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

Abstract

Background Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO 4 ) is recommended for prevention and treatment of pre-eclampsia/eclampsia. However, MgSO 4 remains underused, particularly in low-and middle-income countries (LMICs).Objective This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy-makers regarding factors affecting use of MgSO 4 to prevent or treat pre-eclampsia/eclampsia.

Mechanisms of Mg carbonates precipitation and implications for CO2 capture and utilization/storage

“…catechol or metallic organic frameworks) to assist the cleavage of the Si-O bonds, thus producing Si oxyanions and facilitating the dissolution of silicate minerals. 3,115 129 Epsomite is the most abundant mineral of the MgSO 4 -H 2 O system, being well known for its use as active pharmaceutic ingredient in the treatment against prophylaxis 130 and eclampsia, 131 as well as applications as fertilizers, cosmetics, and coatings. 132 Even though China is the lead producer of Mg sulphate (118 M$ per year), the European Union surpass China's exports, when the total exports from Germany (97 M$ per year) and Ireland (37 M$ per year) are considered together.…”

Quality and outcomes of maternal and perinatal care for 76,563 pregnancies reported in a nationwide network of Nigerian referral-level hospitals

“…The situation is further compounded by the lack of capacity to initiate magnesium sulphate administration at lower level facilities (or sources of referral) due to complex dosing regimens, fear of magnesium toxicity, or regulatory issues, such that women referred with severe pre-eclampsia or eclampsia to referral-level facilities arrive when magnesium sulphate can make little or no difference to maternal survival. 27 , 28 …”

Is intravenous magnesium sulphate safe to be administered outside the critical care setting?

“… Based on the available literature, there is sufficient evidence to support the safe administration of up to 50 mg/kg (maximum 2 g) intravenous MgSO 4 as a 20‐min bolus in children >2 years with acute severe asthma. There are insufficient data to comment on the safety of higher doses. Delivery of MgSO 4 outside the critical care setting is appropriate provided that line of sight nursing and cardiorespiratory monitoring are available. In order to effectively implement such an approach outside the critical care setting, local units should offer education to increase staff confidence and competence, ensure adequate staffing, have access to clear guidelines and polices and ensure that an escalation plan is in place 20 …”

“…• In order to effectively implement such an approach outside the critical care setting, local units should offer education to increase staff confidence and competence, ensure adequate staffing, have access to clear guidelines and polices and ensure that an escalation plan is in place. 20…”