Table 2 An abbreviated timeline of key events

1955

First Pritchard case series published, showing effectiveness of MgSO4. Updated every 10 years until 1984

1968

British physicians in Hong Kong suggest use of diazepam

1970's

MgSO4 introduced into obstetric care at key medical faculties in South Africa

1979

Obstetrics criticised by Archie Cochrane as being least evidence based medical speciality

1980's

Use of MgSO4 spreads through teaching and inter-institutional contact between academics. International divisions on the choice of anti-convulsant are reflected in the country

1980's-90's

South African researchers become increasingly connected to the international obstetric research community and simultaneously the local research output increases

Although provinces and institutions have their own policies there are no national policies or guidelines

By early 1990's

MgSO4 in widespread use in SA for treating eclampsia

1990

Randomised controlled trial, of MgSO4 vs phenytoin for eclampsia conducted in South Africa published in British Journal of Obstetrics and Gynaecology 1990 Feb; 97 (2): 104–9.

1992

Pregnancy and Childbirth Group, first Cochrane Review Group to be registered

1993–95

South African researchers collaborate in Eclampsia Trial at local trial sites

1994

Change of government promotes new focus on maternal health and openness to academic involvement in policy making

1995

Collaborative Eclampsia Trial published

1995

Senior obstetricians in South Africa publish editorial on implications of Collaborative Eclampsia Trial

1996

Maternal health organised into a separate directorate within national DoH

Academic advocacy for maternal mortality monitoring followed by the appointment of the first National Committee for Confidential Enquiry into Maternal Deaths (NCCEMD)

1999

First NCCEMD report published. Eclampsia accounts for highest percentage of the deaths due to hypertensive disorders of pregnancy, which is the second largest cause of maternal deaths. National policy and guidelines recommended.

2000

First national "Guidelines Maternity Care" published. Evidence is referred to but not referenced

2001

NCCEMD publishes policy and management guidelines for common causes of maternal deaths. MgSO4 recommended and use of evidence made explicit.

South African researchers collaborate in Magpie Trial at local sites. South Africa is the regional trial co-ordinating centre.

2002

Magpie Trial published

2003

Following on from trial, MgSO4 is recommended for women with moderate to severe pre-eclampsia, where it can be administered safely, in South African Medical Journal.