The Frequency of Primary Post-Partum Hemorrhage in Patients with Eclampsia Receiving Injection Magnesium Sulphate during Labour: A Cross Sectional Study
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/087Keywords:
Eclampsia, Magnesium sulfate, Postpartum hemorrhage, Uterine atony, Maternal outcomes, Blood transfusionAbstract
Background: Eclampsia remains a leading cause of maternal morbidity and mortality, particularly in low- and middle-income countries. While magnesium sulfate (MgSO₄) is the standard treatment for seizure prophylaxis, concerns persist regarding its potential association with postpartum hemorrhage (PPH).
Objective: To determine the frequency of primary PPH in women with eclampsia receiving MgSO₄ and to evaluate its association with maternal characteristics, labor variables, and outcomes.
Methods: A cross-sectional study was conducted on 83 women diagnosed with eclampsia. Demographic, clinical, and labor-related data were recorded, and PPH was defined according to WHO criteria. Associations between PPH and study variables were analyzed using chi-square tests with Cramer’s V for strength of association.
Results: Primary PPH occurred in 25.3% of women, predominantly due to uterine atony (61.9%) within the first hour after delivery. Strong associations were found between PPH occurrence and both its type and onset (Cramer’s V = 1.000, p < 0.001). PPH was significantly associated with blood transfusion requirements (Cramer’s V = 0.706, p < 0.001), but not with age, parity, gestational age, severity of eclampsia, blood pressure, proteinuria, or delivery mode. No maternal deaths or ICU admissions were attributed to PPH.
Conclusion: In eclamptic women receiving MgSO₄, PPH was primarily atonic and early onset, with blood transfusion frequently required. MgSO₄ use did not independently increase PPH risk, supporting its continued role in eclampsia management. Strengthening active third-stage labor management and PPH preparedness may further reduce morbidity.
References
1. Okonkwo, M. and C.M. Nash, Duration of Postpartum Magnesium Sulphate for the Prevention of Eclampsia: A Systematic Review and Meta-analysis. Obstetrics & Gynecology, 2022. 139(4).
2. Belizán, J.M., L. Gibbons, and G. Cormick, Maternal mortality reduction: a need to focus actions on the prevention of hypertensive disorders of pregnancy. International Journal for Equity in Health, 2021. 20(1): p. 194 DOI: 10.1186/s12939-021-01535-x.
3. Padda, J., et al., Efficacy of magnesium sulfate on maternal mortality in eclampsia. 2021. 13(8).
4. Pergialiotis, V., et al., Magnesium sulfate and risk of postpartum uterine atony and hemorrhage: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2021. 256: p. 158-164 DOI: https://doi.org/10.1016/j.ejogrb.2020.11.005.
5. Adepoju, A.A., et al., The ability and safety of community-based health workers to safely initiate lifesaving therapies for pre-eclampsia in Ogun State, Nigeria: An analysis of 260 community treatments with MgSO4 and/or methyldopa. Pregnancy Hypertension, 2021. 25: p. 179-184 DOI: https://doi.org/10.1016/j.preghy.2021.05.005.
6. Jamieson, M., R. Luckett, and G.J. Hofmeyr, Novel use of local analgesia prior to intramuscular magnesium sulphate injection compared to mixed local analgesia with magnesium sulphate to reduce pain: a randomised crossover study in patients being managed for eclampsia and preeclampsia. 2024. Volume 5 - 2024 DOI: 10.3389/fpain.2024.1376608.
7. Katsi, V., et al. Diagnosis and Treatment of Eclampsia. Journal of Cardiovascular Development and Disease, 2024. 11, DOI: 10.3390/jcdd11090257.
8. Arif, N., et al., EFFICACY OF MAGNESIUM SULPHATE ON MATERNAL MORBIDITY AND MORTALITY IN ECLAMPSIA. 2021(2): p. 598.
9. Haq, A.I.u., et al., Comparison of efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia. Journal of Rawalpindi Medical College, 2022. 26(4) DOI: 10.37939/jrmc.v26i4.1901.
10. Midhet, F., et al., Trends in the levels, causes, and risk factors of maternal mortality in Pakistan: A comparative analysis of national surveys of 2007 and 2019. 2025. 20(1): p. e0311730.
11. Pan, Y., et al., Risk Factors for Postpartum Hemorrhage in Severe Pre-Eclampsia: A Retrospective Single-Centre Study of 1953 Cases. Med Sci Monit, 2024. 30: p. e943772 DOI: 10.12659/msm.943772.
12. Pippen, J.L., et al., Interrupted versus continuous magnesium sulfate and blood loss at cesarean delivery. The Journal of Maternal-Fetal & Neonatal Medicine, 2022. 35(20): p. 3853-3859 DOI: 10.1080/14767058.2020.1841162.
13. Young, S., et al., Intrapartum magnesium sulfate exposure and obstetric hemorrhage risk. J Matern Fetal Neonatal Med, 2022. 35(25): p. 10036-10043 DOI: 10.1080/14767058.2022.2086796.
14. Cagino, K., M. Prabhu, and B. Sibai, Is magnesium sulfate therapy warranted in all cases of late postpartum severe hypertension? A suggested approach to a clinical conundrum. American Journal of Obstetrics & Gynecology, 2023. 229(6): p. 641-646 DOI: 10.1016/j.ajog.2023.07.021.
15. Countouris, M., et al., Hypertension in Pregnancy and Postpartum: Current Standards and Opportunities to Improve Care. Circulation, 2025. 151(7): p. 490-507 DOI: 10.1161/CIRCULATIONAHA.124.073302.
16. Dhillon, N., et al., Investigation of Intrapartum Parenteral Magnesium Sulfate as an Independent Risk Factor for Postpartum Hemorrhage Using Quantitative Blood Loss Assessment. American Journal of Obstetrics & Gynecology MFM, 2023. 5(7): p. 100951 DOI: https://doi.org/10.1016/j.ajogmf.2023.100951.
17. Kileo, J.S., S. matovelo, and G. Kitinusa, Factors associated with pharmacologic serum concentration of Magnesium and corresponding obstetric outcomes among women with severe pre-eclampsia at Iringa Regional Referral Hospital. medRxiv, 2024: p. 2024.08.21.24312387 DOI: 10.1101/2024.08.21.24312387.
18. Quist-Nelson, J., et al., Early magnesium discontinuation postpartum and eclampsia risk: A systematic review and meta-analysis. Pregnancy Hypertension, 2024. 37: p. 101141 DOI: https://doi.org/10.1016/j.preghy.2024.101141.
19. Negesa Beyene, B., et al., Factors associated with postpartum hemorrhage in selected Southern Oromia hospitals, Ethiopia, 2021: an unmatched case-control study. 2024. Volume 5 - 2024 DOI: 10.3389/fgwh.2024.1332719.
20. Bienstock, J.L., A.C. Eke, and N.A. Hueppchen, Postpartum Hemorrhage. N Engl J Med, 2021. 384(17): p. 1635-1645 DOI: 10.1056/NEJMra1513247.
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