Factors associated with appropriate administration of magnesium sulfate for neuroprotection prior to early preterm birth

Abstract

To evaluate factors associated with appropriate administration of magnesium sulfate (MgSO4) for fetal neuroprotection prior to preterm birth (PTB) in a large United States university-based health system. Multicenter retrospective cohort of all PTBs between 23 0/7-31 6/7 weeks’ gestation from 1/1/2019 to 12/31/21. Exclusion criteria included patients with hypertensive disorders of pregnancy (to assure only indication for MgSO4 administration was fetal neuroprotection and not maternal seizure prophylaxis), stillbirths, higher-order multiple gestations, and extramural deliveries. Cases were stratified into two groups based on whether MgSO4 was administered prior to PTB or not. Maternal characteristics were compared between the two groups using Chi-squared or Mann-Whitney U test with statistical significance set at P < 0.05. A subgroup analysis evaluating reasons for lack of administration in those who did not receive MgSO4 prior to delivery was also performed. Of the 527 patients included, 438 (83.1%) received MgSO4 prior to delivery. Baseline characteristics and delivery outcomes compared between the two groups are displayed in Table 1. Patients who did not receive MgSO4 prior to delivery were more commonly admitted for fetal status abnormalities and non-obstetric complaints, and had a significant shorter median time interval from arrival to delivery (1.5 hours vs. 59.0 hours, P = < 0.001) (Table 1). Lack of adherence to health system protocol for MgSO4 administration occurred in 16.9% (15/89, 2.8% of overall study cohort) of patients who did not receive MgSO4 prior to delivery (Table 2). The overall adherence to a protocol of MgSO4 administration for fetal neuroprotection prior to early PTB was high. Admission for fetal status abnormalities and non-obstetric complaints were more common among patients who did not receive MgSO4 prior to delivery, with most patients who did not receive MgSO4 either arrived < 2 hours from delivery or had an acute change in maternal/fetal status requiring immediate delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)