A Two-Year Comparison (2022–2023) of Therapeutic Approach and Maternal Outcome in the Management of Preeclampsia/Eclampsia: Evidence of a Practice Shift toward the Pritchard Magnesium Sulphate Regimen

Timi Fiekumo Buseri, Osuji Franklin Chukwuemeka, Ruth Ebiegberi Obidake, Buseri, Oyintokoni Beauty, Esther Oduru

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Abstract

Background: Magnesium sulphate, most commonly administered as the intramuscular Pritchard regimen, is the internationally recommended anticonvulsant for the prevention and treatment of eclamptic seizures, with established trial evidence of reduced maternal mortality relative to alternative anticonvulsants. Whether hospital-level adoption of this regimen is reflected in observable maternal outcomes over time is less often documented in single-centre African case series. Objective: To compare the therapeutic approach and maternal, fetal and obstetric outcomes among women managed for preeclampsia/eclampsia in 2022 and 2023 at one facility. Methods: Retrospective cross-sectional analysis of 104 hospital records of women managed for preeclampsia/eclampsia (44 from 2022, 60 from 2023). Associations were tested with Pearson's chi-square test and Fisher's exact test, with Cramér's V as effect size; α = 0.05. Results: Therapeutic approach differed almost completely by year: 100% of 2022 cases received antihypertensive-led management alone, versus 86.7% of 2023 cases managed with the Pritchard magnesium sulphate regimen (χ²(1) = 72.84, p < 0.001, V = 0.84). Maternal mortality fell from 15.9% in 2022 to 1.7% in 2023 (χ²(1) = 5.39, p = 0.020; Fisher's exact p = 0.010). Comparing therapeutic approach directly, mortality was 13.5% with antihypertensive-led management versus 1.9% with the Pritchard regimen, a difference that approached but did not reach conventional significance (χ²(1) = 3.39, p = 0.066; Fisher's exact p = 0.060). No significant differences by therapeutic approach were found for mode of delivery, fetal outcome, birth weight, or Apgar score (all p > 0.7), and the complication profile of the two annual cohorts differed significantly (p = 0.002), indicating that year and treatment protocol were closely confounded. Conclusion: A marked reduction in maternal mortality coincided with a hospital-wide shift toward the Pritchard magnesium sulphate regimen, consistent with its known seizure-prophylactic mechanism and selective effect on maternal rather than fetal outcome; however, because calendar year, treatment protocol and case-mix moved together in this dataset, a causal effect of the regimen change cannot be established from these data alone.

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