Pritchard vs Zuspan Regimens in Pre-Eclampsia & Eclampsia: A Tertiary Care Perspective

Objectives: 

This research compares the efficacy of the Pritchard and Zuspan regimens of magnesium sulphate in managing convulsions in pre-eclampsia and eclampsia patients. It evaluates maternal, foetal, and pregnancy outcomes to determine the effectiveness and safety of both regimens. The study also identifies factors influencing therapeutic outcomes and prescribing practices in a tertiary care hospital in Pakistan. By assessing intravenous versus intramuscular administration, it offers insights to improve clinical guidelines and therapeutic approaches for managing pre-eclampsia and eclampsia.

Design:

This was a prospective observational study conducted at a tertiary care hospital in Islamabad, Pakistan, from August 1, 2023, to August 30, 2024. Using a simple random sampling method, the study included patients with pre-eclampsia or eclampsia at ≥20 weeks gestation or within 10 days postpartum. Data on demographics, medical history, clinical findings, and treatments were collected via a structured questionnaire.

Methodology: 

This prospective observational study, conducted from August 2023 to August 2024 at a tertiary care hospital in Islamabad, included patients with pre-eclampsia or eclampsia at 20 weeks gestation or up to 10 days postpartum. Essential hypertension and epilepsy were exclusion criteria. Data on demographics, medical history, treatments, and outcomes were collected using a structured questionnaire. Statistical analysis with SPSS version 22 included linear logistic regression to analyze associations, with a significance level of p<0.05.

Results:

The study examined 150 patients with pre-eclampsia and eclampsia, revealing that the Zuspan regimen (IV MgSO4) resulted in better foetal and pregnancy outcomes compared to the Pritchard regimen (IV+IM MgSO4). MgSO4 alone also showed superior maternal, pregnancy, and foetal outcomes compared to its combination with diazepam. A significant proportion of patients received three or more antihypertensive drugs, with one or two drugs linked to better outcomes. No maternal deaths occurred, but 32% experienced intrauterine death, stillbirth, or neonatal death. The study concluded that the Zuspan regimen is preferred for improved outcomes in managing pre-eclampsia and eclampsia.

Conclusion: 

The study concluded that the Zuspan regimen (IV MgSO4) should be preferred over the Pritchard regimen (IV+IM MgSO4) due to better foetal and maternal outcomes. While MgSO4 use significantly improved outcomes, the study highlighted challenges in administering it, especially in pre-eclampsia cases, due to intensive monitoring requirements. Additionally, it emphasized the importance of considering risk factors and therapeutic interventions when updating treatment guidelines for eclampsia and pre-eclampsia, particularly in resource-limited settings where traditional healthcare practices may prevail.