Abstract：
BACKGROUND: The optimal duration of magnesium administration postpartum for prevention of eclampsia has not yet been established. Our objective was to investigate the effect of early discontinuation of postpartum magnesium on the rates of postpartum eclampsia compared to continuation for 24-hours postpartum.
METHODS: Searches were performed using keywords related to \"preeclampsia\" and \"magnesium sulfate\" from inception of database until August 2023. Randomized controlled trials of women with preeclampsia were included if they received magnesium prior to delivery and were randomized to early discontinuation versus 24-hours of magnesium postpartum. The primary outcome was the rate of postpartum eclampsia.
RESULTS: Nine RCTs with 2183 women were included with five different magnesium administration time frames. In total, seven patients with postpartum eclampsia were reported in three studies. Eclampsia rates were not different between the two groups (5/1088 (0.5 %) after early discontinuation, versus 2/1095 (0.2 %) in the 24-hour group; RR 2.25, 95 % CI 0.5-9.9, I2 = 0 %, 8 studies, 2183 participants). A number needed to treat was calculated; 374 women would need to receive 24-hours of magnesium postpartum to prevent one episode of postpartum eclampsia. The early discontinuation group had a significant decrease in time to ambulation (-9.1 h, 95 % CI -14.7 - (-3.6), I2 = 98 %, 3 studies, 1509 participants) and breastfeeding (-8.4 h, 95 % CI -12.0 - (-4.8), I2 = 98 %, 2 studies, 1397 participants).
CONCLUSIONS: Early magnesium discontinuation postpartum, usually ≤6 h or none at all, did not significantly increase the rate of postpartum eclampsia, however this study is likely underpowered to demonstrate a difference. The number needed to treat is similar to the number needed to treat for antepartum preeclampsia without severe features, for which magnesium is not recommended. The largest proportion of women did not receive magnesium postpartum after receiving at least 8 h of magnesium intrapartum (e.g., loading and maintenance dose). Thus, it is reasonable to consider not using magnesium postpartum, particularly if a woman has received similar adequate dose prior to delivery.
METHODS: Searches were performed using keywords related to \"preeclampsia\" and \"magnesium sulfate\" from inception of database until August 2023. Randomized controlled trials of women with preeclampsia were included if they received magnesium prior to delivery and were randomized to early discontinuation versus 24-hours of magnesium postpartum. The primary outcome was the rate of postpartum eclampsia.
RESULTS: Nine RCTs with 2183 women were included with five different magnesium administration time frames. In total, seven patients with postpartum eclampsia were reported in three studies. Eclampsia rates were not different between the two groups (5/1088 (0.5 %) after early discontinuation, versus 2/1095 (0.2 %) in the 24-hour group; RR 2.25, 95 % CI 0.5-9.9, I2 = 0 %, 8 studies, 2183 participants). A number needed to treat was calculated; 374 women would need to receive 24-hours of magnesium postpartum to prevent one episode of postpartum eclampsia. The early discontinuation group had a significant decrease in time to ambulation (-9.1 h, 95 % CI -14.7 - (-3.6), I2 = 98 %, 3 studies, 1509 participants) and breastfeeding (-8.4 h, 95 % CI -12.0 - (-4.8), I2 = 98 %, 2 studies, 1397 participants).
CONCLUSIONS: Early magnesium discontinuation postpartum, usually ≤6 h or none at all, did not significantly increase the rate of postpartum eclampsia, however this study is likely underpowered to demonstrate a difference. The number needed to treat is similar to the number needed to treat for antepartum preeclampsia without severe features, for which magnesium is not recommended. The largest proportion of women did not receive magnesium postpartum after receiving at least 8 h of magnesium intrapartum (e.g., loading and maintenance dose). Thus, it is reasonable to consider not using magnesium postpartum, particularly if a woman has received similar adequate dose prior to delivery.
摘要：
背景：预防子痫的产后施用镁的最佳持续时间尚未确定。我们的目的是研究与产后24小时继续治疗相比，早期停用产后镁对产后子痫发生率的影响。
方法：从数据库开始到2023年8月，使用与“先兆子痫”和“硫酸镁”相关的关键词进行搜索。包括先兆子痫妇女的随机对照试验，如果她们在分娩前接受镁，并随机分为早期停药与产后24小时镁。主要结局是产后子痫的发生率。
结果：纳入了9个包含2183名女性的RCTs，具有5个不同的镁给药时间框架。总的来说,在三项研究中报告了7例产后子痫患者.早期停药后，两组的子痫发生率没有差异（5/1088（0.5％），与24小时组的2/1095（0.2％）相比；RR2.25，95％CI0.5-9.9，I2=0％，8研究,2183名与会者)。计算了需要治疗的数量；374名妇女需要在产后接受24小时的镁治疗，以防止一次产后子痫发作。早期停药组的步行时间显着减少（-9.1h，95%CI-14.7-（-3.6），I2=98%，3研究,1509参与者）和母乳喂养（-8.4小时，95%CI-12.0-（-4.8），I2=98%，2研究,1397名参与者)。
结论：产后早期镁停药，通常≤6小时或根本没有，没有显着增加产后子痫的发生率，然而，这项研究可能不足以证明差异。需要治疗的数量与没有严重特征的产前先兆子痫需要治疗的数量相似，镁是不推荐的。最大比例的妇女在接受至少8小时的镁后产后未接受镁（例如，加载和维持剂量)。因此，产后不使用镁是合理的，特别是如果一名妇女在分娩前接受了类似的足够剂量。
方法：从数据库开始到2023年8月，使用与“先兆子痫”和“硫酸镁”相关的关键词进行搜索。包括先兆子痫妇女的随机对照试验，如果她们在分娩前接受镁，并随机分为早期停药与产后24小时镁。主要结局是产后子痫的发生率。
结果：纳入了9个包含2183名女性的RCTs，具有5个不同的镁给药时间框架。总的来说,在三项研究中报告了7例产后子痫患者.早期停药后，两组的子痫发生率没有差异（5/1088（0.5％），与24小时组的2/1095（0.2％）相比；RR2.25，95％CI0.5-9.9，I2=0％，8研究,2183名与会者)。计算了需要治疗的数量；374名妇女需要在产后接受24小时的镁治疗，以防止一次产后子痫发作。早期停药组的步行时间显着减少（-9.1h，95%CI-14.7-（-3.6），I2=98%，3研究,1509参与者）和母乳喂养（-8.4小时，95%CI-12.0-（-4.8），I2=98%，2研究,1397名参与者)。
结论：产后早期镁停药，通常≤6小时或根本没有，没有显着增加产后子痫的发生率，然而，这项研究可能不足以证明差异。需要治疗的数量与没有严重特征的产前先兆子痫需要治疗的数量相似，镁是不推荐的。最大比例的妇女在接受至少8小时的镁后产后未接受镁（例如，加载和维持剂量)。因此，产后不使用镁是合理的，特别是如果一名妇女在分娩前接受了类似的足够剂量。
