Clinical practice patterns on the use of magnesium sulphate for treatment of pre-eclampsia and eclampsia: a multi-country survey

Objective: To characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO4) for eclampsia prevention and treatment in a multi-country network of health facilities and compare with international recommendations. Design: Cross-sectional survey. Setting: A total of 147 health facilities in 15 countries across Africa, Latin America and Asia. Population: Heads of obstetric departments or maternity units. Methods: Anonymous online and paper-based survey conducted in 2015. Main outcome measures: Availability and use of MgSO4; availability of a formal clinical protocol for MgSO4 administration; and MgSO4 dosing regimens for eclampsia prevention and treatment. Results: Magnesium sulphate and a formal protocol for its administration were reported to be always available in 87.4% and 86.4% of all facilities, respectively. MgSO4 was used for the treatment of mild pre-eclampsia, severe pre-eclampsia and eclampsia in 24.3%, 93.5% and 96.4% of all facilities, respectively. Regarding the treatment of severe pre-eclampsia, 26.4% and 7.0% of all facilities reported using dosing regimens that were consistent with Zuspan and Pritchard regimens, respectively. Across regions, intramuscular maintenance regimens were more commonly used in the African region (45.7%) than in the Latin American (3.0%) and Asian (22.9%) regions, whereas intravenous maintenance regimens were more often used in the Latin American (94.0%) and Asian (60.0%) regions than in the African region (21.7%). Similar patterns were found for the treatment of eclampsia across regions. Conclusions: The reported clinical use of MgSO4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations. Tweetable abstract: MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.