Comparison of Zuspan regimen and its 12-hour modification in women with severe pre-eclampsia and eclampsia in two hospitals in Abeokuta

Hypertensive disorders in pregnancy are leading causes of maternal and perinatal morbidity and mortality [1]. It complicates about 2–10% of pregnancies and accounts for 14.0% of maternal mortality globally [2], [3], [4]. The subsets; preeclampsia and eclampsia are mainly responsible for adverse maternal and perinatal outcomes accounting for about 9% of maternal deaths in Africa and Asia and about one-quarter of maternal deaths in Latin America and the Caribbean [3], [4]. In Nigeria, eclampsia alone contributes to 12.4%−43.1% of maternal mortality [5], [6], [7].

Preeclampsia is a multi-systemic disorder characterised by development of hypertension with associated proteinuria, maternal organ dysfunction and/or placental dysfunction [8]. Eclampsia is the occurrence of generalized tonic-clonic convulsions in a woman with background pre-eclampsia in the absence of neurological, endocrinologic or metabolic derangements [9]. Eclampsia occurs in 1/43 – 1/41 (2.3 – 2.45%) deliveries in Nigeria, 7.4/10,000 deliveries in Japan and 2.7/10,000 in the United Kingdom [7], [10], [11], [12]. It is a major cause of death in patients with hypertensive disorders of pregnancy [5].

Magnesium sulphate (MgSO4) regimens have evolved over time with the commonest being Zuspan and Pritchard regimens [13]. The Zuspan regimen involves a loading intravenous dose of 4 g given over 10 – 15mins followed by an intravenous infusion of 1 g per hour for 24 h [14]. In a study by Oguntunde et al. [15], the challenges with the use of MgSO4 were facility-oriented (most facilities assessed had no MgSO4 in store), provider oriented (there was inadequate staffing and less than half of the providers had ever been trained on the correct use of MgSO4 and community/patient-oriented (misconception of the disease entity thus preventing prompt presentation for care was identified).

Imaralu et al in their study on clinical correlates of MgSO4 revealed that using the Pritchard regimen, MgSO4 levels peak at 8 h and thereafter decline with recorded seizures occurring within 4 h before the onset of maintenance dose [16]. The effect of reduction in the maintenance dose of the Zuspan regimen to 12 h in Eclampsia and severe preeclampsia by Anjum et al and Unwaha et al respectively revealed its efficacy and safety in the prevention of convulsions [17], [18]. However, while Anjum and colleagues did not assess maternal adverse effects and perinatal outcomes, Unwaha et al did not assess the effect as regards postpartum haemorrhage [17], [18].

This study thus aimed to compare the Zuspan regimen with its 12-hour modification in the treatment of severe pre-eclampsia and eclampsia (SPE/EC) at Federal Medical Centre and Sacred Heart Hospital, Abeokuta, Ogun state, Nigeria. The outcomes of interest include the occurrence of seizures, maternal signs of MgSO4 toxicity including loss of deep tendon reflex, respiratory depression and pulmonary oedema, blood loss at delivery, Apgar scores, incidence of neonatal admissions and perinatal/neonatal deaths following treatment with the short course of MgSO4 regimen as against the Zuspan Regimen in patients with SPE/EC.

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