Abstract
ObjectiveMagnesium sulphate is recommended by international guidelines to prevent eclampsia among women with pre-eclampsia, especially when it is severe, but fewer than 70% of such women receive magnesium sulphate. We aimed to identify variables that prompt Canadian physicians to administer magnesium sulphate to women with pre-eclampsia.MethodsData were used from the Canadian Perinatal Network (2005–11) of women hospitalized at <29 weeks’ who were thought to be at high risk of delivery due to pre-eclampsia (using broad Canadian definition). Unadjusted analyses of relative risks were estimated directly and population attributable risk percent (PAR%) calculated to identify variables associated with magnesium sulphate use. A multivariable model was created and a generalized estimating equation was used to estimate the adjusted RR that explained magnesium sulphate use in pre-eclampsia. The adjusted PAR% was estimated by bootstrapping.ResultsOf 631 women with pre-eclampsia, 174 (30.1%) had severe pre-eclampsia, of whom 131 (75.3%) received magnesium sulphate. 457 (69.9%) women had non-severe pre-eclamspia, of whom 291 (63.7%) received magnesium sulphate. Use of magnesium sulphate among women with pre-eclampsia could be attributed to the following clinical factors (PAR%): delivery for ‘adverse conditions’ (48.7%), severe hypertension (21.9%), receipt of antenatal corticosteroids (20.0%), maternal transport prior to delivery (9.9%), heavy proteinuria (7.8%), and interventionist care (3.4%).ConclusionsClinicians are more likely to administer magnesium sulphate for eclampsia prophylaxis in the presence of more severe maternal clinical features, in addition to concomitant antenatal corticosteroid administration, and shorter admission to delivery periods related to transport from another institution or plans for interventionist care.
Highlights
Magnesium sulphate is effective for treatment of eclampsia [1]
Use of magnesium sulphate among women with pre-eclampsia could be attributed to the following clinical factors (PAR %): delivery for ‘adverse conditions’ (48.7%), severe hypertension (21.9%), receipt of antenatal corticosteroids (20.0%), maternal transport prior to delivery (9.9%), heavy proteinuria (7.8%), and interventionist care (3.4%)
Clinicians are more likely to administer magnesium sulphate for eclampsia prophylaxis in the presence of more severe maternal clinical features, in addition to concomitant antenatal corticosteroid administration, and shorter admission to delivery periods related to transport from another institution or plans for interventionist care
Summary
Magnesium sulphate is effective for treatment of eclampsia [1]. The Magpie Trial demonstrated that magnesium sulphate could halve the rate of seizures among women with preeclampsia [2]. In the seminal Magpie Trial, the definition of severe pre-eclampsia was based on severe hypertension and heavier proteinuria (!3+), or less severe hypertension associated with findings of ‘imminent eclampsia’ for which there is no standard definition but is usually interpreted as central nervous system symptoms or hyperreflexia [2]. This definition of severe disease does not align well with current international definitions between which there is substantial variability from country to country, and within countries over time [5]
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