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

BJOG. 2017 Nov;124(12):1883-1890. doi: 10.1111/1471-0528.14400. Epub 2016 Nov 24.


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.

Keywords: dosing regimen; eclampsia; low- and middle-income settings; magneisum sulphate; pre-eclampsia.

MeSH terms

  • Africa
  • Asia
  • Cross-Sectional Studies
  • Eclampsia / drug therapy*
  • Female
  • Health Facilities / statistics & numerical data*
  • Humans
  • Latin America
  • Magnesium Sulfate / therapeutic use*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pre-Eclampsia / drug therapy*
  • Pregnancy
  • Surveys and Questionnaires
  • Tocolytic Agents / therapeutic use*


  • Tocolytic Agents
  • Magnesium Sulfate