IJG-07968; No of Pages 5

International Journal of Gynecology and Obstetrics xxx (2014) xxx–xxx

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International Journal of Gynecology and Obstetrics

journal homepage: www.elsevier.com/locate/ijgo

CLINICAL ARTICLE

Abbreviated (12-hour) versus traditional (24-hour) postpartum

magnesium sulfate therapy in severe pre-eclampsia
Sabina B. Maia a, Leila Katz a, Carlos Noronha Neto a, Bárbara V.R. Caiado b,
Ana P.R.L. Azevedo a, Melania M.R. Amorim a,⁎
a
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
b
Faculdade Pernambucana de Saúde, Recife, Brazil

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To compare the use of magnesium sulfate for 12 hours versus 24 hours in postpartum women with
Received 7 September 2013 stable severe pre-eclampsia. Methods: In 2011, an open randomized clinical trial was conducted with 120 post-
Received in revised form 11 March 2014 partum women with severe pre-eclampsia who gave birth at a tertiary hospital in Brazil; 60 women received
Accepted 30 April 2014 magnesium sulfate for 24 hours and 60 for 12 hours. The analysis was by intention-to-treat and the intervention
was not masked. Results: Abbreviated (12-hour) magnesium sulfate therapy was associated with less exposure to
Keywords:
the drug, and clinical outcomes were similar in both groups. No woman developed eclampsia and there was no
Magnesium sulfate therapy
Postpartum
need to re-initiate treatment after completing the scheduled magnesium sulfate therapy in either group. Magne-
Pre-eclampsia sium sulfate therapy was extended in only three women in the 12-hour group. In addition, in this group, signif-
icant reductions were found in the duration of postpartum use of an indwelling bladder catheter, the time to
ambulation, and the time to maternal contact with the newborn. Conclusion: Abbreviated postpartum magne-
sium sulfate therapy in patients with stable severe pre-eclampsia was associated with less drug exposure, similar
outcomes, and benefits such as a reduction in the time to contact with the newborn.
Clinical trials registration: clinicaltrials.gov NCT1408979
© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

1. Introduction found that some women who received a short-duration magnesium

Pre-eclampsia occurs in 8% of pregnancies [1–3]. An important com-
plication is eclampsia, which may occur prior to, during, or following de-
livery and is associated with an increased risk of maternal death [4–8].
Eclampsia can be prevented with magnesium sulfate, which de-
creases the risk of seizures by 50%, paralleled by a reduction in maternal
mortality [6,9]. Although magnesium sulfate administration is recom-
mended for all women with severe pre-eclampsia [1,9–11], consensus
has yet to be reached on the ideal duration of prophylactic postpartum
anticonvulsant therapy [9,12].
Traditionally, the use of magnesium sulfate has been recommended
for 24 hours following delivery, the period of greatest risk for the occur-
rence of eclampsia [1,13]. Nonrandomized studies have used clinical
criteria for stopping magnesium sulfate earlier in some women with
pre-eclampsia [14,15]. By reducing the duration of therapy, the frequen-
cy of monitoring maternal blood pressure and urinary output may be
curtailed and the possibility for the woman to ambulate and care for
her newborn may be increased. However, a systematic review [16]
⁎ Corresponding author at: Rua Neuza Borborema de Souza, 300, Bairro Santo Antônio,
58406-120, Campina Grande, PB, Brazil. Tel.: +55 8388221514; fax: +55 8333424525.
E-mail address: melania.amorim@gmail.com (M.M.R. Amorim).
treatment regimen required a prolongation or re-institution of therapy,
although this finding was not statistically significant.
In economically developing nations, the use of magnesium sulfate is
also effective [1]. However, unnecessarily prolonged use of magnesium
seizure prophylaxis in resource-constrained regions might delay a
mother’s return to normality and thus preclude such recommended
practices as kangaroo care [17].
The present study was undertaken to compare the use of intrave-
nous magnesium sulfate for 12 hours versus 24 hours postpartum on
the process of care for women with stable severe pre-eclampsia.
2. Materials and methods
The present study was an open-label, randomized clinical trial of
12 hours versus 24 hours of intravenous magnesium sulfate adminis-
tered immediately postpartum to women with stable severe pre-
eclampsia. The study was conducted at the Instituto de Medicina Inte-
gral Professor Fernando Figueira in Recife, Pernambuco, northeastern
Brazil, between July 1 and October 31, 2011, and approved by the inter-
nal Institutional Review Board.
Severe pre-eclampsia was defined as a systolic blood pressure of
160 mm Hg or more and/or a diastolic blood pressure of 110 mm Hg

http://dx.doi.org/10.1016/j.ijgo.2014.03.024
0020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Please cite this article as: Maia SB, et al, Abbreviated (12-hour) versus traditional (24-hour) postpartum magnesium sulfate therapy in
severe pre-eclampsia, Int J Gynecol Obstet (2014), http://dx.doi.org/10.1016/j.ijgo.2014.03.024
2 S.B. Maia et al. / International Journal of Gynecology and Obstetrics xxx (2014) xxx–xxx
or more, persisting at rest in the left lateral decubitus position for 30 mi-
nutes or more, as well as the presence of at least 2 g of urinary protein
over 24 hours or a urinary dipstick value of 3+ [18].
Pre-eclampsia was deemed to be “stable” in the absence of visual signs
or symptoms (scotomata or blurred vision), frontal and/or occipital head-
ache, hyperreflexia, and either epigastric or right hypochondrium pain.
Women with eclampsia were excluded from the study, as were
those with evident hemolysis, elevated liver enzymes, and low platelet
count (HELLP) syndrome [11], pre-existing diabetes mellitus, epilepsy,
renal disease, a contraindication to the use of magnesium sulfate such
as known hypersensitivity to the drug, or anuric or oliguric urinary out-
put under 25 mL/hour.
All women were already receiving magnesium sulfate before and
during delivery (loading dose 6 g; maintenance dose 1 g/hour). Post-
partum, all participants received a 12-hour infusion of magnesium sul-
fate at 1 g/hour. Approximately 6–8 hours after delivery, eligible
women were invited to participate in the trial. Those who provided
written informed consent were enrolled and assigned a randomization
number.
The participants were randomized 1:1 to receive an ongoing
(24-hour) or abbreviated (12-hour) magnesium sulfate infusion at
1 g/hour. Randomization was achieved using a sequential list of
random numbers ranging from 1 to 120, generated by Random Allo-
cation Software version 1.0 (M. Saghaei, Isfahan University of Med-
ical Sciences, Isfahan, Iran). The group allocation was concealed in
opaque, sequentially numbered envelopes, which remained sealed
until randomization.
At 12 hours, after completion of the initial period of intravenous
magnesium sulfate infusion, each woman’s study envelope was opened.
If she was assigned to 24 hours of treatment, her infusion was contin-
ued at 1 g/hour for another 12 hours. If she was assigned to 12 hours
of treatment, her infusion was stopped.
As a safety measure, in the rare situation where a woman was
assigned to the abbreviated magnesium protocol and she had very
high blood pressure (systolic blood pressure of 180 mm Hg or more
and/or a diastolic blood pressure of 120 mm Hg or more), her urine out-
put was under 25 mL/hour, and/or she had signs of imminent eclampsia,
she was maintained on magnesium sulfate for the duration deemed nec-
essary by her attending physician. These women were described as
“need to continue magnesium sulfate treatment after 12 hours” and
were considered to belong to the abbreviated treatment group. In the
24-hour treatment group, the attending physician was also permitted
to extend magnesium therapy if he/she deemed this to be necessary.
Clinical and laboratory measures were assessed in both groups until
at least 24 hours following delivery.
The women were evaluated every 2 hours for heart rate, respiratory
rate, blood pressure, and urine output. Deep tendon reflexes were eval-
uated every 6 hours and laboratory tests to screen for the HELLP syn-
drome were evaluated every 24 hours.
At approximately 24 hours after delivery, each woman’s satisfac-
tion with her care was evaluated on a scale of 1–5 (1 = very satisfied,
2 = satisfied, 3 = not very satisfied, 4 = dissatisfied, and 5 = very
dissatisfied) [19].
The primary study outcome was the duration of anticonvulsant ther-
apy postpartum. Secondary outcomes included patient satisfaction at
24 hours after delivery, clinical measures such as blood pressure, time
to return to ambulation (in hours), duration of indwelling urinary
catheter use (in hours), and time until contact with the newborn infant
(in hours). Additional outcomes included eclampsia, oliguria (urine out-
put b25 mL/hour), postpartum hemorrhage, urinary tract infection,
thromboembolic complications, liver failure, kidney failure, disseminat-
ed intravascular coagulation, cerebrovascular accident, acute pulmo-
nary edema, discontinuation of magnesium treatment because of
adverse effects (heat, flushing, hypersensitivity reaction, nausea, or
vomiting), and the presence of any associated complication occurring
prior to the woman’s discharge from hospital.
Please cite this article as: Maia SB, et al, Abbreviated (12-hour) versus traditional (24-hour) postpartum magnesium sulfate therapy in
severe pre-eclampsia, Int J Gynecol Obstet (2014), http://dx.doi.org/10.1016/j.ijgo.2014.03.024
The analysis was by intention to treat. The t test and the Mann–
Whitney U test were used for the comparison of continuous variables
as appropriate, and the χ2 and Fisher exact tests were used for the com-
parison of categorical variables. All P values were two-tailed; P b 0.05
was considered statistically significant.
To compare the total durations of magnesium sulfate use and post-
partum urinary catheter use and the total times between delivery and
the beginning of ambulation/the mother’s contact with her newborn in-
fant, risk ratios (RR) and their 95% confidence intervals (CI) were calcu-
lated as measures of relative risk. The numbers needed to treat (NNT) to
obtain a benefit were also calculated using the Evidence-Based Calcula-
tor (http://moosenose.com/EBCalculator.htm).
The analysis was conducted using Epi Info version 7 (Centers for Dis-
ease Control and Prevention, Atlanta, GA, USA). The sample size was cal-
culated using OpenEpi version 2.3 (www.openepi.com). Based on
previous data [15], it was assumed that the mean duration of magnesium
sulfate treatment in the abbreviated group would be 18 ± 9 hours,
whereas women in the 24-hour treatment group would receive therapy
for 24 ± 6 hours. To detect this 6-hour difference in the duration of treat-
ment with a statistical power of 80% and a two-sided P value 0.05, 50
women were needed per group. Considering possible drop-outs, the sam-
ple size was increased by 20%, resulting in a total of 60 women per group.
3. Results
During the study period, 140 of 157 women with severe pre-
eclampsia were approached, but 20 women were excluded (Fig. 1). Of
the remaining 120 women who fulfilled the eligibility criteria, 60 were
randomized to receive magnesium sulfate for 12 hours and 60 to re-
ceive magnesium sulfate for 24 hours. During the first 12 hours of mag-
nesium sulfate treatment, four women in each group were excluded.
Therefore, data for 56 women were analyzed in each group.
With respect to the baseline characteristics of the women, no signif-
icant differences were found between the groups (Table 1). Most
clinical and laboratory parameters at admission were similar, with no
differences in the severity of the disease. However, the median platelet
count was lower in the 12-hour group than in the 24-hour group
(178 500/mm3 vs 219 500/mm3; P = 0.01).
During the first 12 hours, no statistically significant differences were
found between the groups with respect to blood pressure or urine output
(Table 2). However, there was a difference in the mean urine output dur-
ing the period of 12–24 hours following treatment initiation (12-hour
group, 128.3 mL/hour; 24-hour group, 159.8 mL/hour; P = 0.008).
There was no difference between the two groups in the number of
women with episodes of very high blood pressure (Table 2). Magne-
sium sulfate therapy was extended in three women in the 12-hour
group; in the 24-hour group, there was no need to prolong the duration
of therapy.
None of the women had to interrupt anticonvulsant therapy because
of adverse effects of the drug or to re-initiate magnesium sulfate treat-
ment following suspension of the drug. There were no occurrences of
eclampsia, acute pulmonary edema, thromboembolic complications,
kidney failure, liver failure, disseminated intravascular coagulation, ce-
rebrovascular accident, or maternal death. One woman had oliguria and
one woman had a urinary tract infection in the 12-hour group, and one
woman in the 12-hour group and two women in the 24-hour group had
postpartum hemorrhage. Even when the presence of any complication
was used as an outcome measure, no difference was found between
the groups. The degree of satisfaction was also similar (Table 2).
The duration of anticonvulsant therapy was significantly shorter in
the 12-hour group (12.5 hours vs 24.0 hours; P b 0.001) (Table 3),
resulting in a reduction of the total dose of magnesium sulfate. The
total time of indwelling urinary catheter use was also significantly
shorter in the 12-hour group (14.3 hours vs 25.3 hours; P b 0.001).
Overall, 98.2% of the women in the 24-hour group used an indwelling
urinary catheter for more than 12 hours compared with 62.5% of the
 S.B. Maia et al. / International Journal of Gynecology and Obstetrics xxx (2014) xxx–xxx 3

Fig. 1. Selection and follow-up of participants (CONSORT flow chart).

Table 1
Baseline characteristics among women with stable severe pre-eclampsia who received magnesium sulfate for 12 versus 24 hours after delivery.a

Characteristic 12 hours 24 hours P value

(n = 56) (n = 56)

Age, y 24.7 ± 6.3 26.3 ± 7.6 0.26

Number of pregnancies 2.1 (1–3) 2.0 (1–2) 0.57
Parity 1.8 (1–2.5) 1.8 (1–2) 0.73
Gestational age at delivery, wk 36.8 ± 3.0 37.2 ± 4.9 0.14
Route of delivery
Cesarean delivery 36 (64.3) 33 (58.9) 0.28
Clinical parameters at inclusion in the study
SBP, mm Hg 142.4 ± 16.4 142.1 ± 15.1 0.91
DBP, mm Hg 92.4 ± 11.9 95.4 ± 10.8 0.17
Heart rate, bpm 88.1 (80–94) 86.1 (80–92) 0.38
Respiratory rate, breaths/min 19.0 (18–20) 18.8 (18–20) 0.60
Urine output, mL/h 117.2 ± 77.6 112.5 ± 79.6 0.76
Laboratory parameters at diagnosis
Hematocrit, % 34.9 ± 15.1 35.3 ± 13.6 0.53
Platelets, mm3 178 500 (158 000–228 500) 219 500 (176 000–268 000) 0.01
Creatinine, mg/dL 0.6 ± 0.1 0.6 ± 0.1 0.63
Uric acid, mg/dL 5.2 ± 1.4 5.8 ± 1.6 0.26
LDH, U/l 280.0 ± 110.7 278.1 ± 97.6 0.92
AST, U/l 24.0 ± 16.5 25.2 ± 16.5 0.99
Total bilirubin, mg/dL 0.5 ± 0.4 0.4 ± 0.2 0.13

Abbreviations: AST, aspartate aminotransferase; DBP, diastolic blood pressure; LDH, lactate dehydrogenase; SBP, systolic blood pressure.
a
Values are given as mean ± SD, median (interquartile range), or number (percentage).

Please cite this article as: Maia SB, et al, Abbreviated (12-hour) versus traditional (24-hour) postpartum magnesium sulfate therapy in
severe pre-eclampsia, Int J Gynecol Obstet (2014), http://dx.doi.org/10.1016/j.ijgo.2014.03.024
4 S.B. Maia et al. / International Journal of Gynecology and Obstetrics xxx (2014) xxx–xxx

Table 2 Library [9], convulsions occurred in only 1.45% of women with pre-
Outcomes of magnesium sulfate use for 12 versus 24 hours: need to prolong treatment, eclampsia receiving magnesium sulfate; therefore, to determine any dif-
clinical parameters, complications, and treatment satisfaction.a
ference in the frequency of eclampsia with the shorter regimen, a sam-
Outcome measure 12 hours 24 hours P value ple of approximately 18 000 women would have been required. Perhaps
(n = 56) (n = 56) a future meta-analysis of randomized clinical trials will have sufficient
Need to prolong treatment 3 (5.4) 0 (0.0) 0.50b power to determine whether there is any difference in the incidence
Blood pressure and urinary of eclampsia.
output at 0–12 hours
Previous nonrandomized studies [14,15] used clinical parameters
Highest SBP, mm Hg 151.3 ± 15.8 152.3 ± 16.6 0.75
Highest DBP, mm Hg 102.2 ± 11.3 100.7 ± 12.5 0.51 (for example absence of symptoms of the imminence of eclampsia, re-
Urinary output, mL/h 107.0 ± 46.7 119.7 ± 76.5 0.29 establishment of diuresis) as criteria for interrupting magnesium sulfate
Blood pressure and urinary use in postpartum women with pre-eclampsia, with the result that a
output at 12–24 hours significant reduction in the duration of treatment was achieved.
Highest SBP, mm Hg 148.8 ± 15.7 151.5 ± 16.4 0.38
In a randomized clinical trial [20] comparing an abbreviated 6-hour
Highest DBP, mm Hg 98.6 ± 11.4 100.3 ± 10.4 0.40
Urinary output, mL/h 128.3 ± 50.9 159.8 ± 61.6 0.008 magnesium sulfate regimen versus 24-hour treatment in postpartum
Presence of very high blood pressure 12 (21.4) 12 (21.4) N0.99 women with pre-eclampsia considered to be at a low risk for eclampsia,
episodes (0–24 hours)c only one woman in the 6-hour magnesium sulfate group needed to re-
Complicationsd
initiate therapy because of worsening hypertension nine hours follow-
Urinary tract infection 1 (1.8) 0 (0.0) 0.50b
Oliguria 1 (1.8) 0 (0.0) 0.50b ing delivery.
Postpartum hemorrhage 1 (1.8) 2 (3.6) 0.50b In another study [21] comparing 12-hour versus 24-hour magne-
Any complication 13 (23.3) 15 (26.8) 0.66 sium sulfate therapy in postpartum women with mild pre-eclampsia,
Satisfaction clinical conditions such as chronic hypertension and type I diabetes
Very satisfied or satisfied 41 (73.2) 36 (64.3) 0.30
were also found to be factors that would increase the risk of aggravating
Abbreviations: CI, confidence interval; DBP, diastolic blood pressure; RR, relative risk; SBP, the condition, requiring postpartum anticonvulsant therapy to be
systolic blood pressure.
a extended.
Values are given as mean ± SD or number (percentage).
b
Fisher exact test. Another randomized clinical trial [22] that used the evaluation of
c
“Very high blood pressure” defined as systolic blood pressure of 180 mm Hg or more urine output as the criterion for interrupting magnesium sulfate therapy
and/or a diastolic blood pressure of 120 mm Hg or more. in postpartum women with severe pre-eclampsia reported results sim-
d
Participants may have had more than one complication. ilar to those found in the present study, in particular a reduction in the
duration of treatment.
women in the 12-hour group, reflecting a significant reduction in its use The mean urine output during the period of 12–24 hours after deliv-
(RR, 0.63; 95% CI, 0.51–0.78; NNT = 3). Similar results were obtained for ery was approximately 30 mL/hour higher when magnesium sulfate
the time from delivery to ambulation (18.8 hours vs 25.8 hours in the therapy was used for 24 hours compared with the shorter treatment
12-hour and 24-hour groups, respectively; P b 0.001) (Table 3). duration. The higher level of diuresis found in the 24-hour group may
A reduction in the time between delivery and contact with the new- be attributable to the longer duration of treatment and the volume of
born infant was found (29.6 vs 35.0 hours in the 12-hour and 24-hour fluid administered together with the anticonvulsant.
groups; P = 0.03). In the abbreviated treatment group, there was a A significant reduction was found in the duration of postpartum in-
38% reduction in the risk of late (after 24 hours of delivery) contact dwelling urinary catheter use, which may account for the reduction in
with the neonate (NNT = 3) (Table 3). the risk of urinary tract infection [23] and the decrease in postpartum
discomfort reported by the women; these outcomes remain to be eval-
4. Discussion uated in future studies.
A reduction was found in the time to ambulation with the shorter
In women with stable severe pre-eclampsia, a shorter duration of regimen of postpartum magnesium sulfate. Early ambulation is impor-
magnesium sulfate therapy was associated with less exposure to the tant for the prophylaxis of deep vein thrombosis [24]. The shorter, 12-
drug, both in terms of treatment duration and in terms of total dose, hour magnesium sulfate therapy enables women to benefit from this
and the clinical outcomes were similar to those among women who prophylactic practice.
had received the traditionally recommended 24-hour regimen of mag- Another benefit associated with shorter magnesium sulfate therapy
nesium sulfate therapy. was the possibility of earlier contact with the newborn, improving the
The shorter regimen was found to be safe for this particular group of likelihood of establishing breastfeeding. It is common practice during
women, although the study did not have sufficient power to evaluate magnesium sulfate administration for the woman to remain in an inter-
the frequency of eclampsia. However, in a systematic review on magne- mediate or intensive care unit, which may contribute toward keeping the
sium sulfate for the prevention of eclampsia available in the Cochrane mother apart from her infant, with all resulting disadvantages. In the

Table 3
Outcomes of magnesium sulfate use for 12 versus 24 hours: total duration of magnesium sulfate use, duration of catheterization, time to ambulation, and time to contact with the
newborn.a

Outcome measure 12 hours (n = 56) 24 hours (n = 56) RR (95% CI) P value NNT

Total duration of magnesium sulfate use, h 12.5 ± 2.3 24.0 ± 3.6 — b0.001 -
Total duration of postpartum use of an indwelling urinary catheter, h 14.3 ± 3.7 25.3 ± 3.5 — b0.001 -
Postpartum use of an indwelling urinary catheter for N12 hours 35 (62.5) 55 (98.2) 0.63 (0.51–0.78) b0.001 3
Time from delivery to beginning of ambulation, h 18.8 ± 4.9 25.8 ± 6.9 — b0.001 —
Time from delivery to beginning of ambulation N15 hours 36 (64.3) 51 (91.1) 0.57 (0.42–0.77) b0.001 3
Time from delivery to contact with newborn, hb 29.6 ± 14.0 35.0 ± 10.6 — 0.03 —
Time from delivery to contact with newborn N24 hoursb 30 (55.6) 49 (89.1) 0.62 (0.48–0.80) b0.001 3

Abbreviations: CI, confidence interval; NNT, number needed to treat; RR, relative risk.
a
Values are given as mean ± SD or number (percentage).
b
Time until contact with the newborn infant was not evaluated in one woman in the 24-hour group (stillbirth) and in two women in the 12-hour group (one stillbirth and one early
neonatal death).

Please cite this article as: Maia SB, et al, Abbreviated (12-hour) versus traditional (24-hour) postpartum magnesium sulfate therapy in
severe pre-eclampsia, Int J Gynecol Obstet (2014), http://dx.doi.org/10.1016/j.ijgo.2014.03.024
 S.B. Maia et al. / International Journal of Gynecology and Obstetrics xxx (2014) xxx–xxx
present study, a significant reduction was found in the time from deliv-
ery until contact with the newborn in the 12-hour group. We believe
that this difference would have been greater if these women had been
discharged from the intensive care unit to a rooming-in environment im-
mediately after discontinuation of the anticonvulsant medication. How-
ever, because the abbreviated therapy protocol represented a change
from the routine management protocol at the study institution, the par-
ticipants were kept in intensive care for safety and ethical reasons, to
guarantee more rigorous surveillance for at least 24 hours. In a systemat-
ic review [16], postpartum hospital stay was not evaluated because the
data (obtained from only three clinical trials) were heterogeneous.
As a future perspective, shorter magnesium sulfate therapy may per-
mit the mother to be released earlier from intensive care, freeing up
hospital beds. The available beds would benefit other postpartum
women with more severe clinical conditions, and there would also be
a reduction in the total time of postpartum hospitalization. Although
further studies are indispensable before this practice can be incorporat-
ed, there is evidence of real benefits, both for the users and for the public
healthcare system, which would translate into savings on the costs of
improvements in tertiary care.
It should be emphasized that postpartum women with other more
severe hypertensive syndromes (exacerbation of chronic hypertension,
HELLP syndrome, eclampsia) and those with associated clinical condi-
tions were excluded from the present study, and the available evidence
in relation to the shorter regimen of magnesium sulfate therapy in these
woman is incipient and sparse. Therefore, we do not recommend early
discontinuation of postpartum anticonvulsant therapy in this group of
women. Moreover, well-designed studies should be conducted with
larger sample sizes to avoid hasty conclusions based on a single study.
In conclusion, in ideal conditions (when the surveillance of postpar-
tum women can be guaranteed), women with stable severe pre-
eclampsia can be re-evaluated clinically and through laboratory tests
after 12 hours of postpartum magnesium sulfate use and the magne-
sium sulfate infusion can be stopped, allowing other possible benefits
derived from this practice.
Conflict of interest
The authors have no conflicts of interest.
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