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Objective The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia.Design Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998(recruitment in -2001, which compared magnesium sulphate with placebo for pre-eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the followup centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources.Results Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). ConclusionsThe reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years.

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Warfarin is the drug of choice to achieve therapeutic anticoagulation in patients with mechanical heart valves. Factors that interfere with the reliable absorption of warfarin may result in difficult to control international normalized ratio (INR) and can cause significant bleeding complications due to supra-therapeutic INR and thromboembolism from sub-therapeutic INR. The patient's non-compliance is an important factor leading to difficult to control INR but there are additional factors that should be considered in difficult cases when dietary and medication compliance are observed. Gastroparesis is one such predominant and overlooked factor. A 58-year-old African American female with a history of mechanical mitral valve who was on anticoagulation with warfarin was admitted multiple times, with frequent episodes of significant bleeding episodes and fluctuating INR between sub- and supra-therapeutic readings despite being on a relatively stable dose of Coumadin. She was eventually diagnosed with severe gastroparesis, which was the cause of her fluctuating INR. A case can be made to consider gastric motility testing in such patients, where achieving a therapeutic range for anticoagulation is difficult in the setting of medication and dietary compliance.