Magnesium Sulphate and Nifedipine in Management of Preterm Premature Rupture of Membranes

Abstract

Premature rupture of membranes (PROM) is defined as rupture before delivery that can occur at any gestational age. If it occurs before 37 weeks of gestation, it’s called Preterm Premature Rupture of Membrane (PPROM). PROM is a condition that still occurs in both developed and developing countries and cause a serious threat to the fetal and maternal well-being if not managed properly. Conservative management is chosen in PPROM until the fetus is viable, consist of hospitalization, assessment of sign of infection, well-being of the fetal and maternal. Spesific treatment includes the administration of corticosteroid, antibiotics, and tocolytics. Tocolytic agents that are widely used as first-line agents are magnesium sulphate (MgSO4) and nifedipine, one of the Calcium Channel Blocker (CCB) groups. MgSO4 and nifedipine both have an effect in reducing myometrial contractility. MgSo4 also has a neuroprotective effect in PPROM less than 31 weeks if there is a threat of delivery within 24 hours. Meta-analysis related to the use of these two agents in PPROM is still subject to differing result. Some studies have shown nifedipine is considered to have milder side effect than MgSO4, more easily tolerated by oral administration, and more affordable. However, some studies have shown that the two agents have the same efficacy. Other studies have shown no significant benefit in administering nifedipine to neonates or prolong pregnancy in women with PPROM without contractions.