Problem and Proposed Intervention
The second leading cause of maternal death is pre-eclampsia/eclampsia—most often detected through the elevation of blood pressure during pregnancy—which can lead to seizures, kidney and liver damage, and both maternal and infant deaths, if untreated. These conditions claim the lives of an estimated 63,000 women each year, as well as the lives of many of their babies.1 Where a woman gives birth should not decide her fate, and yet the risk that a woman in a developing country will die of pre-eclampsia/eclampsia is approximately 300 times higher than that for a woman in a developed country.1 Several studies have identified magnesium sulfate (MgSO4) as the most effective anticonvulsant for preventing and treating the life-threatening seizures of eclampsia. MgSO4 is needed at every level of the health care system where deliveries occur, from urban hospitals to rural clinics.2 Most of women with pre-eclampsia will also require antihypertensive therapy, even while on MgSO4.10 Supportive policies and appropriate practices are required to take this important medicine to scale to help reach the Millennium Development Goal (MDG) 5 target: reducing maternal mortality by 75% by 2015.
Magnesium Sulfate (MgSO4) product characteristics:
||Magnesium Sulfate (MgSO4)
||Prevention and treatment of eclampsia.
||Injection 500 mg/ml in a 2-ml ampoule (50% solution), 500 mg/ml in a 10-ml ampoule (20% solution).3 Note: MgSO4 is also widely available in other formulations.
||Loading dose: Slow IV injection of 4g (20mL of 20% solution in saline) at a rate of 1g/5 minutes over 5-20 minutes.
Maintenance regime (Intramuscular (IM)): 10g of 50% solution; with 5g of 50% solution every 4 hours for 24 hours following last convulsion.
Maintenance regime (IV): 1 to 2g/ hour in 100mL of maintenance solution.
||Approximately US$0.10 per ml (supplier median price)4 or approximately US$1.00 per dose.
Read more below.
Initial Findings from Product Case Study Working Paper
* Note: The strengths and challenges outlined below are initial findings from a longer working paper developed to analyze the current global situation of each product. The findings are presented below to catalyze further thinking and discussion in order to finalize a list of issues and recommendations. The full working paper texts are forthcoming.
Coming soon: Read the full case study (PDF).
 USAID, JHPIEGO. Rapid Landscape Analysis of technologies for postpartum hemorrhage. Conducted by JHPIEGO/Accelovate for USAID at the Technologies for Health Consultative Meeting - MNCH Pathways. Unpublished. 2012.
 WHO. WHO Model List of Essential Medicines (March 2011), 17th edition. Available at: http://whqlibdoc.who.int/hq/2011/a95053_eng.pdf. Accessed March 26,2011
 USAID, PATH. Rapid Landscape Analysis of Technologies for Preeclampsia/Eclampsia. Presented at: Technologies for Health Consultative Meeting—MNCH Pathways, February 15, 2012; Washington, DC.
 Fujioka A, Smith J. Prevention and Management of Postpartum Hemorrhage and Pre-Eclampsia/Eclampsia: National Programs in Selected USAID Program-Supported Countries. Maternal and Child Health Integrated Program (MCHIP); 2011. Available at: http://www.k4health.org/system/files/PPH_PEE%20Program%20Status%20Report.pdf. Accessed February 2012.
 UNFPA, Lao PDR Ministry of Health. Review of Current Status in Access to a Core Set of Critical, Life-saving Medicines for Maternal/Reproductive Health in Lao PDR: Mission Report. UNFPA and Lao PDR Ministry of Health; 2008.
 United Nations Population Fund (UNFPA), WHO. Joint UNFPA/WHO Mission in Collaboration with the Ministry of Health to Review the Current Status of Access to a Core Set of Critical, Life-saving Maternal/Reproductive Health Medicines in Mongolia. 2009. Available at: http://digicollection.org/hss/documents/s16325e/s16325e.pdf. Accessed February 2012.
 MSH. Active Management of the Third Stage of Labor in Health Care Facilities: Results of a National Study in Ghana, 2007. Arlington, VA: MSH, Prevention of Postpartum Hemorrhage Initiative; 2008.
 Barua A, Shuchita M, Bracken H, Easterling T, Winikoff B. Facility and personnel factors influencing magnesium sulfate use for eclampsia and pre-eclampsia in 3 Indian hospitals. The International Journal of Gynecology & Obstetrics. 2011; 115(2):231–234.
 Duley L, Farrell B, Spark P, Roberts B, Watkins K, Bricker L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002;359:1877-90