Comparison of Loading Dose of MgSO4 Versus Standard Regimen in Severe Pre-Eclampsia in Pregnant Women from Swat, Pakistan: A Randomized Clinical Trial

Background: Pre-eclampsia is a serious hypertensive disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Magnesium sulfate (MgSO₄) is the standard treatment for seizure prevention in severe pre-eclampsia.Objective: To compare the efficacy and safety of a single loading dose of MgSO₄ versus the standard regimen in patients with severe pre-eclampsia in Swat, Pakistan.Methods: A randomized clinical trial was conducted on 248 pregnant women with severe pre-eclampsia at Saidu Group of Teaching Hospital, Swat. Participants were randomized into two groups: Group A received a single loading dose of 4 g intravenous MgSO₄ followed by 5 g intramuscularly, while Group B received the standard regimen of a loading dose followed by 1 g per hour intravenous infusion for 24 hours. Efficacy was assessed by the absence of seizure recurrence, and safety was evaluated based on complications like knee jerk reflex loss, low respiratory rate, and low urine output.Results: Seizure recurrence occurred in 29.8% in Group A and 21.8% in Group B (p=0.147). Knee jerk reflex loss was significantly higher in Group A (48.4% vs. 24.2%; p=0.000), with no significant differences in low respiratory rate or urine output.Conclusion: A single loading dose of MgSO₄ is as effective as the standard regimen for seizure prophylaxis in severe pre-eclampsia but is associated with higher knee jerk reflex loss.