Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Feb 2005
ReviewEvidence and practice: the magnesium sulphate story.
There is now strong evidence from systematic reviews of randomised trials to support the use of magnesium sulphate for the prevention and treatment of eclampsia. Magnesium sulphate more than halves the risk of eclampsia for women with pre-eclampsia (relative risk (RR) 0.41, 95% confidence interval (CI) 0.29-0.58; number needed to treat (NNT) 102 (95% CI 72-173) compared to placebo. For treatment of eclampsia, magnesium sulphate lowers the risk of maternal death (RR 0.59, 95% CI 0.37-0.94) and of recurrence of further fits (RR 0.44, 95% CI 0.34-0.57) compared to diazepam. Magnesium sulphate also reduces the risk of further fits compared to phenytoin (RR 0.31, 95% CI 0.20-0.47) and to lytic cocktail (RR 0.09, 95% CI 0.03-0.24).
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Systematic reviews help people to make well-informed decisions about health care by bringing together the relevant evidence, appraising it and, where appropriate, combining it in a meta-analysis. The ultimate aim for a systematic review should be to present all relevant data on all participants in all research judged to be eligible for the review. ⋯ It allows the reviewer to overcome many of the problems associated with a reliance on published data alone, and some of the problems associated with using aggregate data supplied by the trialist, and will add to the analyses that can be performed. This chapter discusses the rationale for individual patient data reviews and describes some of their features.