Intramuscular injection of magnesium sulphate in the treatment of eclampsia

Background: Eclampsia remains a significant cause of maternal and neonatal morbidity and mortality globally. The standard treatment to prevent and control eclamptic seizures is the administration of magnesium sulfate. In Bangladesh, the commonly used "Dhaka regimen" involves both  intravenous (IV) and intramuscular (IM) routes, but its implementation in primary healthcare settings is often challenging due to the need for intravenous access. Objective: This study aimed to compare the effectiveness and safety of intramuscular magnesium sulfate against the traditional combined intravenous and intramuscular regimen in the management of eclampsia. Methods: A randomized controlled trial was conducted at Chittagong Medical College Hospital from September 2017 to February 2018. A total of 100 patients with eclampsia were randomly assigned into two groups: the IM group (n=50) and the IV+IM group (n=50). The primary outcome measure was the recurrence of convulsions. Secondary outcomes included maternal and fetal outcome, adverse effects, and signs of magnesium sulfate toxicity. Data were collected via a structured questionnaire and analyzed using SPSS-22.Results: The recurrence of convulsions was observed in 10% of patients in the IM group and 8% in the IV+IM group. Maternal mortality was consistent across both groups, with 4% mortality in each. The stillbirth rate was 20.5% in the IM group compared to 23.8% in the IV+IM group. Injection site  pain was more prevalent in the IM group (10% vs. 6%), although no abscesses or significant inflammation were noted. Magnesium toxicity was minimal and comparable between the two groups, with instances of diminished knee jerks (4% vs. 6%) and oliguria (4% vs. 2%), and no cases of respiratory depression. The mode of delivery did not differ significantly between groups. Conclusion: Intramuscular magnesium sulfate is comparable to the standard IV+IM regimen for the management of eclampsia in terms of seizure control. It presents practical benefits, including ease of administration, lower cost, and reduced need for skilled personnel, making it a viable alternative for use in primary healthcare settings J Shaheed Suhrawardy Med Coll 2025; 17(1): 66-72