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Sandra G. García,
Marieke G.
van Dijk,
Kate S. Wilson,
and Patricio Sanhueza Smith.
"Use of magnesium sulfate to treat severe preeclampsia."
(Poster 75)
ABSTRACT
Learning objectives
Describe the barriers to the use of magnesium sulfate in
preeclampsia/eclampsia in Mexico.
Background
In Mexico, complications due to preeclampsia and eclampsia are
the leading cause of maternal mortality and in 2005 accounted for
26 percent of total maternal deaths. The international standard of
care for preventing and treating seizures in women with severe
preeclampsia or eclampsia is magnesium sulfate—a low-cost
anticonvulsant. Despite the fact that magnesium sulfate is
stipulated as the drug of choice in the national guidelines of the
Mexican Ministry of Health (MOH) and its general availability in
public health services, it is not used routinely. In order to
understand why, three complementary studies were carried out.
Design/methods
The first study reviewed the charts of women who died of
preeclampsia and eclampsia in Mexico City in 2005 to determine the
proportion of times magnesium sulfate was used. The second study
consisted of self-administered questionnaires among physicians of
MOH hospitals in Mexico City, to assess their knowledge and use of
magnesium sulfate in preeclampsia and eclampsia. The third study
entailed in-depth interviews with 11 key informants on the barriers
to use of magnesium sulfate in Mexico.
Results/outcomes
The chart review found that 49 maternal deaths out of 167 were
attributed to preeclampsia or eclampsia (29 percent) in Mexico City.
Magnesium sulfate was used in 55 percent of the cases, often
combined with other drugs such as phenytoin and diazepam. The 113
obstetricians/gynecologists who responded to the questionnaire of
the second study reported a higher preference for magnesium
sulfate: 79 percent stated that magnesium sulfate is their preferred
drug to prevent convulsions in patients with preeclampsia, and 46
percent said it is for treating eclampsia. The second drug of choice
was phenytoin—17 percent of physicians reported using it for
preeclampsia, and 31 percent for eclampsia. Our interviews with key
informants (MOH officials, other well-known physicians, and members
of the academic community) identified the following main barriers
for the use of magnesium sulfate: drug-related barriers (fear of
side effects, intramuscular administration not possible), preference
for other drugs due to different “schools of thought,” and lack of
knowledge on the use of magnesium sulfate (no time or access to
update knowledge, inadequate training). At the political level,
respondents said an important barrier was the lack of coordination
between the reproductive health area of the MOH and practicing
obstetricians/gynecologists.
Conclusions
Despite the fact that magnesium sulfate is recognized as the
drug of choice in the national guidelines for the treatment of (pre)eclampsia,
there are still many barriers to its use in Mexico. The
self-reported preference for using magnesium sulfate is higher than
its actual use as revealed by maternal mortality charts. The use of phenytoin is very common.
Poster Session—Reproductive Health
Thursday, 29 May 2008,
10:30
am–12:30
pm
2008
International Conference on Global Health Web site
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