Magnesium sulfate use for the treatment of severe preeclampsia and eclampsia in Oaxaca state, Mexico

The most common, yet treatable, cause of maternal death in Mexico is severe pre-eclampsia. If left untreated it can lead to seizures (eclampsia), kidney and liver damage, or death. With the target of the Millennium Development Goals in sight, the Mexican Ministry of Health (MOH) identified preeclampsia/eclampsia as a priority area. The MOH national guidelines indicate magnesium sulfate as the treatment of choice for these conditions, but although it is widely available, previous research suggests it is not routinely or correctly used. To document the use of magnesium sulfate for women with severe preeclampsia/eclampsia in the rural state of Oaxaca, in 2009 we reviewed medical charts of 502 women suffering severe preeclampsia/eclampsia in the state's 10 principal MOH hospitals. The chart review reveals that the majority of women had gone through a trajectory of up to four visits to healthcare facilities. Among women with severe preeclampsia, magnesium sulfate was administered in 16% of the first visits to health facilities with an increase to 79% in the fourth visit, often alongside other anticonvulsant drugs such as phenytoin and diazepam. Conversely, among women with eclampsia magnesium sulfate (alone or combined) was administered in 46% of first visits and its usage decreased to under 7% by the fourth visit. We are analyzing reasons for the differences of magnesium sulfate use in different health facilities, but the findings suggest that magnesium sulfate and additional anticonvulsive drugs are used inconsistently according to the level of care of the hospital and the patient's condition.