Preeclampsia Y Sulfato De Magnesio

Magnesium Sulfate for the Treatment of Eclampsia : A Brief Review
Anna G. Euser and Marilyn J. Cipolla
Stroke. 2009;40:1169-1175; originally published online February 10, 2009;
doi: 10.1161/STROKEAHA.108.527788

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Go Red for Women
Magnesium Sulfate for the Treatment of Eclampsia
A Brief Review
Anna G. Euser, PhD; Marilyn J. Cipolla, PhD
Background and Purpose—Magnesium sulfate is usedextensively for prevention of eclamptic seizures. Empirical and
clinical evidence supports the effectiveness of magnesium sulfate; however, questions remain as to its safety and
mechanism. This review summarizes current evidence supporting the possible mechanisms of action and several
controversies for magnesium sulfate treatment.
Summary of Review—Several mechanisms are presented, includingthe effects of magnesium sulfate on peripheral and
cerebral vasodilation, blood-brain barrier protection, and as an anticonvulsant.
Conclusions—Though the specific mechanisms of action remain unclear, the effect of magnesium sulfate in the prevention
of eclampsia is likely multi-factorial. Magnesium sulfate may act as a vasodilator, with actions in the peripheral
vasculature or thecerebrovasculature, to decrease peripheral vascular resistance or relieve vasoconstriction. Additionally, magnesium sulfate may also protect the blood-brain barrier and limit cerebral edema formation, or it may act
through a central anticonvulsant action. (Stroke. 2009;40:1169-1175.)
Key Words: eclampsia

magnesium sulfate

M

agnesium sulfate (MgSO4) has been used throughout
the 20th century forprevention of eclamptic seizures,1,2
and it continues to be used extensively.3–5 Empirical evidence
supports the effectiveness of MgSO4 in preventing and
treating eclamptic seizures,1,6 – 8 in addition to recent controlled clinical trials.5,9,10 For eclamptic seizure prophylaxis
in preeclamptic women, MgSO4 is superior to phenytoin,11,12
nimodipine,13 diazepam,14 and placebo.9 In themultinational
Collaborative Eclampsia Trial, MgSO4 reduced the risk of
recurrent seizures in eclamptic women by 52% when compared to diazepam and by 67% when compared to phenytoin.15 The publication of these clinical trials significantly
increased the use of MgSO4 versus other anticonvulsants in
the United Kingdom and Ireland, where the reported use in
preeclampsia increased from 2% to 40%.16 Inaddition, 60%
of providers surveyed indicated they would use magnesium
as an anticonvulsant for eclampsia in 1998, up from only 2%
of eclamptic women who received MgSO4 in 1992.16,17
Although the effectiveness of MgSO4 in treating and
preventing eclampsia has been established, questions still
exist as to its safety. There are concerns regarding the
possibility of hypermagnesemia toxicity in...