Preeclampsia and eclampsia continue to be a major cause of maternal death. Currently ~18% of US maternal deaths are attributed to hypertensive disorders and eclampsia and several hundred women die from eclampsia and its complications every year. In the USA, preeclamptic women have received magnesium sulfate as a seizure prophylaxis agent for three decades and following publication of the MAGPIE trial(1) this practice is becoming more widely accepted internationally. In addition to a recognized failure rate, there are financial, logistic and safety concerns associated with the universal administration of magnesium sulfate.

Many institutions in the developing world lack the necessary equipment and expertise to administer the medication and many preeclamptic patients thus do not receive magnesium sulfate prior to their first seizure. As effective as it has been in reducing mortality from eclampsia, magnesium sulfate is also associated with appreciable morbidity and mortality from administration errors and magnesium toxicity. The availability of an easily administered, cheap, safe and orally administered alternative to magnesium sulfate would be welcomed in the developing world and would provide an extremely useful alternative therapy to the current standard of care.

Recent advances in the understanding of the pathophysiology of preeclampsia and eclampsia, primarily related to cerebral perfusion and blood flow, could allow us to reduce the seizure rate in treated preeclamptic women even further than what is currently reported. This could be possible by employing a scientifically directed and well tolerated therapy, i.e. labetalol, that is better suited to managing the underlying cerebrovascular pathology of preeclampsia/eclampsia than the empiric administration of an effective, but difficult to administer and potentially hazardous, drug (magnesium sulfate).