MgSO4 In Women Research Articles

Magnesium sulfate and risk of postpartum uterine atony and hemorrhage: A meta-analysis

ObjectivesMagnesium sulfate (MgSO4) is among the most commonly used medications in labor and delivery units. It has been used as a mean to protect against eclampsia and a neuroprotective agent for fetuses at risk of preterm birth. In the present study we investigated its impact in the occurrence of postpartum uterine atony and hemorrhage. MethodsWe searched the Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, Clinicaltrials.gov and Google Scholar databases for randomized trials and observational studies. Statistical analysis was performed with the Hartung-Knapp-Sidik-Jonkman model in RStudio using the meta package. ResultsTwelve studies fitted the predetermined criteria and these involved 41,190 women of whom 10,565 (25.6 %) received MgSO4. The meta-analysis revealed that the risk of postpartum uterine atony was similar among patients that received MgSO4 and those that did not (OR 1.93, 95 % CI 0.78, 4.81). Estimated blood loss (SMD 0.04, 95 % CI -0.10, 0.18) as well as the risk of postpartum hemorrhage (OR 1.82, 95 % CI 0.99, 3.35) also did not differ. Subgroup analysis revealed that evidence drawn from observational studies indicates a significant effect of MgSO4 on the odds of postpartum uterine atony and hemorrhage; however, randomized trials do not support this. ConclusionsThe results of our meta-analysis suggest that it is reasonable to consider MgSO4 in women at risk of delivering before the completion of its elimination half-life. However, physicians should be vigilant in cases at risk of postpartum hemorrhage as current data are very heterogeneous and should not be considered as definitive.

The WHO Safe Childbirth Checklist implementation: impact on the prescription of magnesium sulphate through a one-year longitudinal study

BackgroundPreeclampsia is a relatively frequent condition during pregnancy and childbirth. The administration of magnesium sulphate as a prophylactic and treatment measure is an evidence-based practice for eclampsia; however, it is not consistently used, compromising the health of pregnant women. This study aimed to assess compliance with recommendations of the International Society for the Study of Hypertension in Pregnancy (ISSHP) for the use of MgSO4 in pregnant women with preeclampsia, before and after the implementation of the World Health Organization Safe Childbirth Checklist (SCC).MethodsThis quasi-experimental study was conducted between July 2015 and July 2016 at a third-level maternity hospital in northeastern Brazil, where the SCC was implemented. Compliance (underuse and overuse of MgSO4) was assessed in biweekly samples of 30 deliveries assessed 6 months before and 6 months after SCC implementation, using indicators based on international guidelines. A total of 720 deliveries were assessed over 1 year using an ad hoc application for reviewing medical records. Aggregated adequate use was estimated for the study period, and the time series measurements were compared to a control chart to assess change.ResultsThe incidence of preeclampsia was 39.9% (287/720). Among these, 64.8% (186/287) had severe signs or symptoms and needed MgSO4. Underuse (no prescription when needed) of MgSO4 was observed in 74.7% (139/186) of women who needed the drug. Considering all women, non-compliance with the prescription protocol (underuse and overuse) was 20.0% (144/720). After introducing the SCC, the use of MgSO4 in women with preeclampsia with severe features increased from 19.1 to 34.2% (p = 0.025). Longitudinal analysis showed a significant (p < 0.05) ascending curve of adequate use of MgSO4 after the SCC was implemented.ConclusionsCompliance with recommendations for the use of MgSO4 in preeclampsia was low, but improved after implementation of the SCC. Interventions to improve compliance based on diagnosis and treatment reminders may help in the implementation of this good practice.

432: The association of magnesium sulfate with maternal morbidity when used for preeclampsia without severe features

Current recommendations, based on low quality evidence, suggest avoiding magnesium sulfate (MgSO 4) in women who have preeclampsia (PreE) without severe features. Yet, since more than half of women who experience an eclamptic seizure have no prior severe features, practitioners often use MgSO4. We aimed to quantify the risk of adverse outcomes associated with MgSO4 in women without severe features of PreE. This was a secondary analysis of an observational cohort of 115,502 mother/infant dyads who delivered at 25 U.S. hospitals, Mar 2008 to Feb 2011. Included were women with PreE without severe features at any time in pregnancy, per local hospital standards, and who delivered after 32 weeks gestation (to exclude MgSO4 use for CP prophylaxis). Our primary outcome was a composite of severe maternal morbidity: postpartum hemorrhage (PPH), pulmonary edema, intensive care unit (ICU) admissions or death. Secondary outcomes included cesarean, use of any uterotonic beyond oxytocin, MgSO4 toxicity requiring calcium gluconate, neonatal ICU admission and perinatal death. PPH was defined by an EBL ≥ 1500 mL at delivery or the immediate postpartum period, a blood transfusion, or a hysterectomy for hemorrhage or atony. Comparisons were made based on the administration of of MgSO4 anytime during the delivery hospitalization. Multivariable logistic regression was used to adjust for confounding. Of the women in the initial cohort, 2,468 (2.1%) met inclusion criteria. The groups differed by maternal race, insurance status, tobacco/drug use and gestational age at birth. The crude and adjusted odds ratios (OR) are in Table. The frequency of composite maternal morbidity was significantly higher in women who received MgSO4 (8.6%) compared with those who did not (3.9%; aOR 2.1). Those who received MgSO4 had 4-fold higher odds of ICU admission (aOR 4.2) and were more likely to require additional uterotonics (aOR 1.6). Neonatal outcomes were similar. Magnesium toxicity occurred in 7 women (0.5%). Results were similar after adjustment for hospital. When MgSO4 is used in preeclampsia without severe features, it is associated with an increased risk of severe maternal morbidity.

Neuraxial magnesium sulfate improves postoperative analgesia in Cesarean section delivery women: A meta-analysis of randomized controlled trials

BackgroundWe conducted this meta-analysis to elucidate whether additional neuraxial magnesium sulfate (MgSO4) can improve postoperative analgesia in women undergoing Cesarean section (CS) delivery. MethodWe searched Pubmed, Embase and ClinicalTrial.gov. We included only randomized controlled trials that have compared the quality of postoperative analgesia with and without additional neuraxial MgSO4 in women undergoing CS delivery with neuraxial anesthesia regimens. The primary outcomes included analgesic duration of neuraxial anesthesia, postoperative pain scores and postoperative consumption of analgesics. The secondary outcomes included patients' satisfaction and adverse effects related to postoperative analgesia. ResultsNine relevant studies comprising a total of 827 women undergoing CS delivery were included. Analyses revealed that CS women receiving additional neuraxial MgSO4 (the MgSO4 group) had longer duration of neuraxial anesthesia (effect size [ES] = 1.920, 95% confidence interval [CI] = 0.999 to 2.842, P < 0.001), longer duration of sensory block (ES = 1.020, 95% CI = 0.463 to 1.577, P < 0.001), lower postoperative pain scores at rest (ES = −1.206, 95% CI = −2.084 to −0.329, P = 0.007), pain scores with motion (ES = −1.435, 95% CI = −2.631 to −0.240, P = 0.019) and consumption of analgesics (ES = −1.620, 95% CI = −2.434 to −0.806, P < 0.001) than CS women without receiving additional neuraxial MgSO4 (the control group). Of note, the MgSO4 group tended to have higher rate on rating satisfaction as “excellent” than the control group did (odds ratio = 3.748, 95% CI = 2.218 to 6.332, P < 0.001). However, the incidences of adverse effects (i.e., nausea and vomiting, pruritus and hypotension) were not significantly different between these two groups. ConclusionNeuraxial MgSO4 improves postoperative analgesia in CS women.

Use of magnesium sulfate before 32 weeks of gestation: a European population-based cohort study

ObjectivesThe use of magnesium sulfate (MgSO4) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO4 in women delivering before 32 weeks of...

Seizures in the peripartum period: Epidemiology, diagnosis and management

The occurrence of seizures in the peripartum period is a rare but particularly challenging situation. Seizures in the peripartum period could result from three categories of conditions: first and most frequent is the exacerbation of a known pre-existing seizure disorder, mainly epilepsy. A therapeutic evaluation is needed; second is the new onset of seizures due to a non-pregnancy-related problem. An accurate diagnosis and a specific treatment are required; third is range of pregnancy-related conditions. The present review focuses on this third category, with a special attention to disorders occurring in the peripartum period. It is structured in two sections. The first section is a focus on eclampsia since, based on ICU admission data, it appears to be the leading cause of pregnancy-related seizures. Its epidemiology, pathophysiology, clinical diagnosis, neuro-imaging features and recommended management are reviewed. The efficacy and safety of the recommended regimens of MgSO4 therapy are discussed, as well as controversies on the alteration of these regimens and the use of MgSO4 in women with mild preeclampsia. In the second section, the other causes of pregnancy-related new onset seizures are summarized. These include posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis, thrombotic thrombocytopenic purpura, amniotic fluid embolism, and air embolism. Noteworthy is the fact that most of these pregnancy-related seizure conditions overlap with each other, mainly in terms of clinical presentations and neuro-imaging. Therefore, the diagnosis and the treatment options should be considered on a multidisciplinary basis.

Some Uncommon Acute Neurological Disorders

The occurrence of seizures in the peripartum period is a rare but particularly challenging situation. Seizures in the peripartum period could result from three categories of conditions: first and most frequent is the exacerbation of a known pre-existing seizure disorder, mainly epilepsy. A therapeutic evaluation is needed; second is the new onset of seizures due to a non-pregnancy-related problem. An accurate diagnosis and a specific treatment are required; third is range of pregnancy-related conditions. The present review focuses on this third category, with a special attention to disorders occurring in the peripartum period. It is structured in two sections. The first section is a focus on eclampsia since, based on ICU admission data, it appears to be the leading cause of pregnancy-related seizures. Its epidemiology, pathophysiology, clinical diagnosis, neuro-imaging features and recommended management are reviewed. The efficacy and safety of the recommended regimens of MgSO4 therapy are discussed, as well as controversies on the alteration of these regimens and the use of MgSO4 in women with mild preeclampsia. In the second section, the other causes of pregnancy-related new onset seizures are summarized. These include posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis, thrombotic thrombocytopenic purpura, amniotic fluid embolism, and air embolism. Noteworthy is the fact that most of these pregnancy-related seizure conditions overlap with each other, mainly in terms of clinical presentations and neuro-imaging. Therefore, the diagnosis and the treatment options should be considered on a multidisciplinary basis.