• L Duley and D Henderson-Smart.
• Resource Centre for Randomised Trials, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF. lelia.duley@ndm.ox.ac.uk
• Cochrane Db Syst Rev. 2000 Jan 1 (2): CD000127.

BackgroundA number of different anticonvulsants are used to control eclamptic fits and to prevent future seizures.ObjectivesThe objective of this review was to assess the effects of magnesium sulphate compared with diazepam when used for the care of women with eclampsia. Magnesium sulphate is compared with phenytoin and with lytic cocktail (in preparation) in other Cochrane reviews.Search StrategyWe searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials Register, 1999 Issue 3.Selection CriteriaRandomised trials comparing magnesium sulphate (intravenous or intramuscular administration) with diazepam for women with a clinical diagnosis of eclampsia.Data Collection And AnalysisTrial quality was assessed and data extraction was done by the two reviewers.Main ResultsFive trials involving 1236 women were included. Most of these trials were of good quality. Magnesium sulphate was associated with a substantial reduction in the recurrence of convulsions, when compared to diazepam (relative risk 0.45, 95% confidence interval 0.35 to 0.58). Maternal mortality was also reduced, although this difference was borderline for statistical significance (relative risk 0.60, 95% CI 0.36-1.00). There are no differences in any other measures of outcome, except for fewer Apgar scores <7 at five minutes (relative risk 0.72, 95% CI 0.55-0.94) and in length of stay in SCBU >7 days (relative risk 0. 66, 95% CI 0.46-0.95) associated with magnesium sulphate.Reviewer's ConclusionsMagnesium sulphate appears to be substantially more effective than diazepam for treatment of eclampsia.

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