Magnesium toxicity antidote5/6/2023 17, 18 In brief, a stratified, multi-stage cluster sampling approach was used to obtain a global sample of countries from Africa, Asia, Latin America and the Middle East. Methodological details of the WHO MCS have been published elsewhere. This was a cross-sectional survey conducted in the network of health facilities in the WHO MCS. The study is part of the converging research activities by WHO towards identifying a clinically non-inferior but simpler MgSO 4 regimen for eclampsia prevention and treatment. Characterisation of clinical practices related to MgSO 4 use will help to inform international efforts to bridge the current evidence-to-practice gap. The main objectives of this study were to characterise the current clinical practices regarding MgSO 4 administration for the treatment of pre-eclampsia and eclampsia by obstetric providers within the WHO MCS network to determine what MgSO 4 regimens are recommended for use in these facilities and to what extent these regimens are consistent with current international recommendations. For instance, the WHO Multi-Country Survey on Maternal and Newborn Health (WHO MCS) in 2010/11 reported high coverage of MgSO 4 use for eclampsia prevention and treatment in facilities in many low- and middle-income countries however, it did not appear to be related to lower rates of adverse outcomes due to pre-eclampsia/eclampsia. 10- 15 Nonetheless, there is evidence to suggest that limited coverage of MgSO 4 may be related more to local clinical practices than the availability of the medication. These include MgSO 4 not being registered or licensed for use for pre-eclampsia/eclampsia, lack of centralised purchasing and distribution mechanisms, lack of evidence-based clinical protocols, insufficient training and shortage of staff to safely deliver MgSO 4 and fear of toxicity. Several barriers to access to and use of MgSO 4 have been identified at multiple levels of health systems. 6, 8, 9 Despite global efforts, translating this knowledge into clinical practice has been challenging in many countries, particularly those with the highest burden of adverse outcomes associated with pre-eclampsia/eclampsia. 6, 7 Currently, the World Health Organization (WHO) and other international organisations recommend two MgSO 4 regimens for eclampsia prophylaxis, namely the Pritchard regimen, which is predominantly administered intramuscularly, and the Zuspan regimen, which is administered intravenously. It is the drug of choice for both prevention and treatment of eclampsia halving the risk of eclampsia in women with pre-eclampsia and is superior to either diazepam or phenytoin. Magnesium sulphate (MgSO 4) is one of the critical interventions required for reducing severe adverse outcomes from pre-eclampsia/eclampsia. 1, 2 It is estimated that approximately 50 000 women die of pre-eclampsia/eclampsia each year, accounting for over one-tenth of maternal deaths in Asia and Africa, and around one-quarter of maternal deaths in Latin America. Pre-eclampsia/eclampsia is a multisystem disorder of pregnancy that carries a high risk of maternal and perinatal mortality and morbidity worldwide. MgSO 4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations. The reported clinical use of MgSO 4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations. Similar patterns were found for the treatment of eclampsia across regions. 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%). 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. MgSO 4 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. 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. Main outcome measuresĪvailability and use of MgSO 4 availability of a formal clinical protocol for MgSO 4 administration and MgSO 4 dosing regimens for eclampsia prevention and treatment. MethodsĪnonymous online and paper-based survey conducted in 2015. Heads of obstetric departments or maternity units. DesignĪ total of 147 health facilities in 15 countries across Africa, Latin America and Asia. To characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO 4) for eclampsia prevention and treatment in a multi-country network of health facilities and compare with international recommendations.
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