Neonatal Adverse Effects Research Articles

Tramadol versus hyoscine-N-butylbromide as intrapartum analgesics during the first stage of labor

Objective The aim was to evaluate and compare the analgesic efficacy of tramadol versus hyoscine-N-butylbromide intramuscularly given during the active phase of the first stage of labor. Materials and methods This prospective study included 140, American Society of Anesthesiologists I, laboring primigravidae, who were divided into two equal groups: group I (group B) received hyoscine-N-butylbromide (Buscopan) 40 mg intramuscular and group II (group T) received tramadol 100 mg intramuscular. Labor pain was assessed by visual analog scale before and at 30 min, 1 h, 2 h, and 3 h after drug administration. Maternal and neonatal adverse effects, drug-delivery interval, mode of delivery, need for additional analgesia, and postpartum maternal satisfaction were assessed too. Results Baseline visual analog scale scores were comparable between the groups (P>0.05). Pain scores at 30 min, 1 h, 2 h, and 3 h were significantly higher (P 0.05). A total of 56 (80%) women in group B had adverse effects versus 54 (77.1%) women in group T (P>0.05). Adverse effects were generally mild (well tolerated). Cesarean delivery percentages were comparable between the groups (P>0.05). Postpartum maternal satisfaction was significantly higher (P Conclusion Although Buscopan is cheap and safe, it is a less effective intrapartum analgesic than tramadol. It offers shorter duration of labor, so it is better recommended for primiparous women.

Diabetes Mellitus in Pregnancy

Gestational and pregestational diabetes make up the most common maternal metabolic disorder of pregnancy. Suboptimal control of blood glucose has the potential for serious maternal and neonatal adverse effects. Neonates of diabetic mothers are at risk for congenital malformations, perinatal mortality, preeclampsia, preterm birth, increased birthweight, neonatal hypoglycemia and respiratory distress. The nature and severity of risks depend on the timing and duration of hyperglycemia. Through glycemic control and proper prenatal care, many of these risks can be mitigated. Pediatric providers must be sensitive to the association between a newborn’s risk and the mother’s level of glycemic control, often linked to her adherence to prenatal care.

Magnesium in obstetric anesthesia and intensive care.

Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic andpostoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.

Remifentanil for labor analgesia: a comprehensive review.

Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world. Intravenous patient-controlled analgesia (IVPCA) with remifentanil is considered to be a reasonable option for labor pain relief. Several studies have demonstrated its efficacy with minimal maternal and neonatal adverse effects. On the other hand, reports of cases of maternal cardiac and respiratory arrest with remifentanil IVPCA within the past couple of years have redirected our attention to its safe use. Remifentanil IVPCA warrants one-to-one nursing monitoring, appropriate education of healthcare providers, continuous maternal oxygen saturation monitoring, end-tidal CO2 monitoring, and availability of both maternal and neonatal resuscitation equipment. This article provides an overview of knowledge and principles of using remifentanil IVPCA for labor analgesia and introduces its potential usage in Japan.

Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period.

Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period.

Food contaminants and programming of type 2 diabetes: recent findings from animal studies.

It is now accepted that the way our health evolves with aging is intimately linked to the quality of our early life. The present review highlights the emerging data of Developmental Origins of Health and Disease field on developmental disruption by toxicants and their subsequent effect on type 2 diabetes. We report adverse neonatal effects of several food contaminants during pregnancy and lactation, among them bisphenol A, chlorpyrifos, perfluorinated chemicals on pancreas integrity and functionality in later life. The described alterations, in conjunction with disruption of β cell mass in early life, can lead to dysregulation of glucose metabolism, insulin synthesis, which facilitates the development of insulin resistance and progression of diabetes in the adult. Despite limited and often inconclusive epidemiologic and experimental data, more recent data clearly show that infants appear to be at increased risk of type 2 diabetes in later life. This may be a result of continued exposure to chemical food contaminants during the critical window of pancreas development. In societies already burdened with increased incidence of non-communicable chronic diseases, there is a clear need for information regarding the potential harmful effects of chemical food contaminants on adult health diseases.

Certolizumab pegol does not bind the neonatal Fc receptor (FcRn): Consequences for FcRn-mediated in vitro transcytosis and ex vivo human placental transfer

Antibodies to tumor necrosis factor (anti-TNF) are used to treat inflammatory diseases, which often affect women of childbearing age. The active transfer of these antibodies across the placenta by binding of the Fc-region to the neonatal Fc receptor (FcRn) may result in adverse fetal or neonatal effects. In contrast to other anti-TNFs, certolizumab pegol lacks an Fc-region. The objective of this study was to determine whether the structure of certolizumab pegol limits active placental transfer.Binding affinities of certolizumab pegol, infliximab, adalimumab and etanercept to human FcRn and FcRn-mediated transcytosis were determined using in vitro assays. Human placentas were perfused ex vivo to measure transfer of certolizumab pegol and positive control anti-D IgG from the maternal to fetal circulation.FcRn binding affinity (KD) was 132nM, 225nM and 1500nM for infliximab, adalimumab and etanercept, respectively. There was no measurable certolizumab pegol binding affinity, similar to that of the negative control. FcRn-mediated transcytosis across a cell layer (mean±SD; n=3) was 249.6±25.0 (infliximab), 159.0±20.2 (adalimumab) and 81.3±13.1ng/mL (etanercept). Certolizumab pegol transcytosis (3.2±3.4ng/mL) was less than the negative control antibody (5.9±4.6ng/mL). No measurable transfer of certolizumab pegol from the maternal to the fetal circulation was observed in 5 out of 6 placentas that demonstrated positive-control IgG transport in the ex vivo perfusion model.Together these results support the hypothesis that the unique structure of certolizumab pegol limits its transfer through the placenta to the fetus and may be responsible for previously reported differences in transfer of other anti-TNFs from mother to fetus.

The Effect of Intramuscular Administration of Atropine and Hyoscine Combination on Labor Progress and Maternal and Neonatal Outcomes in Primigravid Women

The Effect of Intramuscular Administration of Atropine and Hyoscine Combination on Labor Progress and Maternal and Neonatal Outcomes in Primigravid Women Authors Mehri Jamilian* 1 ; Maryam Karamali2 ; Bahman Sadeghi3 ; Maasoumeh Ghazi Mirsaeed2 1Associated Professor, Department of Obstetrics and Gynecology, Taleghani Hospital, Arak University of Medical Sciences, Arak, Iran 2Assistant Professor, Gynecologist, Department of Obstetrics and Gynecology, Arak University of Medical Sciences, Arak, Iran 3Assistant Professor, Department of Social Medicine, Arak University of Medical Sciences, Arak, Iran Abstract Background: Previous studies reported that neonatal and maternal complications as well as duration of labor could be diminished through labor management. Therefore, we aimed to evaluate the effect of intramuscular (IM) administration of atropine and hyoscine combination on labor progress and maternal and neonatal outcomes in primigravid women admitted to Taleghani Hospital of Arak, Iran. Methods: In this double-blind, placebo-controlled clinical trial, 216 primigravid women were randomly allocated to four groups (54 cases in each group) as follows: atropine group received 0.01-0.5 mg (1cc) of IM atropine; hyoscine group received 20 mg of IM hyoscine in a single dose; atropine and hyoscine combination group received 0.01-0.5 mg of atropine and 20 mg of IM hyoscine in a single dose; and control group only received IM injection of 1cc distilled water in a single dose. Thereafter, Bishop score, duration of the active phase and the second stage of labor, type of delivery, and Apgar scores at one and five minutes were recorded. Chi-square/Fisher’s exact tests and One-way ANOVA were run, using SPSS version 20. Results: The Bishop scores were significantly higher in the atropine and hyoscine groups, compared to the other groups (P 0.05). Conclusion: The atropine and hyoscine combination reduced the duration of active phase in the primigravid women without serious maternal or neonatal adverse effects. Keywords: Active phase; Atropine; Hyoscine; Maternal and neonatal outcomes; Primigravid

Study on the effect of dexmedetomidine in reducing hemodynamic responses to general anesthesia for elective cesarean section in patients with pre-eclampsia

Background Because of the effect of dexmedetomidine (DEX) in hemodynamic stability, it was started as a sedative before and during surgical and other procedures in nonintubated adult and pediatric patients. Since 2009 DEX has been successfully used in laboring parturients. It provides maternal hemodynamic stability, anxiolysis, and stimulation of uterine contractions. Studies have shown that DEX has high placental retention and does not cross the placenta, and there is lower incidence of fetal bradycardia. We hypothesized that dexmedetomidine would be effective in reducing the maternal hemodynamic responses to elective cesarean section in pre-eclamptic patients without adverse neonatal effects. Patients and methods The present study included 40 parturients with pre-eclampsia who were planned for elective cesarean delivery for different indications under general anesthesia. The patients were divided in two groups and they were selected randomly to receive either fentanyl (control group) or 0.4 μg/kg/h intravenous DEX 10 min before induction (n = 20 per group). Changes in maternal heart rate, mean blood pressure, time from induction to delivery, the full anesthesia time, uterine contraction after placental delivery, umbilical blood gas parameters, and sedation scores were recorded. Results The heart rate in the DEX group was lower than that in the fentanyl group. Patients in the dexmedetomidine group had statistically significantly lower change in mean arterial blood pressure, whereas patients taking fentanyl showed much higher mean arterial blood pressure from induction until 5 min after extubation. Further, the dexmedetomidine group showed greater uterine contraction, but there was no difference between the two groups in terms of Apgar score at 1 and 5 min, NACS below 35, and umbilical blood gas analysis. Conclusion It can be concluded that DEX is effective in pre-eclamptic patients undergoing elective cesarean as it stabilizes the maternal hemodynamic parameters with negligible effect on the fetus.

Pushing/bearing down methods for the second stage of labour.

Pushing/bearing down methods for the second stage of labour.

Efficacy of Tranexamic Acid in Decreasing Blood Loss in Elective Caesarean Delivery

AbstractObjective: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after elective caesarean section (CS).Methods: This prospective randomized trial was conducted among 124 pregnant women subjected to term elective CS. Patients were equally divided into two groups. Study group received 10 mg/kg TA intravenously 5 min before skin incision while the control group did not. In addition, both groups received 10 units oxytocin and 1 ml ergometrine after delivery of the fetus. Blood loss in both groups was measured from placental delivery to end of the surgery and from end of the surgery to 2 h postpartum. Hemoglobin and hematocrit values were determined preoperatively and on the third day postpartum (before discharge) for all cases. Maternal and neonatal adverse effects in study groups were recorded.Results: TA group showed lower amount of blood loss (391 ml) when compared to control group (597 ml). Risk estimation has revealed that treatment with TA resulted in decrease in r...

A Perioperative Course of Gabapentin Does Not Produce a Clinically Meaningful Improvement in Analgesia after Cesarean Delivery: A Randomized Controlled Trial.

Studies examining the efficacy of a single preoperative dose of gabapentin for analgesia after cesarean delivery (CD) have been inconclusive. The authors hypothesized that a perioperative course of gabapentin would improve analgesia after CD. This single-center, randomized, double-blind, placebo-controlled, parallel-group, superiority trial was designed to determine the analgesic efficacy of a perioperative course of gabapentin when added to a multimodal analgesic regimen. Women scheduled for elective CD during spinal anesthesia were randomized to receive a perioperative oral course of either gabapentin (600 mg preoperatively followed by 200 mg every 8 h for 2 days) or placebo. Postoperative pain was measured at 24 and 48 h, at rest and on movement, on a visual analogue scale (VAS, 0 to 100 mm). The primary outcome was pain on movement at 24 h. Neonatal outcomes, opiate consumption, VAS satisfaction (0 to 100 mm), adverse effects, and persistent pain were also assessed. Baseline characteristics were similar between groups. There was a statistically significant but small reduction in VAS pain score (mean [95% CI]) on "movement" (40 mm [36 to 45] vs. 47 mm [42 to 51]; difference, -7 mm [-13 to 0]; P = 0.047) at 24 h in the gabapentin (n = 100) compared with control group (n = 97). There was more sedation in the gabapentin group at 24 h (55 vs. 39%, P = 0.026) but greater patient VAS satisfaction (87 vs. 77 mm, P = 0.003). A perioperative course of gabapentin produces a clinically insignificant improvement in analgesia after CD and is associated with a higher incidence of sedation.

Comparison of the Effect of Incremental Bolus and Incremental Infusion Regimens of Remifentanil on Labour Pain

Background: Most pregnant women who deliver in obstetrics units require pharmacological or non-pharmacological pain relievers that could provide potent analgesic effects with least maternal and neonatal adverse effects. Objectives: The aim of this investigation was to compare the efficacy and adverse maternal and neonatal effects of Remifentanil given by bolus patient-controlled analgesia (PCA) versus continuous intravenous (IV) infusion for labor analgesia. Patients and Methods: This randomized, single-blind clinical trial was conducted on 82 nulliparous parturient women in the active phase of labor, admitted to Ali Ebn-e Abitaleb Hospital, Zahedan, Iran from January 2010 to March 2013. The participants were randomly assigned into two equal groups of 41. In the infusion group, patients received incremental Remifentanil IV infusion from 0.025 to 0.1 µg/kg/min. In the bolus group, participants received incremental PCA bolus Remifentanil from 0.25 to 0.4 µg/kg with a lock-out time of four minutes. Average Visual Analog Scale (AVAS) pain scores in stages 1 and 2, labor duration, adverse effects, neonatal outcomes, total amount of administered Remifentanil and maternal satisfaction were assessed. Results: In both methods, the pain scores were significantly reduced after Remifentanil administration in both stages of labor (P < 0.001). There were no statistically significant differences in the pain intensity reduction between the groups (P = 0.49, P = 0.36, in the stages I and II of labor, respectively). There were no statistically remarkable differences between the two groups for labor duration (P = 0.4), neonatal outcomes (P = 0.9) and maternal satisfaction (P = 0.8). The total amount of administered Remifentanil was significantly lower in infusion group compared to bolus group (P = 0.001). Conclusions: Remifentanil in both infusion and bolus methods could decrease labor pain in both stages without serious maternal or neonatal adverse effects and without increasing the duration of labor. The average dose of Remifentanil needed to reduce pain was significantly lower in the infusion method compared to the bolus method.

Effect and Placental Transfer of Dexmedetomidine During Caesarean SectionUnder General Anaesthesia.

Many drugs can pass through the placenta and cause adverse effects on the foetus. Thus, during Caesarean section for puerperas who have contraindications for intravertebral anaesthesia, the use of proper drugs that have sedative, analgesic effects on the puerperas without adverse effects on the foetus is important. In this study, we investigated the effect and placental transfer of dexmedetomidine during Caesarean section under general anaesthesia. Thirty-eight puerperas were randomly divided to receive dexmedetomidine or saline before anaesthesia induction and during the operation. The dexmedetomidine-treated parturients had lower mean arterial pressure and heart rate at the delivery and at the end of the operation. The dexmedetomidine-treated parturients also needed 5.5% less propofol and 8.4% less fentanyl than the saline-treated ones. Between the dexmedetomidine-treated and saline-treated parturients, there was no difference in the maternal artery, umbilical vein, umbilical artery blood gas analysis results and the Apgar scores at 1 and 5min. after delivery. The placental transfer rate of dexmedetomidine was 0.76. We concluded that dexmedetomidine was effective in maintaining the haemodynamic stability in the parturients during Caesarean section under general anaesthesia without adverse neonatal effects. Dexmedetomidine can pass through the placenta with a placental transfer rate of 0.76.

Antiinfective therapy for pregnant or lactating patients in the emergency department.

Special considerations in pharmacotherapy for infectious diseases in pregnant and lactating women in the emergency department (ED) setting are reviewed. With many women turning to the ED as a source of primary care, it is essential for pharmacists involved in providing ED services to guide the selection of appropriate antiinfective agents during pregnancy and lactation; this area of practice is complicated by the very limited body of published data on the safety and efficacy of maternal antimicrobial use and potential fetal or neonatal adverse effects. Infectious diseases commonly encountered in the ED include sexually transmitted diseases, bacterial vaginosis and other vaginal infections, respiratory and urinary tract infections, and pneumonia. Recommended first-line therapies for pregnant or lactating women may differ from those recommended for other patient populations. Although some widely used antiinfective classes and agents are generally considered safe for use in pregnant women, others (e.g., clarithromycin, fluoroquinolones) have been linked to birth defects and neonatal adverse effects. In addition to guiding ED practitioners in the appropriate use of antiinfective agents in pregnant women and nursing mothers, pharmacists can reinforce the importance of appropriate follow-up care (including specialist referral or culture testing in some cases) and ongoing preventive health measures such as vaccine administration. The use of antiinfective agents in pregnant or lactating women requires consideration not only of the drugs' effectiveness but also their possible effects on the fetus or newborn and the nature of follow-up care. References are available to help clinicians make treatment decisions.

Study of the Effect of Dexmedetomidine in Reducing Hemodynamic Responses to General Anesthesia for Elective Cesarean Section in Patients with Preeclampsia

Background: Depending on the effect of dexmedetomidine in haemodynamic stability, it was started to be used as a sedative prior to and/or during surgical and other procedures in non-intubated adult and pediatric patients. In 2009, dexmedetomidine has been successfully used in laboring parturients. It provides maternal hemodynamic stability, anxiolysis, and stimulation of uterine contractions. Literature describes that dexmedetomidine has a high placental retention and does not cross the placenta, with less incidence of fetal bradycardia. We hypothesized that dexmamedetomidine would be effective in reducing the maternal hemodynamic responses to elective cesarean section in preeclmaptic patients without adverse neonatal effects. Methods: The series of the present study included forty parturients with preeclampsia who were planned for elective caesarean delivery for different indications under general anesthesia. The patients were divided in 2 groups and they were selected randomly to receive either fentanyl (control group), or 0.4 μg/kg/h intravenous dexmedetomidine 10 min before induction (n=20 per group). Changes in maternal heart rate, mean blood pressure, time from induction to delivery, the full anesthesia time, uterine contraction after placental delivery, umbilical blood gas parameters and Sedation scores were recorded. Results: The heart rate in the dexmedetomidine group was lower than that in fentanyl group, patients in dexamedetomidine group had statistically significant lower change in mean arterial blood pressure, while patients taken fentanyl showed much higher mean arterial blood pressure from the induction till 5 minutes after extubation, Also the dexamedetomidine group showed greater uterine contraction, while there was no difference between both groups in Apgar score at 1 and 5 minute, NACS<35 and the umbilical blood gas analysis. Conclusion: It could be concluded that, this study suggests the effective use of dexmedetomidine in preeclamptic patients undergoing elective cesarean as it stabilizes the maternal hemodynamic parameters with negligible effect on the fetus.

Sleep Quality and Obstructive Sleep Apnea in Pregnant Women.

DEAR EDITOR, One of the common disorders during pregnancy is sleep-disordered breathing (SDB).[1] SDB includes snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA)-hypopnea syndrome.[1] Snoring is considered as a risk factor for adverse pregnancy outcomes, including fetal heart rate abnormalities, fetal demise, fetal growth restriction, gestational diabetes, and preeclampsia.[2,3] Eighty-two pregnant women with gestational age more than 28 weeks were enrolled. All cases were asked to fill valid and reliable Persian versions of Pittsburg Sleep Questionnaire (PSQI) and Berlin questionnaire (BQ).[4,5] Mean age and mean gestational age 28 ± 4.6 years and 33.5 ± 2.7 weeks. According to BQ, 36 (43.9%) were classified as high risk for OSA and 46 (56.1%) classified as low risk [Table 1]. Table 1 High-risk cases in women with and without diabetes and preeclampsia Mean PSQI score was 8 ± 2.9 in all cases and it was significantly different between high- and low-risk group (mean PSQI in high-risk group was 9.3 ± 2.4 and in low-risk group was 7.1 ± 2.9, P = 0.001) [Table 2]. Table 2 Regression analysis regarding OSA as a dependent variable Frederick et al. evaluated 1303 pregnant women and found that habitual snoring was present in 7%.[3] Facco et al. found that 34% of enrolled pregnant women are at high risk for OSA and age, body mass index (BMI), and chronic hypertension were significant predictors of OSA.[6] Increase BMI and obesity are considered to be a risk factor for sleep disorders during pregnancy as the mass of the upper airway of the neck increases.[7] These evidences may suggest that OSA is a problem during pregnancy which is associated with some maternal factors such as GDM and preeclampsia and it is associated with some neonatal adverse effects.

Combined spinal epidural labour analgesia: Complications and their management

Combined spinal-epidural analgesia (CSEA) is an effective and increasingly popular analgesia method used in vaginal delivery. CSEA provides rapid and excellent analgesia, allows mobilization, reduces drug consumption significantly and generally causes negligible maternal and fetal /neonatal adverse effects /complications not requiring treatment. The resulting adverse effects /complications are often associated with technical and /or agent/agents used and cause maternal and fetal /neonatal or, albeit rarely, serious adverse effects. Therefore, these cases should be monitored closely during analgesia, necessary preventive measures should be taken by anticipating the potential problems and if necessary, appropriate medical intervention should be performed.

The effect of addition of low dose fentanyl to epidural bupivacaine (0.5%) in patients undergoing elective caesarean section: A randomized, parallel group, double blind, placebo controlled study.

Background:Opioids have synergistic action with local anesthetics which may alter characteristics of epidural block. Giving opioids to mother before delivery of baby is still fully not accepted with some fearing risk of neonatal depression.Aims:Our primary aim was to evaluate the analgesic effect of addition of 50 μg fentanyl to epidural 0.5% bupivacaine in patients undergoing elective caesarean section using visual analog scale. The secondary aim was to assess onset of analgesia, volume of drug required to achieve T6 level, grade and duration of motor block and Apgar score.Materials and Methods:In this prospective, randomized, double blind, placebo controlled study 64 patients scheduled for elective caesarean section under epidural anesthesia were randomly divided into two groups of 32 each. The fentanyl group received 1ml of 50 μg fentanyl and the saline group received 1ml of normal saline mixed with 10ml of 0.5% bupivacaine for epidural anesthesia. VAS score, time to achieve T6 level, dose of bupivacaine, intraoperative analgesic consumption and duration of analgesia, grade and duration of motor block and any adverse maternal and neonatal effects were noted.Statistical Analysis:Data was analyzed using Students t test, chi-square test and Mann-Whitney U-test. The values of P < 0.05 were considered statistically significant.Results:Fentanyl improved the VAS score significantly (1.6 ± 1.32) compared to the saline group (3.77 ± 1.0, P < 0.0001). It also reduced the intraoperaitve analgesic supplementation compared to the saline group. (P = 0.031). The postoperative duration of analgesia was prolonged in the fentanyl group (275.80 ± 13.61 min) compared to the saline group (191.47 ± 12.16 min, P < 0.0001). The other characteristics of epidural block were unaltered.Conclusion:Addition of 50 μg fentanyl to epidural 0.5% bupivacaine significantly reduces the VAS score. It also reduces intra-operative analgesia supplementation and prolongs the duration of postoperative analgesia without altering the other characteristics of block. The neonatal outcome is not affected with addition of fentanyl before delivery of baby.

The use of intravenous magnesium in non-preeclamptic pregnant women: fetal/neonatal neuroprotection.

To review the effect of intravenous magnesium in obstetrics on fetal/neonatal neuroprotection. A systematic review of published studies. Five randomized trials and 4 meta-analyses have shown a significant 32% reduction of cerebral palsy when administering magnesium sulfate in case of preterm delivery. The pathophysiologic mechanism is not fully unraveled: modulation of the inflammatory process, both in the mother and the fetus, and downregulation of neuronal stimulation seem to be involved. After long-term high-dose intravenous administration of magnesium, maternal and neonatal adverse effects such as maternal and neonatal hypotonia and osteoporosis and specific fetal/neonatal cerebral lesions have been described. In case of administration for less than 48 h at 1 g/h and a loading dose of 4 g, these toxic amounts are not achieved. American, Canadian and Australian guidelines recommend the use of intravenous magnesium in any threatening delivery at less than 32 weeks. The "number needed to treat" to avoid 1 cerebral palsy is between 15 and 35. Intravenous magnesium significantly reduces the risk for cerebral palsy in preterm birth. Open questions remain the optimal dosing schedule, whether or not repeating when delivery has been successfully postponed and a new episode of preterm labor occurs. Some concern has been raised on a too optimistic value for random error which might have led to over-optimistic conclusions in classic meta-analysis. Randomized trials comparing different doses and individual patient data meta-analysis might resolve these issues.