Convulsions

Magnesium sulphate has been shown to reduce the incidence of eclampsia in pre-eclampsia by about half, although whether it should be offered routinely to pre-eclamptics is controversial since only 1-2% of the latter go on to develop pre-eclampsia and a significant proportion of eclamptics cannot be identified beforehand (see, Chapter 82, Magnesium sulphate, p. 196).

Magnesium sulphate reduces the incidence of recurrent convulsions in eclampsia, by about half compared with phenytoin and diazepam, and 'magnesium packs' should be available on every labour ward.

There is no place for clomethiazole or phenytoin in the prophylaxis or treatment of eclampsia. Diazepam is still used to terminate eclamptic fits, although magnesium sulphate is also effective, and it would seem logical to treat with a single agent rather than two. Some authorities claim that eclamptic fits are self-limiting and that no treatment other than initiation of the magnesium sulphate regimen is needed.

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