Duration of Postpartum Magnesium Sulphate for the Prevention of Eclampsia

Okonkwo, Maureen; Nash, Chris

doi:10.1097/aog.0000000000004720

Cited by 12 publications

(2 citation statements)

References 20 publications

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“…An intravenous bolus of 4 g and infusion of 1 g.h -1 is typically used. A recent systematic review and meta-analysis of 10 randomised controlled trials found that a shorter duration (< 12 h) of magnesium sulphate was not associated with an increased risk of eclamptic seizures compared with the standard 24 h regimens [83]. However, external validity is limited due to significant heterogeneity across studies (71%) and data remain underpowered to draw firm conclusions.…”

Section: Eclampsiamentioning

confidence: 99%

Emergencies in obstetric anaesthesia: a narrative review

2022

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We conducted a narrative review in six areas of obstetric emergencies: category-1 caesarean section; difficult and failed airway; massive obstetric haemorrhage; hypertensive crisis; emergencies related to neuraxial anaesthesia; and maternal cardiac arrest. These areas represent significant research published within the last five years, with emphasis on large multicentre randomised trials, national or international practice guidelines and recommendations from major professional societies. Key topics discussed: prevention and management of failed neuraxial technique; role of high-flow nasal oxygenation and choice of neuromuscular drug in obstetric patients; prevention of accidental awareness during general anaesthesia; management of the difficult and failed obstetric airway; current perspectives on the use of tranexamic acid, fibrinogen concentrate and cell salvage; guidance on neuraxial placement in a thrombocytopenic obstetric patient; management of neuraxial drug errors, local anaesthetic systemic toxicity and unusually prolonged neuraxial block regression; and extracorporeal membrane oxygenation use in maternal cardiac arrest.

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Section: Eclampsiamentioning

confidence: 99%

Emergencies in obstetric anaesthesia: a narrative review

2022

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“…In some non-randomized trials 11,12 , the duration of MgSO4 treatment for preeclamptic women has been decided based on clinical factors. Early postpartum ambulation, less frequent healthcare worker surveillance, and improved infant care may be aided by MgSO4 treatment that is administered for a shorter period of time 13 .…”

Section: Introductionmentioning

confidence: 99%

Eight Hours Versus twenty four hours Postpartum Magnesium Sulphate for Prophylaxis in Women with Pre-Eclampsia

Mushtaq¹,

Zafar²,

Ahmed³

et al. 2023

PJMHS

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Aim: To compare the outcome of 8 hours versus 24 hours postpartum magnesium sulphate for eclampsia prophylaxis in women with moderate to severe pre-eclampsia. Study design: Randomized control trial Place and duration of study: The study was conducted in Gynecology and Obstetrics Department, MCH -1, PIMS Hospital, Islamabad from August 2020- Jan 2021 Methodology: After getting approval from hospital ethical committee and informed consent from patients the randomized controlled trial was conducted. The sample size was calculated by using WHO sample size calculator and total sample size was 108 patients that were selected after fulfilling of selection criteria. Complete history, physical examination, laboratory investigations and sonographical evaluation was performed for the selected women. The selected women were randomly assigned to either group A or B using a random list developed by lottery method. Group A received MgSO4 for 8 hour (8micro drops/min) and Group B received MgSO4 for 24 hours only (8micro drops/min). The primary outcome was occurrence of eclamptic fits and secondary outcomes were ambulation time, initiation of breast feeding, patient’s hospital stay and patient satisfaction in both groups. Data was analyzed by using SPSS version 21.0. P-value <0.05 was considered significant Results: Women in both groups had similar demographic profile. Baseline patients’ characteristics (systolic BP, diastolic BP, Hb, ALT and uric acid, urinary protein) were also similar in both groups. Main symptoms were headache, blurred vision and epigastric pain in both groups Eclamptic fits in the first 72 hours were not observed in both groups. In group A patients, mean ambulation time was 10.6±1.1 hours and in group B it was 18.8±7.5 hours (P=0.001). In group A patients, mean time to initiate breast feeding was 14.6 ± 1.9 hours and in group B it was 24.3±8.3 hours (P=0.001). In group A patients, mean duration of hospital stay was 2.8±0.43 days and in group B it was 3.4±0.49 days (P=0.001). In group A patients, mean patient satisfaction score was 8.9±1.1 and in group B it was 4.5±1.8 (P=0.001). Clinical implication:Less risk of side effects observed and less monitoring required. Conclusion:Both the dosing regimens were equally effective and eclamptic fits in the first 72 hours were not observed in both groups. Mean ambulation time, mean time to initiate breastfeeding and mean duration of hospital stay was significantly shorter in patient treated with MgSO4 for 8 hours compared to those treated with MgSO4 for 24 hours. Patients treated with MgSO4 for 8 hours demonstrated better satisfaction when compared to those treated with MgSO4 for 24 hours. Keywords: Postpartum magnesium sulphate, eclampsia, prophylaxis, pre-eclampsia. Ambulation time, Breastfeeding

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Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Pergialiotis,

Sapantzoglou,

Rodolaki

et al. 2023

Arch Gynecol Obstet

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Purpose Magnesium sulfate (MgSO4) has been widely used in obstetrics as a mean to help decrease maternal and neonatal morbidity in various antenatal pathology. As a factor, it seems to regulate immunity and can, thus, predispose to infectious morbidity. To date, it remains unknown if its administration can increase the risk of chorioamnionitis. In the present meta-analysis, we sought to accumulate the available evidence. Methods We systematically searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search along with the reference lists of electronically retrieved full-text papers. Results Eight studies were included that investigated the incidence of chorioamnionitis among parturient that received MgSO4 and control patients. Magnesium sulfate was administered in 3229 women and 3330 women served as controls as they did not receive MgSO4. The meta-analysis of data revealed that there was no association between the administration of magnesium sulfate and the incidence of chorioamnionitis (OR 0.98, 95% CI 0.73, 1.32). Rucker’s analysis revealed that small studies did not significantly influence the statistical significance of this finding (OR 1.12, 95% CI 0.82, 1.53). Trial sequential analysis revealed that the required number to safely interpret the primary outcome was not reached. Two studies evaluated the impact of MgSO4 in neonates delivered in the setting of chorioamnionitis. Neither of these indicated the presence of a beneficial effect in neonatal morbidity, including the risk of cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, stillbirth, or neonatal death. Conclusion Current evidence indicates that magnesium sulfate is not associated with an increased risk of maternal chorioamnionitis. However, it should be noted that its effect on neonatal outcomes of offspring born in the setting of chorioamnionitis might be subtle if any, although the available evidence is very limited.

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Duration of Postpartum Magnesium Sulphate for the Prevention of Eclampsia

Cited by 12 publications

References 20 publications

Emergencies in obstetric anaesthesia: a narrative review

Emergencies in obstetric anaesthesia: a narrative review

Eight Hours Versus twenty four hours Postpartum Magnesium Sulphate for Prophylaxis in Women with Pre-Eclampsia

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

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