Eclampsia

Introducción: Desde su primer uso en 1926 en el manejo de la eclampsia el sulfato de magnesio ha sido un medicamento utilizado y estudiado ampliamente por obstetras. Durante mucho tiempo se mantuvo escepticismo sobre sus potenciales beneficios, pero la aparición de estudios bien estructurados aportó evidencia a favor o en contra de algunos de estos. Objetivo: Realizar una revisión de la literatura acerca dela farmacología, fisiología, farmacocinética, mecanismos de acción, principales usos y regímenes de administración del sulfato de magnesio en obstetricia. Metodología: Búsqueda bibliográfica en Medline, a través de PubMed, utilizando los términos Magnesium Sulfate, Pharmacology, Obstetrics, Pre-eclampsia, Eclampsia, Neuroprotective Agents. Se adicionaron otros artículos con el fin de ampliar información en ciertos temas. Conclusiones: Las propiedades farmacológicas que expresa el sulfato de magnesio se relacionan directamente con su efecto antagónico con el calcio. Muestra efectos a nivel muscular, neuronal, cardiovascular, entre otros. Sus usos en obstetricia abarcan principalmente el manejo de la preeclampsia, prevención de la eclampsia, y prevención de la parálisis cerebral del recién nacido prematuro. El uso como agente tocolítico en el trabajo de parto prematuro aun es discutido ya que la evidencia es inconclusa. [Rodríguez-Hernández PA, Beltrán-Avendaño MA. Aproximación a la farmacología del sulfato de magnesio desde la perspectiva obstétrica. MedUNAB 2016; 19(1): 25-32].

Introduction: Since its first use in 1926 in eclampsia´s management magnesium sulphate has been a drug used and studied extensively by obstetricians. For a long time, practitioners remained sceptical about its potential benefits but the emergence of well-structured studies provided evidence in favor and against. Objective: A review of the literature on the pharmacology, physiology, pharmacokinetics, mechanisms of action, main applications and schemes of administration of the sulfate of magnesium in obstetrics. Methodology: Search in the database MEDLINE via PubMed, using the terms: Magnesium Sulfate, pharmacology, Obstetrics, Preeclampsia, Eclampsia, Neuroprotective Agents. Other papers were added in order to expand information on some topics. Conclusions: The pharmacological properties that express the magnesium sulfate is linked directly with its effect antagonistic with the calcium. Shows effects to level muscle, neuronal, cardiovascular, among others. Its uses in obstetrics include mainly the management of preeclampsia, prevention of eclampsia, and prevention of cerebral palsy in the premature neonate. The magnesium sulphate tocolytic effects even is discussed because the evidence is inconclusive. [Rodríguez-Hernández PA, Beltrán-Avendaño MA. An approach to the pharmacology of magnesium sulfate from an obstetric perspective. MedUNAB 2016; 19(1): 25-32].

Introdução: Desde que o sulfato de magnésio foi utilizado em 1926, no tratamento de eclampsia, tem sido usado e amplamente estudado por obstetras. Longo o ceticismo sobre seus potenciais benefícios permaneceu, mas tarde o aparecimento de estudos bem estruturados forneceram evidências a favor ou contra algum destes. Objetivo: Revisar a literatura sobre a farmacologia, fisiologia, fármaco cinética, mecanismos de ação, principais usos e administração de sulfato de magnésio em obstetrícia. Metodologia: Pesquisa bibliográfica Medline via PubMed utilizando os termos sulfato de magnésio, farmacologia, obstetrícia, pré-eclâmpsia, eclâmpsia, agentes neuroprotectores. Foram adicionados outros itens, a fim de obter maior informação sobre determinados temas. Conclusões: As propiedades farmacológicas que expressa o sulfato de magnésio estão diretamente relacionadas com o efeito antagônico do cálcio. Mostra os efeitos a nível muscular, neuronal, cardiovascular, entre outros. Em obstetrícia o uso abrange principalmente o tratamento da pré-eclampsia, a prevenção da eclampsia, e prevenção de paralisia cerebral no recém-nascido prematuro. Usa-lo como agente toco lítico no trabalho de parto prematuro é incerto porque a evidência é inconclusa. [Rodríguez-Hernández PA, Beltrán-Avendaño MA. Abordagem farmacológica do sulfato de magnésio a partir da perspectiva obstétrica. MedUNAB 2016; 19(1): 25-32].

Preeclampsia and eclampsia cases continue to rise in northern Zambia as people search for babies and continuity of clans' survival. Due to the competitive nature of cultural demands/ myths on pregnancy and maternal socio-demographic factors (low-age, low socioeconomic status, and poor health-seeking behaviour), women in rural prefer unprofessional primary health care services that are presumably affordable to them thereby, delaying in seeking for professional healthcare services. High levels of poverty in resource-limited areas have put many female adolescents at risk of falling pregnant. Thus, this study probed on the interaction between these maternal socio-demographic factors and disease distribution in both rural and urban areas with respect to various pregnancy outcomes. The study used retrospective quantitative methods in eliciting information from data sources (women, registers) in Mbala, Mpulungu, Senga, and Mungwi districts covering 3-year period (2017-2019). In all, 202 female respondents from Northern Zambia were interviewed through selfadministered questionnaires. Thereafter, data were analysed using a statistical package for the social sciences (SPSS v16). Findings indicate severe; socioeconomic status and low maternal age affect pre-eclampsia disease distribution coupled with adverse pregnancy outcomes more in rural than urban areas. The better the socio-demographic conditions, the lower the disease distribution with good pregnancy outcomes. However, worsening maternal socio-demographic conditions may increase the incidence of pre-eclampsia among pregnant women of northern Zambia. The study recommended interventions tarred towards public health programmes such as social behaviour change and communication (SBCC) towards adolescent women and socioeconomic empowerment of pregnant women in resource-limited areas.