Determinants of magnesium sulphate use in women hospitalized at <29 weeks with severe or non-severe pre-eclampsia

Abstract

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.

Clinical Effects of Integrated Traditional Chinese and Western Medicine in Treating Severe Preeclampsia and Its Influence on Maternal and Infant Outcomes after Cesarean Section under Combined Lumbar and Epidural Anesthesia

“…However, the clinical effect of single use is not good because severe placental ischemia and hypoxia will lead to maternal endothelial dysfunction [17]. Studies have found that giving a scientific dose of magnesium sulfate for preeclampsia maternity can reduce the incidence of Evidence-Based Complementary and Alternative Medicine cerebral palsy in children [18]. However, Ugwu et al reported that long-term application of magnesium sulfate has the risk of magnesium ion poisoning, which is not conducive to maternal and child health [19].…”

Factors affecting use of magnesium sulphate for pre‐eclampsia or eclampsia: a qualitative evidence synthesis

“…20 Alternative dosage regimens of MgSO 4 are also being evaluated. 21,22 Despite strong evidence of effectiveness and costeffectiveness, MgSO 4 is often underused for these indications, 13,[23][24][25] particularly in LMICs. 26 Previous research has explored factors affecting MgSO 4 guideline implementation, identifying system and market failures that restrict drug availability, absence of clinical protocols and staff reluctance.…”

Effects of compound Danshen injection combined with magnesium sulfate on serum MPO and hs-CRP in patients with severe preeclampsia

“…Severe PE may even bring damage to organs ( 1 , 2 ). At present, the pathogenesis of PE is still unclear, and most scholars believe that PE is caused by systemic vascular endothelial injury after placental pathophysiological changes ( 3 , 4 ). The pathogenesis of PE is also very complex, and may be associated with placental ischemia, genetic predisposition, immune adaptation and oxidative stress response ( 5 , 6 ).…”