Use Of Magnesium Sulfate Research Articles

Magnesium sulfate and fetal neuroprotection: overview of clinical evidence.

Antenatal administration of magnesium sulfate is an important part of the neuroprotective strategy for preterm infants. Strong evidence from five randomized controlled trials and five meta-analyses has demonstrated that magnesium sulfate, when administered before preterm delivery, significantly reduces the risk of cerebral palsy at two years. Through secondary analyses of randomized controlled trials and other original clinical studies, this state-of-the-art review highlights the absence of serious adverse effects in both pregnant women and neonates, as well as the impact of maternal body mass index and preeclamptic status on the maternal and neonatal magnesium levels, which could influence the magnitude of the neuroprotective effect. Although antenatal magnesium sulfate is a cost-effective strategy, some practice surveys have demonstrated that the use of magnesium sulfate is not sufficient and that its use is heterogeneous, differing among different maternity wards. Since 2010, an increasing number of obstetrical societies have recommended its use to improve the neurological outcomes of preterm infants, especially the International Federation of Gynecology and Obstetrics and World Health Organization in 2015, and France in 2017. Considering the neuroprotective impact of magnesium sulfate when administered before delivery, postnatal administration should be considered, and its effects should be assessed using randomized controlled trials.

340: Intrapartum hypertension, diagnosis of preeclampsia and adverse neonatal outcomes

The intrapartum diagnosis of hypertension is challenging given blood pressure (BP) measurements in labor may be affected by pain and hemodynamic changes. Our objective was to determine the prevalence of intrapartum hypertension and its clinical relevance. Secondary analysis of an intrapartum fetal heart rate monitoring trial that enrolled women with singleton gestation at >36 weeks gestation, who were attempting vaginal delivery, had ruptured membranes and a cervix 2-7 cm dilated. Women diagnosed with gestational hypertension (GHTN) or preeclampsia (PE) at the time of enrollment, or receiving magnesium sulfate, were excluded from the analysis, as well as those with chronic hypertension, lupus, or BP measured less frequently than every 30 minutes. BP was measured using an automated machine and digitally stored. The prevalence of various degrees of systolic and diastolic BP elevations after enrollment, and their associations with maternal outcomes and a composite neonatal outcome (intrapartum fetal death, neonatal death, Apgar score ≤ 3 at 5’, neonatal seizure, umbilical-artery blood pH ≤ 7.05 with a base deficit ≥ 12 mmol/L, intubation for ventilation at delivery, or neonatal encephalopathy) were determined. The prevalence of the various BP elevations is summarized in Table 1. One or more systolic BP >140 mmHg or diastolic BP >90 mmHg occurred in 64.5% of laboring women, and was not associated with the composite neonatal outcome or cesarean delivery (CD), but was associated with use of magnesium sulfate (MgSO4), and longer maternal length of stay. In addition to the association with the latter maternal outcomes, 2 or more BPs above these cutoffs at least 4 hours apart was also associated with higher CD rates. Multivariate logistic regression showed that when compared to normotensive women, increased BP with or without the diagnosis of GHTN or PE was associated with CD, but not adverse outcomes (Table 2). Two women had seizures after enrollment: one had normal BP but was diagnosed with GHTN /PE and the other had a single BP elevation BP elevations above the cutoffs used to diagnose hypertension are very common in labor and are not associated with adverse neonatal outcomes. They are, however, associated with higher cesarean rates and maternal length of stay, even if they do not lead to diagnosis of GHTN or PE

Magnesium Sulfate for Prophylaxis against Postoperative Atrial Fibrillation after Isolated Cardiac Valve Replacement Surgery in Adult Patients with Rheumatic Heart Disease: A Randomized Controlled Trial

Objectives: To evaluate the role of prophylactic magnesium sulfate administration in preventing postoperative atrial fibrillation (POAF), attenuating the inflammatory response and promoting myocardial protection after isolated cardiac valve replacement surgery in adult patients with rheumatic heart disease. Design: Prospective randomized, double-blind placebo-controlled trial. Methods: Sixty-four adult patients undergoing isolated cardiac valve replacement surgery were divided into two equal groups (32 patients in each). Patients in magnesium group (group M) received 2.5 gm of magnesium sulfate (dissolved in 100 mL of isotonic saline and infused over 2 h), twelve h preoperatively, within the first hour of ICU arrival, and on the 2nd and 3rd postoperative days (group M). Patients in the control group (group C) received a placebo of isotonic saline at the same time periods. Results: Prophylactic magnesium sulfate significantly decreased the incidence of POAF compared to the placebo group (P=0.005). White blood cell (WBC) count showed no significant difference between the two groups. C-reactive protein (CRP) level showed significant reduction during the 3rd, 4th, and 5th postoperative days in group M compared to group C (P=0.001, 0.001 & 0.012 respectively). Serum level of interleukin-6 (IL-6) showed a significant reduction on the 5th postoperative day in group M compared to group C (P=0.001). Both groups showed no significant differences in serum levels of troponin I during the study. Conclusion: Prophylactic use of magnesium sulfate in patients with rheumatic heart disease undergoing isolated cardiac valve replacement surgery can decrease the incidence of POAF. It may play a role in attenuating the inflammatory process associated with the use of cardiopulmonary bypass (CPB).

561: Neonatal outcomes in obese women undergoing cesarean delivery for fetal heart rate tracing abnormalities

To investigate whether there is an association between maternal obesity and adverse neonatal outcomes and operative time in women undergoing cesarean delivery for a category 2 or 3 fetal heart rate (FHR) tracing. We conducted a retrospective chart review of women who delivered at the University of Virginia Medical Center between 2012 and 2015. Women were included if they delivered a nonanomalous singleton fetus at term by primary cesarean delivery with a category 2 or 3 FHR tracing as an indication for delivery. Operative details, maternal medical and sociodemographic history, and neonatal outcomes were collected by chart review. Body mass index (BMI) was examined as a categorical exposure (BMI 18.5 - 24.99, 25 - 29.99, and ≥30 kg/m2). The adverse neonatal outcome was a composite outcome defined as Apgar score <7 at 5 minutes, arterial cord pH <7.1 and/or base deficit ≥12, admission to the NICU, need for immediate neonatal resuscitation beyond bulb suction and stimulation, or hospitalization for longer than 3 days. Logistic regression was used for univariate and multivariable analyses for the composite outcome. The total operative time, and times from skin incision to hysterotomy, and hysterotomy to delivery were examined using linear regression. 285 mother-neonate pairs were included. Maternal BMI was not associated with adverse neonatal outcomes in univariate analysis (p=0.85). Magnesium sulfate administration, illicit drug or narcotic use, and rupture of membranes (ROM) for 12-24 hours were associated with adverse neonatal outcomes (p<0.05). After adjusting for magnesium sulfate use, drug use, ROM, and pregnancy related hypertension in multivariable analysis, there remained no difference in rates of neonatal adverse outcomes among different BMI groups (p=0.50, Table 1). Displayed in Figure 1, the total operative time had a linear association with maternal BMI (B=3.03; 95% CI: 1.88-4.18) as did the time from skin incision to hysterotomy (B=1.15; 95% CI: 0.85, 1.46), but not time from hysterotomy to delivery (B=0.09; 95% CI: -0.01, 0.18). For women undergoing primary cesarean delivery for category 2 or 3 fetal heart rate tracings, obesity was associated with increased operative times but not with increased rates of adverse neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Determinants of magnesium sulphate use in women hospitalized at

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.

Morbilidad y mortalidad de neonatos < 1,500 g ingresados a la UCIN de un hospital de tercer nivel de atención

IntroductionWith the advances of perinatal and neonatal care, the survival of premature infants has increased. The birth weight and gestational age are the most important determinants of morbidity and neonatal mortality rates. The objective of this study was to determine the morbidity and mortality of neonates with birth weight <1500g who required admission into NICU. Material and methodsAn analysis of a cohort of neonates <1500g admitted to the NICU was carried out consecutively from January to December 2016, with the determination of prenatal care variables (prenatal steroids, use of magnesium sulphate, delivery mode), and neonatal variables (birth weight, gestational age, morbidity and mortality). Statistical analyses in the group of neonates who survived and those who died, included the calculation of chi squared test, Student t test, and Odds Ratio, with 95% confidence interval (OR, 95%CI). ResultsThe study included 135 neonates, 113 (83.71%) of whom survived and 22 (16.29%) died. Birth weight was significantly lower for patients who died (969g vs 842g, P=.0074) as well as gestational age (29 vs 27.9, P=.01). As regards the morbidity of those who survived, severe BPD was present in 38%, severe IVH grade III/IV in 20%, and severe ROP in 2.6%. The principal cause of mortality was sepsis. DiscussionIn this study, mortality was similar to other countries such as Norway, Spain, and some Latin American countries. ConclusionSurvival occurred with increasing gestational age and birth weight, with a mortality of 16.29%.

Inhaled magnesium sulfate in the treatment of acute asthma.

Inhaled magnesium sulfate in the treatment of acute asthma.

Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: A prospective cohort study.

To evaluate the association between blood pressure (BP) measurements and adverse outcomes in women with pre-eclampsia. A prospective cohort study of women with pre-eclampsia admitted to three South African tertiary facilities. BP was measured using the CRADLE Vital Signs Alert (VSA), incorporated with a traffic light early warning system; green: systolic BP <140 mmHg and diastolic BP <90 mmHg, yellow: systolic BP 140-159 and/or diastolic BP 90-109 mmHg (but neither is above the upper threshold), red: systolic BP ≥160 mmHg and/or diastolic BP ≥110 mmHg. Maternal: death, eclampsia, stroke, kidney injury; process measures: magnesium sulfate use, Critical Care Unit (CCU) admission; perinatal: stillbirth, neonatal death, preterm delivery. Of 1547 women with pre-eclampsia (including 42 twin pregnancies), 33.0% of women triggered a red light on admission and 78.6% at their highest BP. Severe hypertension and adverse outcomes were common across yellow and red categories. Comparing admission red to yellow lights, there was a significant increase in kidney injury (OR 1.74, CI 1.31-2.33, trend test p = .003), magnesium sulfate use (OR 3.40, CI 2.24-5.18, p < .001) and CCU admission (OR 1.50, CI 1.18-1.91, p < .001), but not for maternal death, eclampsia, extended perinatal death or preterm delivery. The CRADLE VSA, with integrated traffic light early warning system, can identify women who are hypertensive, at increased risk of severe pre-eclampsia complications and in need of escalation of care. Women who triggered a red light were at increased risk of kidney injury, magnesium sulfate use and CCU admission.

Magnesium sulfate and ophthalmic artery Doppler velocimetry in patients with severe preeclampsia: a case series

BackgroundIn the present study, we used Doppler velocimetry in the ophthalmic artery to evaluate the hemodynamic status of the intracranial vasculature. This is the first time in the literature that indices of ophthalmic artery Doppler sonography of women with preeclampsia were evaluated before and after the use of magnesium sulfate to prevent eclampsia.Case presentationIndices of ophthalmic artery Doppler sonography of six women with severe preeclampsia at 27 to 33 weeks of gestational age were evaluated before and after the use of magnesium sulfate (10 minutes, 30 minutes, and 60 minutes after the magnesium sulfate loading dosage. The patients’ ages were 26 years (patient 01), 29 years (patient 02), 20 years (patient 03), 21 years (patient 04), 20 years (patient 05), and 19 years (patient 06). The ethnic group of patients 01 and 04 was white and the ethnic group of patients 02, 03, 05 and 06 was mulatto.ConclusionsThe apparent increase in resistance index and pulsatility index values, although there is no statistical significance in this series of cases, and the decrease in peak ratio values after the administration of magnesium sulfate reflect an increase in the impedance to flow in the ophthalmic artery and consequently a reduction in cerebral perfusion after the use of magnesium sulfate. This may explain how magnesium sulfate protects women with severe preeclampsia against cerebral damage and prevents acute convulsions in these patients. We believe that this case series report may have a broader clinical impact across medicine because the mechanism of how magnesium sulfate can protect patients and prevent acute convulsions is controversial.

Antenatal magnesium for preterm delivery reduces risk of cerebral palsy among surviving very preterm infants.

Commentary on: Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, Iams JD, Wapner RJ, Sorokin Y, Alexander JM, Harper M, Thorp JM Jr, Ramin SM, Malone FD, Carpenter M, Miodovnik M, Moawad A, O'Sullivan MJ, Peaceman AM, Hankins GD, Langer O, Caritis SN, Roberts JM. Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Networks. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359(9):895–905. PMID 18753646. The current American College of Obstetricians and Gynecologists (ACOG) Committee Opinion supports the use of magnesium sulphate for foetal neuroprotection before 32 weeks of gestation 1. The clinical trial reviewed here is the largest and most recent to inform these guidelines 2. This randomised control trial (RCT), aimed to determine if the administration of magnesium sulphate to women at high risk of preterm delivery would reduce the risk of cerebral palsy (CP), found a reduction in moderate/severe CP at two years of age following antenatal magnesium sulphate exposure (RR 0.55, 95% CI 0.32–0.95) 2. These results were consistent with previous RCTs primarily evaluating the neuroprotective benefits of magnesium sulphate on the incidence of CP in preterm infants 3-5. Additionally, a Cochrane review concluded that 63 women were needed to prevent one diagnosis of CP 6. Further investigation is warranted to provide updated and unified guidelines regarding the use of magnesium sulphate for foetal neuroprotection. There was significant heterogeneity in treatment regimens between RCTs with no trial sharing the same loading dose, treatment dose, duration of dosing or retreatment regimen of magnesium sulphate 2-6. Additionally, although no serious maternal complications of antenatal magnesium exposure have been reported, there were several minor complications, including a 50% increase in maternal hypotension, leading to a 3.2-fold increase in cessation of therapy 6. Optimal treatment regimens would likely lead to a refined understanding of treatment effect size, better protocol adherence, and ultimately improved neurodevelopmental outcomes. The results of this trial should be considered in the context of advances in neonatal medicine affecting neurodevelopmental outcomes. Specifically, during the time of this study's enrolment, the American Academy of Pediatrics (AAP) recommended against routine use of postnatal corticosteroids in preterm infants because of its negative effect on neurodevelopmental outcomes 7. This recommendation significantly curtailed the use of early postnatal steroids, potentially altering neurodevelopmental outcomes if differed between treatment groups 7. Additionally, there has been increased survival of infants 22–23 weeks of gestation 8. Currently, there are no RCTs that investigate the neuroprotective benefit of magnesium sulphate in <24 weeks of gestation. It has been 20 years since recruitment started and nearly 10 years since the publication of this landmark trial has influenced the practice of obstetricians in the United States 2. In that same time, there continue to be advances in the care of extremely low birthweight infants impacting changes in survival and neurodevelopmental outcomes. Although many institutions follow ACOG recommendations of administering antenatal magnesium sulphate in preterm delivery, there are no recommendations for magnesium sulphate treatment regimens or gestational age thresholds presumably leading to a variety of clinical practices 1. Perhaps it is time to repeat this clinical trial in a new era to help elucidate both the optimal treatment regimen as well as the effect of antenatal magnesium exposure in the setting of preterm labour and delivery on neurodevelopmental outcomes. In the meantime, this trial remains consistent with available evidence supporting antenatal magnesium sulphate exposure in preterm infants to reduce CP. https://ebneo.org/2017/10/antenatal-magnesium-for-preterm-delivery-reduces-risk-of-cerebral-palsy-among-surviving-very-preterm-infants/ None. None.

Racial/ethnic disparities in magnesium sulfate neuroprotection: a subgroup analysis of a multicenter randomized controlled trial

Objective: Despite known racial disparities in obstetrics, as well as differences in magnesium pharmacodynamics according to race, the effect of race/ethnicity in magnesium sulfate (MgSO4) use during pregnancy has not been studied. Whether some mothers are at increased risk of side effects, or infants at decreased neuroprotective effects is unknown. We analyze the effect of race/ethnicity in maternal/infant outcomes after MgSO4 neuroprotection.Study design: Subgroup analysis of a multicenter clinical trial (BEAM trial) where pregnant women at risk of preterm birth were randomized to either MgSO4 or placebo. For this study, nonanomalous singleton pregnancies were studied. The effect of race in maternal/neonatal outcomes after MgSO4 was analyzed with Breslow–Day and multifactorial ANOVA. Logistic regression was used to calculate odds ratios (OR) of complications according to race.Results: 922 MgSO4 and 972 placebo cases were included (45.0% African-American, 36.2% Caucasian, 17.8% Hispanics, and 1.0% Asians). Interaction analysis showed a significant effect of race/ethnicity (p = .043). Hispanics presented the highest frequency (88.3%, p < .001), as well as the highest odds of MgSO4 side effects [OR(95%CI) = 6.6 (1.3–33.8)].Conclusion: Hispanics present increased risk of magnesium toxicity compared to other racial/ethnic groups. Whether specific racial/ethnic groups require closer surveillance for early signs of magnesium toxicity needs to be further explored.

Prophylactic magnesium sulphate in prevention of eclampsia in women with severe preeclampsia: randomised controlled trial (PIPES trial)

Optimum dose, route and duration of use of prophylactic magnesium sulphate in women with severe pre-eclampsia is still controversial. We compared the efficacy and safety of ‘low-dose Dhaka’ regime with ‘Loading dose only’ regime for seizure prophylaxis in severe preeclampsia using a randomised controlled trial in 402 women. The incidence of eclampsia in the ‘low-dose Dhaka’ regime group was 1.49% and that in the ‘Loading dose only regime’ was 2.98% (p = .321). In the low-dose Dhaka regime, injection site abscess and respiratory depression occurred in one woman each. Neonatal outcomes such as Apgar score at 5 minutes (5.0% vs. 8.05% p = .251) and perinatal mortality (20.4% vs. 21.9%, p = .724) were similar in both groups. Loading dose only regime may be considered an effective alternative regime for the prevention of eclampsia in women with severe preeclampsia.Impact statementWhat is already known on this subject: Efficacy of therapeutic short regime magnesium sulphate in eclampsia has already been reported. Data regarding prophylactic short regime in women with preeclampsia is sparse.What the results of this study add: We have shown that short regime of magnesium sulphate using only the loading dose in the prevention of seizure in preeclampsia is an effective alternative to the low-dose Dhaka regime.What the implications are of these findings for clinical practice and/or further research: The short regime is less resource-intensive. Further larger studies are needed to confirm the efficacy of this short regime and to establish its cost-effectiveness.

Preeclampsia.

The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with hypertension with proteinuria, but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women's mortality.

Pengaruh Penggunaan Magnesium Sulfate (MgSO4) saat Antenatal sebagai Neuroprotektor Bayi Prematur terhadap Perkembangan Motorik Kasar Usia 2-3 Tahun

Abstract Indonesia is the country with the fifth highest figure in the world of prematurity. The incidence of severe preeclampsia in Indonesia as much as 31.04%.Indonesia still use magnesium sulfate as an anti-seizure medications and recurrent seizures. Some developed countries in the world have been using magnesium sulfate as a neuroprotective fetus during antenatal for baby with a risk of premature birth. Premature babies have an increased risk of morbidity short term and long term. Nearly 50% of premature babies have neurological problems such as motor disorders. This study aimed to determine the effect of a history of the use of magnesium sulfate in the mother during antenatal against gross motor development in children aged 2-3 years. Analytic observational research with cross-sectional approach. Samples were selected by using purposive sampling with 30 respondents. Collecting data on the data preterm infants with a history of giving antenatal magnesium sulfate obtained through medical record RSIA Puri Bunda Malang and gross motor development is obtained by means of door-to-door using a checklist denver II. Analysis of the results of studies using the Fisher Exact Test correlation test. The research data is obtained as much as 43.3% of respondents with a history of antenatal magnesium sulphate diagnosed normal gross motor development, 6.7% suspect and no diagnosed untestable. While the respondents without a history of antenatal magnesium sulphate showed 16.7% of children diagnosed normal gross motor development and 33.3% suspect and no respondents who were diagnosed untestable. The results showed that there was a significant effect (p value = 0.008), so that it can be concluded that a history of antenatal magnesium sulfate use in premature babies have a better effect than the group that did not have a history of use of antenatal magnesiumsulfate.

A Nonlethal Anesthesia Protocol for Accessing the Mantle Cavity of Olympia Oysters in the Laboratory or Field

ABSTRACT An effective method of anesthesia for Olympia oysters (Ostrea lurida) would allow for nonlethal sampling of tissues for genetic analysis, biopsy for diseases, assessing reproductive status, and collection of brooding larvae. The use of magnesium sulfate (MgSO4) as an anesthetization method for Olympia oysters was assessed in laboratory trials and field use. Three replicate groups of 10 oysters were exposed to MgSO4 at three concentrations (0, 75, 85, and 100 g/L) in the laboratory to investigate the optimal concentration for anesthetization. Laboratory trials determined that 45 min of treatment with 100 g/L MgSO4 was the most effective. In the field, more than 14,000 oysters were exposed to MgSO4 as an anesthetic to assess reproductive status and validate the procedure. In field trials, the anesthetization method of 45 min air exposure followed by 45 min submersion in 100 g/L MgSO4 was found to have a success rate >80%. No influence of sampling date, location, or reproductive status on anesthetiz...

BİTÜMLÜ SICAK KARIŞIMLARDAN GERİ DÖNÜŞÜM YOLU İLE ELDE EDİLEN AGREGALARIN PERFORMANSLARININ DEĞERLENDİRİLMESİ: DENEYSEL BİR ÇALIŞMA

Waste asphalt pavements occurring from the faulty road construction or similar reasons cause great environmental pollution. This paper presents an experimental study on determination of fundamental characteristics of the recycled aggregates obtained from waste bituminous hot mixtures. For this purpose, 20 drilling core samples from a road segment in Antalya city were taken out by using core drilling machine. Aggregates and bitumen which are the main components of the bituminous hot mixture were separated from each other by using reflux extractor test set. Sieve analysis was performed on the each drilling core samples. Obtained results were compared to the lower and upper limit values of the bituminous base layer according to the related specification. Then, the performance of recycled aggregate, new limestone and basalt aggregates as well were analysed with aggregate tests such as Los Angeles abrasion, flakiness index, stripping resistance, soundness of aggregate by use of magnesium sulfate and methylene blue. According to the results obtained from the experimental tests, it can be said that recycled aggregates meet requirements of asphalt specifications and they can be used as aggregate again in asphalt pavement. Keywords: Waste asphalt, faulty road construction, recycled aggregate, extraction of asphalt, bituminous base laye

Sulfato de magnesio y el cerebro en la preeclampsia

El sulfato de magnesio ha sido el medicamento de elección en la profilaxis y tratamiento de la eclampsia. Sin embargo, la compresión de las manifestaciones neurológicas producidas por la preeclampsia englobadas dentro de la leucoencefalopatía posterior reversible ha puesto en evidencia que los mecanismos propuestos basados en estudios en animales son ciertos, revalorando más a este antiguo fármaco. Desde el estudio MAGPIE hasta nuestros días son muchas las interrogantes aun no resueltas con respecto al sulfato de magnesio en la preeclampsia, pero es indudable su valor como tratamiento de primera línea para las manifestaciones cerebrales en dicha complicación.

Re: Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate

Re: Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate

Association between the use of magnesium sulfate as neuroprotector in prematurity and the neonatal hemodynamic effects

Purpose: Cerebral palsy is often associated with prematurity and magnesium sulfate (MgSO4) has been used as a neuroprotector, with favorable results. However, its mechanism of action has not been fully elucidated. This study aimed to evaluate the association between MgSO4 at the imminent premature delivery and neonatal hemodynamic effects.Materials and methods: A cross-sectional study involving 94 newborns (NB) between 24 and 32 weeks at a Brazilian hospital was performed. Bivariate analysis between the use or the non-use of MgSO4 and hemodynamic characteristics was performed, using the Chi-square test.Results: NB were evaluated between those who received MgSO4 (27.7) and those who did not (72.3%). Normal heart rate was verified in 62.8% of NB, normal respiratory rate in 70.2%, and normal temperature in 22.3%. Oxygen saturation higher or equal than 95% was evidenced in 85.1% of NB, normal hemoglucotest in 74.5%, and hemoglobin greater or equal than 16.4 g/dL in 30.9%. Non-invasive ventilation was performed in 48.9% of NB, while 51.1% were submitted to endotracheal ventilation. There was no significance relation detected between the use of MgSO4 and the hemodynamic characteristics.Conclusions: MgSO4 does not appear to influence hemodynamic factors as a cause of the neuroprotection in premature NB.

Antenatal risk factors associated with need of postpartum antihypertensives in women with preeclampsia in South India: Case control study.

To investigate the antepartum risk factors associated with the need for antihypertensive medication in the postpartum period in women with pre-eclampsia. Matched retrospective case control study was done in a tertiary center in south India between January 2016 and June 2016. We compared 100 preeclamptic women requiring antihypertensive medication in the postpartum period at discharge with 100 preeclamptic women who were not on antihypertensive medication at discharge, matched for age and parity at a ratio 1:1. Demographic data, maternal medical conditions, and delivery data were abstracted from maternal charts. Risk factors were evaluated using conditional logistic regression. Gestational age at delivery was comparable in both groups (34.3vs. 35.6weeks, p=0.220). Cesarean section rates were higher in the cases compared to controls (53% vs. 32%, p=0.004). After adjusting for age and parity women who had eclampsia, required prophylactic magnesium sulphate therapy and high peak antenatal systolic blood pressure were associated with postpartum antihypertensives. Using multivariate conditional logistic regression, mean systolic blood pressure (OR=1.03, 95% CI 1.00-1.07), development of eclampsia (OR=6.43, 95% CI 1.03-39.91) and need of prophylactic magnesium sulphate (OR=5.02, 95% CI 2.02-12.47) were found to be associated with the need of postpartum antihypertensives. In women with preeclampsia, development of eclampsia, use of prophylactic magnesium sulphate and high peak antenatal systolic blood pressure are more likely to require antihypertensives in postpartum period.