There was no correlation
betwem the amount of particulate matter and any marker of
asphyxia. Conclusions: There was no correlation between
markers of acute asphyxia (i.e., umbilical artery blood pH, lac-
tie, or hypoxanthine) and meconium. However,
erythropoietin levels were significantly elevated in newborns
with meconium-stainedamniotic fluid. This latter marker may
better correlate with chronic asphyxia.
W&II an- for women with eclampsia? Evidence from
the coIIaborative damp& trial
Duley L.; Adadevoh S.; Atallah A.; Belixan J.; Carroli G.;
George K.; Grant A.; Mahomed K.; Mehta S.; Mmiro F.;
Moodley J.; Neilson J.; Sheth S.; Walker G.; Chalmers I.;
Collins R.; Munjanja S.; Redman C.
LANCET 1995345/8963(1455-1463)
Eclampsia, the occurrence of a seizure in association with
pre-echnnpsia,remains an important causeof maternal mortal-
ity. Although it is standard practice to use an anticonvulsant
for managementof eclampsia, the choice of agent is controver-
sial and there has been little properly controlled evidence to
support any of the options. 1687women with eclampsia were
recruited into an international multicenter randomized trial
comparing standard anticonvulsants regimens. Primary mea-
suresof outcome were recurrence of convulsions and maternal
death. Data are available for 1680 (99.6%) women: 453
allocated magnesium sulphate versus 452 allocated diaxepam,
and 388 allocated magnesium sulphate versus 387 allocated
phenytoin. Most women (99%) received the anticonvulsant that
they had been allocated. Women allocated magnesiumsulphate
had a 52% lower risk of recurrent convulsions (95% CI 64 to
37% reduction) than those allocated diazepam (60 (13.2%) vs.
126(27.9%);ie, 14.7(S.D.2.6) fewer women with recurrent con-
vulsions per 100 women; 2 P < 0.00001).Maternal mortality
was non-significantly lower among women allocated magne-
sium sulphate. There were no significant differences in other
measuresof serious maternal morbidity, or in perinatal mor-
bidity or mortality. Women allocated magnesium sulphate had
a 67% lower risk of recurrent convulsioqs (95% CI 79 to 47%
reduction) than those allocated phenytoin (22 (5.7%) vs. 66
(17.1%)ie, 11.4(S.D.2.2) fewer women with recurrent convul-
sions per 100women; 2 P < 0.00001).Maternal mortality was
non-significantly lower among women allocated magnesium
sulphate. Women allocated magnesium sulphate were also less
likely to be ventilated, to develop pneumonia, and to be admit-
ted to intensive care facilities than those allocated phenytoin.
The babies of women who had been allocated magnesium sul-
phate before delivery were significantly less likely to be in-
tubated at the place of delivery, and to be admitted to a special
222 Citations from the literature/International
care nursery, than the babies of mothers who had been
allocated phenytoin. There is now compelling evidence in favor
of magnesiumsulphate, rather than diazepam or phenytoin, for
the treatment of eclampsia.
Bhdness associated with preeclampsia and eclampsia
Cunningham F.G.; Femandez C.O.; Hemandez C.
AM J OBSTET GYNECOL 1995 17z4 I (1291-1298)
Objective: Over a 14-year period at Parkland Hospital, the
clinical courses of 15 women with severe preeclampsia or
eclampsia were further complicated by blindness. Our purpose
is to describetheir managementand outcome, as well as to offer
insight to the pathophysiologic characteristics of blindness
complicating pregnancy-induced hypertension. Study design:
Prospective ascertainment of women with blindness and
pregnancy-induced hypertension was done. These cases were
managed according to the standardized preeclampsia-
eclampsia regimen used at our hospital since 1955.Briefly, this
regimen includes magnesium sulfate given intramuscularly to
prevent or control seizures, hydralazine to lower dangerously
elevated blood pressure, intravenous fluid restriction, and de-
livery. Results: There were 15 women with blindness that per-
sisted from 4 h to 8 days; it subsequently resolved completely
in all. Of the 13women who underwent computed tomography,
8 had low-density areaslocalized predominantly in the occipital
lobes. Five of these 13 subsequently underwent magnetic reso-
nance imaging and 2 showed corresponding hyperintense le-
sions in the occipital areas. Conclusions: On the basis of
previously published experiences with computed tomography
in women with eclampsia, as well as the experiences described
here, we conclude that cortical blindness associated with
preeclampsia-eclampsia results from petechial hemorrhages
and focal edema in the occipital cortex. These lesions are likely
stimulated by disparity in cerebral regional blood flow that is
characterized by vasospasm and diminished flow primarily
affecting the posterior circulation.
Recurrencerate of shoulder dystocia
Lewis D.F.; Raymond R.C.; Perkins M.B.; Brooks G.G.;
Heymann A.R.
AM J OBSTET GYNECOL 1995 172/5(1369-1371)
Objective: Shoulder dystocia continues to be a major com-
plication of obstetrics, and several factors have been identified
to help predict its occurrence. A previous shoulder dystocia is
one of the risk factors. However, the recurrence rate is un-
known. The purpose of this study is to report the recurrence
rate of shoulder dystocia. Study design: Our obstetric database
was usedto identify all vaginal deliveries between January 1983
through December 1992. A subset of vaginal deliveries com-
plicated by shoulder dystocia was selectedfrom this database.
These records were reviewed to identify subsequent pregnan-
cies, outcomes, risk factors, and demographic data. Results:
During the study period there were 37 465 total vaginal deliver-
ies, with shoulder dystocia complicating 747 (overall rate 2%).
Of these747 cases,101patients had 123subsequentvaginal de-
liveries, with shoulder dystocia complicating 17 of these preg-
nancies (13.8% recurrence rate, P < 0.0001). Comparisons
View publication stats
Journal of Gynecology & Obstetrics 52 (19%) 217-227
were made between those patients with recurrent shoulder
dystocia. Conclusion: Shoulder dystocia recurred at a rate ap-
proximately seventimes higher than our primary rate. Whether
patients with a history of shoulder dystocia should be offered
an elective abdominal delivery requires further investigation.
Doppler ultrasoaograpby in highrisk pregnancies: Systematic
review with meta-analysis
Alfirevic Z.; Neilson J.P.
AM J OBSTET GYNECOL 1995 172/5(1379-1387)
Objective: Our objective was to review all available (publish-
ed and unpublished) randomized controlled trials of Doppler
ultrasonography of the umbilical artery in high-risk pregnan-
cies. Study design: Only completed randomized controlled tri-
als were included and reviewed according to the prespecified
protocol. Data were sought for 24 prespecified perinatal out-
comes.All meta-analyseswere based on the ‘intention to treat’.
Primary outcome was defined as perinatal death (any death in
utero or postnatally recorded during duration of individual
randomized controlled trial). Reported perinatal outcomesthat
were not prespecilied were meta-analyzed on a posthoc basis.
Results:Twenty randomized controlled trials of Doppler ultra-
sonography were identified; 12 fulfilled the prespecified cri-
teria. Meta-analysis shows a significant reduction in the
number of antenatal admissions(44%, 95% confidence interval
28 to 57%), inductions of labor (20%, 95% confidence interval
10 to 28%), and cesareansections for fetal distress (52%, 95%
confidence interval 24 to 69%) in the Doppler group and that
the clinical action guided by Doppler ultrasonography reduces
the odds of perinatal death by 38% (95% confidence interval 15
to 55%). The reduction in perinatal deaths was also observed
in five mortality subgroups (i.e., stillbirths, neonatal deaths,
deaths of normally formed babies, normally formed stillbirths,
and deaths of normally formed neonates). Post hoc analyses
revealed a statistically significant reduction in elective delivery,
intrapartum fetal distress, and hypoxic encephalopathy in the
Doppler group. Conclusion: There is now compelling evidence
that women with high-risk pregnancies,including preeclampsia
and suspectedintrauterine growth retardation, should have ac-
cess to Doppler ultrasonographic study of umbilical artery
waveforms.
PLACENTA - RESEARCH
Strategies to respond to polymerase chain reaction deoxy-
ribonucleic acid amplitkation failure in a preimplantation genetic
diagwaisprogram
Gibbons W.E.; Gitlin S.A.; Lanzendorf SE.
AM J OBSTET GYNECOL 1995 172/4 I (1088-1096)
Objectives: Our purpose was to identify and evaluate prac-
tical methods within a preimplantation genetic diagnosis pro-
gram that will increasethe percentage of embryos for which a
genetic diagnosis can be obtained, including clinical responses
after failure of deoxyribonucleic acid amplification has oc-
curred. STUDY Design: Known human lymphoblast cell lines
and human embryo blastomereswere evaluated in a single-cell,
nestedprimer polymerasechain reaction systemwith primer se-