Comparative Study between Magnesium Sulfate and Phenytoin for Prevention of Eclampsia In Severe Preeclamptic Patients with Acute Kidney Injury

Abstract

Preeclampsia is a pregnancy-specific, multisystem disorder that is characterized by the development of hypertension and proteinuria after 20 weeks of gestation. The disorder complicates approximately 5 to 7 percent of pregnancies and is one of the leading causes of maternal and fetal morbidity and mortality. The pathogenesis of preeclampsia is complex; numerous genetic, immunologic, and environmental factors interact. It has been suggested that preeclampsia is a two-stage disease. The first stage is asymptomatic, characterized by abnormal placental development during the first trimester resulting in placental insufficiency and the release of excessive amounts of placental materials into the maternal circulation. This in turn leads to the second, symptomatic stage, where in the pregnant woman develops characteristic hypertension, renal impairment, proteinuria and lower limb odema and is at risk for the HELLP syndrome, eclampsia, and other end-organ damage Delivery remains the ultimate treatment for preeclampsia, although maternal and fetal risks must be weighed in determining the timing of delivery. Diminished renal plasma flow, decreased GFR, and protein¬uria constitute the key renal manifestations of pre-eclampsia. Renal plasma flow and GFR have been reported to decrease by 30%-40% in preeclampsia when compared to normal pregnancy of the same duration. Anticonvulsant therapy administered to parturients at high risk can prevent the first seizure in women with severe preeclampsia. Magnesium sulfate is used widely to prevent eclamptic seizures in pregnant women with hypertension and phenytoin which is a well known antiepileptic drug can also be used to prevent seizures in pregnant women with hypertension. The study was performed upon 40 patients, aging 20-40 years, who are proved to have severe preeclampsia with acute kidney injury and were divided into two groups: Magnesium sulphate group: Twenty patients who received magnesium sulphate for prophylaxis against eclampsia in severe preeclamptic patients with acute kidney injury. Phenytoin group: Twenty patients who received phenytoin for prophylaxis against eclampsia in severe preeclamptic patients with acute kidney injury. For each patient, the following data were collected: age, gestational age, body weight, body heights, urine output,creatinine level,occurance of magnesium or phenytoin toxicity, occurance of fits and fetal outcome. As regards the occurance of fits, we found a statistical significant difference between the (magnesium-group) and (phenytoin-group), as (phenytoin- group) showed occurance of fits of five patients while no fits developed in (magnesium-group). Regarding urine output changes, creatinine level changes, occurance of magnesium or phenytoin toxicity and fetal outcome: In this study we did not found statistically significantly difference between magnesium group and phenytoin group. From these results we concluded that: Performing prophylaxis using magnesium sulphate (with adjusted dose) against eclampsia in severe preeclamptic patients with acute kidney injury showed marked benefits reflected as no occurance of toxicity, no affection on kidney function, no occurance of fits and no affection of fetal outcome.