The collaborative eclampsia trial : which anticonvulsant for women with eclampsia
Objective: To estimate reliably the differential effects of anticonvulsants commonly used for the care of women with eclampsia (magnesium sulphate, diazepam and phenytoin). Design: A multicentre collaborative randomized trial. Setting: Twenty seven hospitals in Africa (Ghana, South Africa, Uganda and Zimbabwe), South America (Argentina, Brazil, Colombia and Venezuela) and India. Subjects: 1687 women with eclampsia. Interventions: In some centres magnesium sulphate was compared with diazepam, other centres compared magnesium sulphate with phenytoin. Main outcome measures: The primary measures were maternal death and recurrence of convulsions. Secondary outcomes were measures of serious maternal morbidity and, for women randomized before delivery, perinatal mortality and morbidity. Results: Of the 1687 women recruited, 910 were entered into the comparison of magnesium sulphate with diazepam and 777 into the comparison of magnesium sulphate with phenytoin. Data are available on 1680 (99.6%) of the women, 99% of whom received the anticonvulsant that they had been allocated. In the diazepam arm of the trial, women allocated magnesium sulphate had a 52% lower risk of recurrent convulsions (95% Cl 64% to 37%) than those on diazepam. In the phenytoin arm, women allocated magnesium had a 67% lower risk of recurrent convulsions (95% Cl 79% to 47%) than those on phenytoin. These reductions in the risk of recurrent convulsions were also reflected in non-significant trends to fewer maternal deaths amongst women allocated magnesium sulphate. Conclusions: There is now compelling evidence in favour of magnesium sulphate, rather than diazepam or phenytoin, for the treatment of eclampsia.