EVOLUTION OF

MAGNESIUM SULPHATE
FOR ECLAMPSIA

Tan Gabriella Heidina Handoko 01073170123

Penguji dr. Iwan, Sp. OG(K)
o MedCrave
o Reproductive System and Sexual Disorder International Journal, Volume
2 Issue I – 2018
o Published January 19, 2018
Introduction
Pre- MgSO4
o Most (99%) of the clampsia
63,000 woman
worldwide that die
every year from
preeclampsia and
eclampsia are in
low in-come Eclampsia
countries
Hypertensive Disorders of
Pregnancy

Preeclampsia
 Multi systemic disorder,
characterized by
hypertension and proteinuria
occurring after the 20th week
of pregnancy in a woman
who has been previously
normotensive and non-
proteinuric
Eclampsia
 When a woman with
PREECLAMPSIA experiences
generalized tonic-clonic
seizures during pregnancy or
shortly after delivery
Symptoms of Preeclampsia

BP ≥ 140/90 mmHg atau Proteinuria > 300mg/hari atau dipstick

≥ 160/110 mmHg urin > 1+
Trombositopenia: trombosit < 100.000/ Edema Paru
mikroliter
Gangguan ginjal: Kreatinin serum > 1,1 Gejala neurologis: Stroke, nyeri kepala,
mg/dL gangguan visus
Gangguan liver: Peningkatan Gangguan pertumbuhan janin:
transaminase 2 kali normal dan atau Oligohdramnion, FGR, absent or
adanya nyeri di daerah epigastrik reversed end diastolic velocity (ARDV)
 The Preeclampsia Syndrome that
Results in Eclampsia
Abnormal
trophoblastic
2 basic invasion of uterine
abnormalities blood vessels
Preeclampsia

Endothelial cell
dysfunction
Mechanism of Seizure in
Preeclampsia

Cerebral Edema
Eclampsia can thus be
ischemic necrosis formation
considered as a form of
Hypertensive
CT & MRIencepahlophaty Vasogenic origin resulting
Or from rapid rise in BP
Posterior reversible
encephalophaty
Areas of vasospasm Overcomes the myogenic
which may cause syndrome vasoconstriction of
nercrosis cerebral arteries & arteriols
Brief Historical

SEDATION
Phlebotomy
Work of Stroganoff who
introduced
o Morphine18th
o Chloral Hydrate
Gastric o O2
Carthasis
lavage o Digitalis
Seizure Prophylaxis
Discussion
Magnesium Sulphate
Magnesium Level in Normal &
Preeclampsia Pregnancies

1-2 %
Extrace- Total
Important role in
llular neuro-chemical transmission &
muscular excitability body
MgSO4
Normal plasma magnesium 1.5 – 2.5 mEq/L
30%
bound to
albumin
Magnesium Level in Normal &
Preeclampsia Pregnancies
Magnesium deficiency

Manifest as neurological
symptoms
o > Reversed at delivery
Muscle excitability
o Seizures
Within 24 hours
o Tremors

Hypomagnasemia
Followed by
hypocalcemia &
In 2nd & 3rd trimesters
hypokalemia
Administration

IV (2-4g dose up to
1g/min)
MgSO4
IM (6g loading dose
followed by 2g/h)
 Cara
Pemberian
MgSO4:
Protocols: Pritchard, Zuspan and Sibai
Pharmacology

Blocking
neuromuscular
transmission &
decreasing the
amount of
acetylcholine in
end plate
Common Adverse Side Effect

Cardiac arrest:
Terms:
At higher serum magnesium level
• CaRespiratory
Glukonas 10%
Paralysis:
• Patella> 13reflex
mEq/L
(+)
• Urine output minimal
Areflexia:
0.5 ml/kg/hour
8 to 10 mEq/L
•Vasodilatation to
improve blood flow
in the pulmonary, •Renal failure
renal, hepatic, •Myasthenia gravis
CNS, and placental •Myocardial ischemia
circulations thereby or failure
delaying the need
for delivery
 Other Seizure Prophylaxis

The Eclampsia Trial Collaborative Group. Which

anticonvulsant for women with eclampsia? Evidence from the
collaborative eclampsia trial. Lancet. 1995;345:1455–1463.
Reduce risk of recurrent seizures in eclamptic women by 52%
when compared to diazepam
Reduce risk of recurrent seizures in eclamptic women by 67%
when compared to phenytoin
Mortality

Associated with patient transfers to busy units with

lower staffing levels, chaotic environments
Should increasing staff ratios to allow for proper
monitoring
Monitoring is the key to prevention of toxicity
Conclusion

MgSO4 is the most effective

remedy in the history of
treatment of eclampsia
Thankyou  Any Question?