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Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound.

Author(s): Naidu S, Payne AJ, Moodley J, Hoffmann M, Gouws E

Affiliation(s): MRC/UN Pregnancy Hypertension Research Unit, University of Natal, Faculty of Medicine, Congella, South Africa.

Publication date & source: 1996-02, Br J Obstet Gynaecol., 103(2):111-6.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: To assess maternal middle cerebral artery flow velocity patterns as measured by transcranial Doppler ultrasound (TCD) in eclampsia and to investigate the effect of the anticonvulsants magnesium sulphate (MgSO4) and phenytoin on cerebral circulation. DESIGN: Prospective randomised study. SETTING: High care obstetric unit, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: Twenty-four eclamptic patients: 13 received MgSO4 and 11 phenytoin. INTERVENTION: Middle cerebral artery flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach in eclamptic patients, before and 15 minutes after the loading dose of anticonvulsant. RESULTS: Magnesium sulphate significantly reduced the pulsatility index (P = 0.002) and mean flow velocity (P = 0.02) in the middle cerebral artery, whereas phenytoin failed to produce any statistically significant effect. However, differences between groups were not statistically significant. Systolic and diastolic blood pressures were reduced in both the MgSO4 and phenytoin groups. CONCLUSION: These findings provide firm evidence that MgSO4 relieves cerebral vasospasm, compared with phenytoin, and may therefore be the better drug for the prevention of eclamptic convulsion.

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