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Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, Pryde P, Wolf HT, Crowther CA. Magnesium Sulfate Before Preterm Birth for Neuroprotection: An Updated Cochrane Systematic Review. Obstet Gynecol 2024; 144:161-170. [PMID: 38830233 PMCID: PMC11250087 DOI: 10.1097/aog.0000000000005644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To systematically review the evidence for the effectiveness and safety of magnesium sulfate as a fetal neuroprotective agent when given to individuals at risk of preterm birth. DATA SOURCES We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov , the World Health Organization International Clinical Trials Registry Platform (through March 17, 2023), and reference lists of relevant studies. METHODS OF STUDY SELECTION Randomized controlled trials (RCTs) assessing magnesium sulfate for fetal neuroprotection in pregnant participants at risk of imminent preterm birth were eligible. Two authors assessed RCTs for inclusion, extracted data, and evaluated risk of bias, trustworthiness, and evidence certainty (GRADE [Grading of Recommendations Assessment, Development and Evaluation]). TABULATION, INTEGRATION, AND RESULTS We included six RCTs (5,917 pregnant participants and 6,759 fetuses at less than 34 weeks of gestation at randomization). They were conducted in high-income countries (two in the United States, two across Australia and New Zealand, and one each in Denmark and France) and commenced between 1995 and 2018. Primary outcomes: up to 2 years of corrected age, magnesium sulfate compared with placebo reduced the risk of cerebral palsy (risk ratio [RR] 0.71, 95% CI, 0.57-0.89; six RCTs, 6,107 children) and death or cerebral palsy (RR 0.87, 95% CI, 0.77-0.98; six RCTs, 6,481 children) (high-certainty evidence). Magnesium sulfate had little or no effect on death up to 2 years of corrected age (moderate-certainty evidence) or these outcomes at school age (low-certainty evidence). Although there was little or no effect on death or cardiac or respiratory arrest for pregnant individuals (low-certainty evidence), magnesium sulfate increased adverse effects severe enough to stop treatment (RR 3.21, 95% CI, 1.88-5.48; three RCTs, 4,736 participants; moderate-certainty evidence). Secondary outcome: magnesium sulfate reduced the risk of severe neonatal intraventricular hemorrhage (moderate-certainty evidence). CONCLUSION Magnesium sulfate for preterm fetal neuroprotection reduces cerebral palsy and death or cerebral palsy for children. Further research is required on longer-term benefits and harms for children, effect variation by participant and treatment characteristics, and the generalizability of findings to low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION The review protocol was based on a standard Cochrane Pregnancy and Childbirth template and our previous Cochrane Systematic Review (doi: 10.1002/14651858.CD004661.pub3 ; published before the introduction of PROSPERO).
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Affiliation(s)
- Emily S Shepherd
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute (SAHMRI), and Adelaide Medical School, University of Adelaide, Adelaide, the Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, and the Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia; INSERM Unit 1245, Team 4, Rouen School of Medicine, Normandy University, and the Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France; Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; the Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark; and the Liggins Institute, University of Auckland, Auckland, New Zealand
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Stephansson O, Sandström A. Can short- and long-term maternal and infant risks linked to hypertension and diabetes during pregnancy be reduced by therapy? J Intern Med 2024. [PMID: 39045893 DOI: 10.1111/joim.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Hypertensive disorders of pregnancy (HDP), especially preeclampsia, and diabetes during pregnancy pose significant risks for both maternal and infant health, extending to long-term outcomes such as early-onset cardiovascular disease and metabolic disorders. Current strategies for managing HDP focus on screening, prevention, surveillance, and timely intervention. No disease-modifying therapies exist so far for established preeclampsia; delivery remains the definitive resolution. Preventive measures-including early pregnancy screening, exercise, and low-dose aspirin-show promise. Antihypertensive treatments reduce severe hypertension risks, whereas magnesium sulfate remains the standard for preventing eclampsia. Planned delivery from gestational week 37 can balance maternal benefits and neonatal risks in women with established preeclampsia. Delivery between 34 and 37 weeks gestation in women with preeclampsia has to balance risks for mother and infant. Lifestyle interventions-particularly diet and physical activity-are pivotal in managing gestational diabetes mellitus and type 2 diabetes. The oral antidiabetic metformin has shown benefits in glycaemic control and reducing maternal weight gain, although its long-term effects on offspring remain uncertain. The safety of other peroral antidiabetics in pregnancy is less studied. Advancements in glucose monitoring and insulin administration present encouraging prospects for enhancing outcomes in women with diabetes types 1 and 2. Both HDP and diabetes during pregnancy necessitate vigilant management through a combination of lifestyle modifications, pharmacological interventions, and timely obstetric care. Although certain treatments such as low-dose aspirin and metformin show efficacy in risk reduction, further research is ongoing to ensure safety for both mothers and their offspring to reduce short- and long-term adverse effects.
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Affiliation(s)
- Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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Liu Y, Zhou M, Cheng H, Du J. Effect of low-molecular-weight heparin calcium combined with magnesium sulfate and labetalol on coagulation, vascular endothelial function and pregnancy outcome in early-onset severe preeclampsia. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03712-7. [PMID: 38904800 DOI: 10.1007/s00228-024-03712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE This paper was aimed at unveiling the effect of low-molecular-weight heparin calcium (LMWH) combined with magnesium sulfate and labetalol on coagulation, vascular endothelial function, and pregnancy outcome in early-onset severe preeclampsia (EOSP). METHODS Pregnant women with EOSP were divided into the control group and the study group, each with 62 cases. Patients in the control group were treated with labetalol and magnesium sulfate, and those in the study group were treated with LMWH in combination with the control grou Blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), 24-h urine protein, coagulation indices [D-dimer (D-D), plasma fibrinogen (Fg), prothrombin time (PT), activated partial thromboplastin time (APTT), and prothrombin time (TT)], endothelial function [endothelin (ET-1) and nitric oxide (NO)], oxidative stress indices [oxidized low-density lipoproteins (ox-LDL), lipid peroxidation (LPO), superoxide dismutase (SOD), and malondialdehyde (MDA)], pregnancy outcome, and adverse effects occurred in the two groups were compared. RESULTS After treatment, lower SBP, DBP, and 24-h urine protein levels; lower Fg and D-D levels; higher PT, APPT, and TT levels; higher NO levels; lower ET-1 levels; lower ox-LDL, MDA, and LPO levels; higher SOD levels; and lower incidence of adverse pregnancy and adverse reactions were noted in the study group in contrast to the control group. CONCLUSION EOSP patients given with LMWH combined with magnesium sulfate and labetalol can effectively reduce the patient's blood pressure and urinary protein level; improve coagulation function, oxidative stress, and vascular endothelial function indices; reduce the adverse pregnancy outcomes; and improve the safety of treatment.
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Affiliation(s)
- Yang Liu
- Department of Clinical Pharmacy, the Forth Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Miao Zhou
- Department of Pharmacy, the Forth Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Hao Cheng
- Hebei Province Pharmaceutical Professional Inspector Corps., Shijiazhuang, 050031, Hebei, China
| | - Jing Du
- Department of Clinical Pharmacy, the Fifth Hospital of Shijiazhuang, No. 42 Ta Nan Road, Shijiazhuang, 050021, Hebei, China.
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Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, Pryde P, Wolf HT, Crowther CA. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2024; 5:CD004661. [PMID: 38726883 PMCID: PMC11082932 DOI: 10.1002/14651858.cd004661.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND Magnesium sulphate is a common therapy in perinatal care. Its benefits when given to women at risk of preterm birth for fetal neuroprotection (prevention of cerebral palsy for children) were shown in a 2009 Cochrane review. Internationally, use of magnesium sulphate for preterm cerebral palsy prevention is now recommended practice. As new randomised controlled trials (RCTs) and longer-term follow-up of prior RCTs have since been conducted, this review updates the previously published version. OBJECTIVES To assess the effectiveness and safety of magnesium sulphate as a fetal neuroprotective agent when given to women considered to be at risk of preterm birth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 17 March 2023, as well as reference lists of retrieved studies. SELECTION CRITERIA We included RCTs and cluster-RCTs of women at risk of preterm birth that assessed prenatal magnesium sulphate for fetal neuroprotection compared with placebo or no treatment. All methods of administration (intravenous, intramuscular, and oral) were eligible. We did not include studies where magnesium sulphate was used with the primary aim of preterm labour tocolysis, or the prevention and/or treatment of eclampsia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed RCTs for inclusion, extracted data, and assessed risk of bias and trustworthiness. Dichotomous data were presented as summary risk ratios (RR) with 95% confidence intervals (CI), and continuous data were presented as mean differences with 95% CI. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included six RCTs (5917 women and their 6759 fetuses alive at randomisation). All RCTs were conducted in high-income countries. The RCTs compared magnesium sulphate with placebo in women at risk of preterm birth at less than 34 weeks' gestation; however, treatment regimens and inclusion/exclusion criteria varied. Though the RCTs were at an overall low risk of bias, the certainty of evidence ranged from high to very low, due to concerns regarding study limitations, imprecision, and inconsistency. Primary outcomes for infants/children: Up to two years' corrected age, magnesium sulphate compared with placebo reduced cerebral palsy (RR 0.71, 95% CI 0.57 to 0.89; 6 RCTs, 6107 children; number needed to treat for additional beneficial outcome (NNTB) 60, 95% CI 41 to 158) and death or cerebral palsy (RR 0.87, 95% CI 0.77 to 0.98; 6 RCTs, 6481 children; NNTB 56, 95% CI 32 to 363) (both high-certainty evidence). Magnesium sulphate probably resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.96, 95% CI 0.82 to 1.13; 6 RCTs, 6759 children); major neurodevelopmental disability (RR 1.09, 95% CI 0.83 to 1.44; 1 RCT, 987 children); or death or major neurodevelopmental disability (RR 0.95, 95% CI 0.85 to 1.07; 3 RCTs, 4279 children) (all moderate-certainty evidence). At early school age, magnesium sulphate may have resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.82, 95% CI 0.66 to 1.02; 2 RCTs, 1758 children); cerebral palsy (RR 0.99, 95% CI 0.69 to 1.41; 2 RCTs, 1038 children); death or cerebral palsy (RR 0.90, 95% CI 0.67 to 1.20; 1 RCT, 503 children); and death or major neurodevelopmental disability (RR 0.81, 95% CI 0.59 to 1.12; 1 RCT, 503 children) (all low-certainty evidence). Magnesium sulphate may also have resulted in little to no difference in major neurodevelopmental disability, but the evidence is very uncertain (average RR 0.92, 95% CI 0.53 to 1.62; 2 RCTs, 940 children; very low-certainty evidence). Secondary outcomes for infants/children: Magnesium sulphate probably reduced severe intraventricular haemorrhage (grade 3 or 4) (RR 0.76, 95% CI 0.60 to 0.98; 5 RCTs, 5885 infants; NNTB 92, 95% CI 55 to 1102; moderate-certainty evidence) and may have resulted in little to no difference in chronic lung disease/bronchopulmonary dysplasia (average RR 0.92, 95% CI 0.77 to 1.10; 5 RCTs, 6689 infants; low-certainty evidence). Primary outcomes for women: Magnesium sulphate may have resulted in little or no difference in severe maternal outcomes potentially related to treatment (death, cardiac arrest, respiratory arrest) (RR 0.32, 95% CI 0.01 to 7.92; 4 RCTs, 5300 women; low-certainty evidence). However, magnesium sulphate probably increased maternal adverse effects severe enough to stop treatment (average RR 3.21, 95% CI 1.88 to 5.48; 3 RCTs, 4736 women; moderate-certainty evidence). Secondary outcomes for women: Magnesium sulphate probably resulted in little to no difference in caesarean section (RR 0.96, 95% CI 0.91 to 1.02; 5 RCTs, 5861 women) and postpartum haemorrhage (RR 0.94, 95% CI 0.80 to 1.09; 2 RCTs, 2495 women) (both moderate-certainty evidence). Breastfeeding at hospital discharge and women's views of treatment were not reported. AUTHORS' CONCLUSIONS The currently available evidence indicates that magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus, compared with placebo, reduces cerebral palsy, and death or cerebral palsy, in children up to two years' corrected age, and probably reduces severe intraventricular haemorrhage for infants. Magnesium sulphate may result in little to no difference in outcomes in children at school age. While magnesium sulphate may result in little to no difference in severe maternal outcomes (death, cardiac arrest, respiratory arrest), it probably increases maternal adverse effects severe enough to stop treatment. Further research is needed on the longer-term benefits and harms for children, into adolescence and adulthood. Additional studies to determine variation in effects by characteristics of women treated and magnesium sulphate regimens used, along with the generalisability of findings to low- and middle-income countries, should be considered.
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Affiliation(s)
- Emily S Shepherd
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lex W Doyle
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Stéphane Marret
- INSERM Unit 1245, Team 4, Rouen School of Medicine, Normandy University, Rouen, France
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France
| | - Dwight J Rouse
- Women & Infants Hospital of Rhode Island, The Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Peter Pryde
- Department of Anesthesiology, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Hanne T Wolf
- Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
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Ragam AS, S R S. Prevalence of Potential Drug-Drug Interactions Among Hypertensive Pregnant Women Admitted to a Tertiary Care Hospital. Cureus 2023; 15:e36306. [PMID: 37082495 PMCID: PMC10111145 DOI: 10.7759/cureus.36306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
AIMS AND OBJECTIVES The aim is to determine the frequency of potential drug-drug interactions (pDDIs) and to analyze the clinically relevant drug interactions among hypertensive pregnant women. MATERIALS AND METHODS This was an observational, cross-sectional study conducted at a tertiary care hospital. The prescriptions of the hypertensive pregnant women admitted to the hospital from June 2021 to December 2021 were analyzed for potential drug-drug interactions using the database from Lexicomp ® Solutions android mobile application version 7.5.4 (Wolters Kluwer, The Netherlands). RESULTS A total of 127 patients were evaluated during the study period of 6 months, of which 70 (55.12%) had pDDIs. The total number of pDDIs was 85, of which 70 (82.35 %) were clinically relevant interactions with the majority of them having moderate severity (81.17%) followed by minor severity (17.65%) and major severity (1.18%). The most frequently interacting pDDIs were between Labetalol and Lornoxicam (42.35%), followed by Labetalol and Diclofenac (22.35%). CONCLUSION This study highlights the high prevalence of potential drug interactions among hypertensive pregnant women and the need for rational drug use and strict vigilance in their monitoring.
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Abdullahi H, Obanimoh A, Isah A, Adewole N, Ekele B. A randomized controlled trial of loading dose alone versus pritchard regimen of magnesium sulphate, for seizure prophylaxis in severe preeclampsia. Ann Afr Med 2023; 22:153-159. [PMID: 37026195 DOI: 10.4103/aam.aam_111_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Background Preeclampsia poses a significant risk of maternal and neonatal morbidity and mortality. Magnesium sulfate superiority for seizure prophylaxis in severe preeclampsia has been proven globally. However, the search for the lowest effective dose is an area of continuing research. Aim The aim of this study was to compare the effectiveness of loading dose with the Pritchard regimen of magnesium sulfate for seizure prophylaxis in severe preeclampsia. Materials and Methods A total of 138 eligible women after 28-week gestation with severe preeclampsia were randomized to either receiving a single loading dose of MgSO4 (study arm: n = 69) or Pritchard regimen of MgSO4 (control: n = 69). The effectiveness was assessed by the development of seizure. The results obtained were analyzed using SPSS version 21. Categorical variables were analyzed using the Chi-square test and normally distributed continuous variables were analyzed with t-test and Fisher's exact test. P < 0.05 was considered statistical significance. Results There were no significant differences between those who received only the loading dose when compared with those who had Pritchard regimen other than a single recorded convulsion among the control group (P = 0.316). Similarly, except for the duration of hospital stay which was significantly longer in the Pritchard group (P = 0.019), both the arms of the study shared similar maternal and fetal outcomes. Conclusion This study suggests the effectiveness of just the loading dose of magnesium sulfate when compared with the standardized Pritchard regimen in the prevention of seizure among women with severe preeclampsia. The study also demonstrated safety and similarity in fetal-maternal outcome. The loading dose only had an added advantage of shorter duration of hospital stay.
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Meazaw MW, Chojenta C, Forder P, Taddele T, Loxton D. Health Care Readiness in Management of Preeclampsia/Eclampsia in Ethiopia: Evidence from National Facility-Based Survey. Healthc Policy 2022; 15:1225-1241. [PMID: 35734013 PMCID: PMC9208466 DOI: 10.2147/rmhp.s366055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Early case detection, treatment, and timely referral for better services can significantly reduce the negative outcomes of preeclampsia and eclampsia. However, evidence on health facilities' readiness to provide such services and the associated challenges is limited in Ethiopia. Therefore, this study aimed to assess the readiness of Ethiopian health care facilities to manage preeclampsia and eclampsia. Methods This study used the 2016 Ethiopia national emergency management of obstetrics and newborn care (EmONC) survey. This survey was a national cross-sectional census of health facilities that provided delivery services. Data on facility infrastructure, equipment and supplies were collected through a facility checklist, and interview health provider experiences. Cross tabulation, summarisation and chi square tests by facility type, location, and management authority were conducted. Results There were 3804 health facilities included in the survey across all regions of Ethiopia. The majority of facilities (92%) were public/government managed with only 1% of available hospitals located in rural areas. Poor availability of dipsticks for proteinuria tests (55.3%), caesarean sections (7.9%), and ambulance services (18.4%) were reported across health facilities with high variations in terms of facility type, location, and type of managing authority. Diazepam was a widely available anticonvulsant compared with magnesium sulfate (MgSO4), with more available in private for-profit facilities compared with public facilities. Nearly one third of health care providers were not trained to administer MgSO4 intravenously. The result indicated that the chi-square test was statistically significant at P < 0.001. Conclusions and Recommendations There were notable gaps in readiness of facilities in detection and management of preeclampsia/eclampsia that increase maternal and perinatal mortality in Ethiopia. Therefore, availability of essential supplies, medications, and referrals are required. In addition, refresher training to healthcare providers on screening, diagnosis and management of preeclampsia/eclampsia and continuous supervision should be provided.
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Affiliation(s)
- Maereg Wagnaw Meazaw
- Federal Ministry of Health, Addis Ababa, Ethiopia.,Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Catherine Chojenta
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Peta Forder
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Tefera Taddele
- Health System and Reproductive Health Directorate, The Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deborah Loxton
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
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Assessing the Potency of the Novel Tocolytics 2-APB, Glycyl-H-1152, and HC-067047 in Pregnant Human Myometrium. Reprod Sci 2022; 30:203-220. [PMID: 35715551 PMCID: PMC9810572 DOI: 10.1007/s43032-022-01000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/02/2022] [Indexed: 01/07/2023]
Abstract
The intracellular signaling pathways that regulate myometrial contractions can be targeted by drugs for tocolysis. The agents, 2-APB, glycyl-H-1152, and HC-067047, have been identified as inhibitors of uterine contractility and may have tocolytic potential. However, the contraction-blocking potency of these novel tocolytics was yet to be comprehensively assessed and compared to agents that have seen greater scrutiny, such as the phosphodiesterase inhibitors, aminophylline and rolipram, or the clinically used tocolytics, nifedipine and indomethacin. We determined the IC50 concentrations (inhibit 50% of baseline contractility) for 2-APB, glycyl-H-1152, HC-067047, aminophylline, rolipram, nifedipine, and indomethacin against spontaneous ex vivo contractions in pregnant human myometrium, and then compared their tocolytic potency. Myometrial strips obtained from term, not-in-labor women, were treated with cumulative concentrations of the contraction-blocking agents. Comprehensive dose-response curves were generated. The IC50 concentrations were 53 µM for 2-APB, 18.2 µM for glycyl-H-1152, 48 µM for HC-067047, 318.5 µM for aminophylline, 4.3 µM for rolipram, 10 nM for nifedipine, and 59.5 µM for indomethacin. A single treatment with each drug at the determined IC50 concentration was confirmed to reduce contraction performance (AUC) by approximately 50%. Of the three novel tocolytics examined, glycyl-H-1152 was the most potent inhibitor. However, of all the drugs examined, the overall order of contraction-blocking potency in decreasing order was nifedipine > rolipram > glycyl-H-1152 > HC-067047 > 2-APB > indomethacin > aminophylline. These data provide greater insight into the contraction-blocking properties of some novel tocolytics, with glycyl-H-1152, in particular, emerging as a potential novel tocolytic for preventing preterm birth.
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Farahani M, Sharifinejad N, Hashemnejad M, Mashak B, Mahboubipour H, Farahani M, Rastad H, Nirouei M. The effect of magnesium sulfate on maternal serum electrolytes and parathyroid hormone in pre-eclampsia. Int J Gynaecol Obstet 2022; 159:938-943. [PMID: 35656755 DOI: 10.1002/ijgo.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate possible interactions of magnesium sulfate-the drug of choice in the management of pre-eclampsia/eclampsia-in response to a few case reports that revealed maternal electrolyte disturbances, especially symptomatic changes, following magnesium sulfate administration in pre-eclampsia. METHODS Prospectively, women with pre-eclampsia were given 4 g of intravenous magnesium sulfate followed by a 2 g/h infusion up to 24 h after delivery. Sequential blood samples were drawn from each patient and used to measure the serum levels of sodium, potassium, calcium, phosphorus, magnesium, and parathyroid hormone. RESULTS A total of 30 pregnant women with pre-eclampsia were evaluated. They were aged between 20 and 41 years with median gestational age of 37.6 (interquartile range 35.4-38.9) weeks. Only five patients reached the therapeutic window of magnesium in at least one of our measuring intervals during magnesium sulfate infusion. Plasma magnesium concentrations increased significantly during magnesium sulfate administration and dropped during the next 12 and 24 h after infusion discontinuation (P < 0.05). Fifteen of 30 (50%) patients developed asymptomatic hypocalcemia, mainly at hour 24 of infusion. Negative moderate correlations were detected between the calcium and magnesium concentrations at 12 and 24 hours of infusion (ρ = -0.390, P = 0.044 and ρ = 0.315, P = 0.096, respectively). None of the patients with hypocalcemia reached the therapeutic level of magnesium or experienced parallel hyperphosphatemia. Eleven of 30 (36.6%) patients developed hyperphosphatemia mainly at 2 and 12 h of magnesium sulfate infusion. CONCLUSIONS Our study implies that magnesium sulfate could cause hypermagnesemia-induced hypocalcemia in women with pre-eclampsia, independent from parathyroid hormone. The negative correlations between calcium and magnesium concentrations could be indicative of dose-dependent associations between serum magnesium level and degree of hypocalcemia in our study.
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Affiliation(s)
- Masoumeh Farahani
- Department of Obstetrics and Gynecology, Alborz University of Medical Sciences, Karaj, Iran
| | - Niusha Sharifinejad
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Maryam Hashemnejad
- Department of Obstetrics and Gynecology, Alborz University of Medical Sciences, Karaj, Iran
| | - Banafsheh Mashak
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Hadith Rastad
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Choi JW, Lahori A, Merlo JA, Gill O, Ghoddoussi F, Patel KM, Desai RG, Hakim J, Zatkoff J, Krishnan S. Adductor Canal Blocks With Bupivacaine and Magnesium After Same-day Discharge Total Knee Arthroplasty Improve Postoperative Pain Relief and Decrease Opioid Consumption: A Prospective Randomized Controlled Trial. Clin J Pain 2022; 38:388-395. [PMID: 35440521 DOI: 10.1097/ajp.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adequate pain management is a critical component of facilitating same-day discharge for total knee arthroplasty (TKA). Adductor canal blocks (ACB) have been shown to be an effective technique for managing pain after TKA. The objective of this study was to investigate the impact of adding magnesium to local anesthetic in ACB on postoperative pain, opioid consumption, nausea, and overall patient satisfaction. MATERIALS AND METHODS A sample of 119 adults undergoing elective unilateral TKA were included. Patients were randomly assigned to receive ACB with magnesium and bupivacaine (n=56) or with bupivacaine only (n=63). Primary outcomes were total opioid consumption in the first 48 hours after surgery and pain scores. Secondary outcomes were the incidence of nausea in the first 48 hours after surgery and total overall satisfaction. RESULTS Opioid consumption decreased significantly in the Mg group compared with the no-Mg group over the first 24 hours (33.2±3.0 vs. 21.3±2.4, P=0.003), the second 24 hours (35.4±2.7 vs. 27.3±2.3, P=0.026), and the first 48 hours total after surgery (68.6±5.1 vs. 48.6±4.3, P=0.004). Pain scores were reduced in the Mg group (24 h: 5.1±2.3 vs. 3.5±2.0, P=0.000; 48 h: 5.1±1.6 vs. 3.9±1.6, P=0.000). Secondary outcomes showed no difference in the incidence of nausea over the first 48 hours and overall satisfaction. CONCLUSION The addition of magnesium to local anesthetic in ACB decreases pain scores and opioid consumption, without increasing nausea, when compared with ACB with local anesthetic alone.
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Affiliation(s)
- Jae W Choi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Anna Lahori
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | | | - Opinderjit Gill
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Ronak G Desai
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Joffer Hakim
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Jason Zatkoff
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
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11
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Dartey AF, Dzansi G, Lotse CW, Obuobisa R, Afua Bosu CE, Afaya A. Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study. SAGE Open Nurs 2022; 8:23779608221094542. [PMID: 35600007 PMCID: PMC9118454 DOI: 10.1177/23779608221094542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives’ experiences in managing patients with eclampsia in Ghana. Methods This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives’ attitude, and client education. Conclusion Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.
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Affiliation(s)
- Anita Fafa Dartey
- School of Nursing and Midwifery, The University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Gladys Dzansi
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Comfort Worna Lotse
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Racheal Obuobisa
- Department of Women and Children, University of Ghana Medical Centre, Ghana
| | | | - Agani Afaya
- College of Nursing, Yonsei University, Yonsei-ro, Seodaemun-gu, Seoul, South Korea
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12
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Liu M, Wang RB, Xing JH, Tang YX. Atractylenolide inhibits apoptosis and oxidative stress of HTR-8/SVneo cells by activating MAPK/ERK signalling in preeclampsia. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 93:153773. [PMID: 34649213 DOI: 10.1016/j.phymed.2021.153773] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Preeclampsia (PE) is a severe hypertension-related disorder occurring during pregnancy that leads to significant mortality and morbidity in both the foetus and mother. Atractylenolide (ATL), a traditional Chinese natural agent isolated from the herb Atractylodes macrocephala, exhibits a series of pharmacological activities, including anti-oxidative stress and anti-inflammatory effects. PURPOSE The impacts of ATL on apoptosis and oxidative stress in HTR-8/SVneo cells during PE development was investigated. STUDY DESIGN We identified ATL by an overlap analysis of the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database using the keyword 'gestational hypertension' and Traditional Chinese Medicine (Batman-TCM) database using the keyword 'Atractylodes macrocephala'. METHODS Cell viability, proliferation, and migration were detected by CCK-8, EdU, and transwell assays. Flow cytometry and 2',7'-dichlorodihydrofluorescein diacetate were used to assess apoptosis and reactive oxygen species (ROS) levels. RESULTS EdU and CCK-8 assays demonstrated that ATL significantly enhanced the viability of HTR-8/SVneo cells. Transwell assays showed that ATL remarkably induced the migration of HTR-8/SVneo cells. Moreover, ROS production in HTR-8/SVneo cells was induced by H2O2, whilst ATL alleviated this H2O2-induced ROS production and apoptosis in cells. CONCLUSION ATL attenuated apoptosis and oxidative stress in HTR-8/SVneo cells in PE by activating the MAPK/ERK signalling pathway. ATL has potential to be utilized as a potential therapeutic candidate for PE.
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Affiliation(s)
- Mei Liu
- Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Shandong, Jinan 250355, China; Department of Obstetrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, Jinan 250011, China
| | - Rui-Bo Wang
- Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Shandong, Jinan 250355, China
| | - Jian-Hong Xing
- Department of Obstetrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, Jinan 250011, China
| | - Ying-Xue Tang
- Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Shandong, Jinan 250355, China.
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13
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Lukac S, Mayer S, Mühlen K, Flock F. Cardiac Arrest during Cesarean Section - A Case Report and Review of the Differential Diagnosis. Z Geburtshilfe Neonatol 2021; 226:63-67. [PMID: 34674192 DOI: 10.1055/a-1653-1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM According to the World Health Organization, approximately 810 pregnant women die every day as a consequence of peripartum complications. A large proportion of deaths happen in developing countries. Peripartum cardiac arrest is a rare event that must be treated immediately. It is important to consider the differential diagnoses in order to save lives. METHODS In this review, we discuss a differential diagnosis of cardiac arrest according to the BEAU-CHOPS scheme of the American Heart Association in the relation to the case report of our 40-year-old G5/P3 patient who went into cardiac arrest during cesarean delivery. RESULTS Typical differentials for cardiac arrest during labor are bleeding, embolism, anesthetic complications, cardiovascular diseases, eclampsia, and sepsis. All of them were considered and ruled out in this patient. In the end, we suspect that physiological cardio-inhibitory reflexes triggered by sudden profound hypovolemia after placental separation along with the patient's risk factors, especially obesity and maternal age, and the administration of spinal anesthesia all potentially contributed to the cardiac arrest. CONCLUSIONS This review highlights that the cardiac arrest during labor can be triggered by the multifactorial etiology, but firstly the typical differential diagnosis needs to be excluded.
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Affiliation(s)
- Stefan Lukac
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - Sebastian Mayer
- Department of Gynaecology and Obstetrics, Hospital Krumbach, Krumbach, Germany
| | - Kathrin Mühlen
- Department of Gynaecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
| | - Felix Flock
- Department of Gynaecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
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14
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Trahan MJ, Malhamé I, Mitric C, Simard C, Lipes J, Abenhaim HA. Severe and critical COVID-19 in pregnancy: A case series from Montreal. Obstet Med 2021; 14:170-176. [PMID: 34646346 PMCID: PMC8504303 DOI: 10.1177/1753495x21990213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/08/2020] [Accepted: 01/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Optimal obstetric management for women with coronavirus disease (COVID-19) is not known. We describe the management of six pregnant women requiring in-hospital care for severe COVID-19. METHODS A retrospective chart review was conducted to identify pregnant women who tested positive for Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) between 15 March and 30 June 2020. A subset of women meeting criteria for severe COVID-19 was included. RESULTS Four women required non-invasive supplemental oxygen therapy and two required mechanical ventilation. Four women were discharged from hospital undelivered and two required preterm delivery. One woman had a pulmonary embolism, and two required re-admission for worsening symptoms. CONCLUSION Management of pregnant women with severe COVID-19 is complex and should involve multidisciplinary expertise. Avoiding early delivery may be a safe option. We recommend an individualized approach to care, including careful consideration of the expected risks and benefits of expectant obstetric management versus delivery.
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Affiliation(s)
- Marie-Julie Trahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University, Montreal, Canada
- Department of Medicine, Division of General Internal Medicine, McGill University Health Centre, Montreal, Canada
| | - Cristina Mitric
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| | - Camille Simard
- Department of Medicine, McGill University, Montreal, Canada
| | - Jed Lipes
- Department of Medicine, McGill University, Montreal, Canada
- Department of Medicine, Division of Internal Medicine, Jewish General Hospital, Montreal, Canada
- Department of Medicine, Division of Adult Critical Care, Jewish General Hospital, Montreal, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jewish General Hospital, Montreal, Canada
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15
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Sullivan M, Cunningham K, Angras K, Mackeen AD. Duration of postpartum magnesium sulfate for seizure prophylaxis in women with preeclampsia: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2021; 35:7188-7193. [PMID: 34187284 DOI: 10.1080/14767058.2021.1946505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Pregnant women diagnosed with preeclampsia are at increased risk of eclampsia. Magnesium sulfate is the standard of care for maternal seizure prophylaxis. Traditional regimens of magnesium sulfate have continued infusions for 24 h postpartum. More recent evidence suggests shortened courses of postpartum magnesium sulfate. The purpose of this systematic review is to evaluate whether the duration of postpartum magnesium sulfate for seizure prophylaxis in women with preeclampsia affects the incidence of seizures postpartum. DATA SOURCE MEDLINE, Cochrane Library, and clinicaltrials.gov were reviewed from inception until 1 May 2020. METHODS OF STUDY SELECTION Two hundred and fifty-three studies were reviewed by three individual authors. Inclusion criteria were as follows: published, randomized controlled trials (RCTs) that included pregnant women diagnosed with preeclampsia who received a maintenance infusion of magnesium sulfate in the postpartum period. Studies were excluded if either arm did not provide maintenance dosing of magnesium sulfate in the postpartum period. We also excluded ongoing, unpublished, and non-randomized trials. RESULTS Nine RCTs (n = 1369) were included in the systematic review. Data were abstracted and reviewed by three authors, then entered into Review Manager data software. The primary outcome of eclampsia was reported in all nine studies. An eclamptic event occurred in 2/696 women who received <24 h of postpartum magnesium compared to 0/673 events in women who received ≥24 h of postpartum magnesium (RD 0.00, 95% CI -0.01, 0.01; p=.71). Women who received <24 h of postpartum magnesium sulfate had a significantly faster time to ambulation postpartum (MD -10.57, 95% CI -17.43, -3.71; p=.003) and shorter durations of indwelling urinary catheter placement (MD -18.97, 95% CI -34.64, -3.29; p=.02). CONCLUSIONS As eclampsia is a rare occurrence, this review was not powered to show a difference in the rate of eclampsia. However, the two cases of eclampsia that were reported occurred in the group of women who received <24 h of postpartum magnesium sulfate. Therefore, the results of this systematic review support continued use of 24 h of postpartum magnesium sulfate for seizure prophylaxis.
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Affiliation(s)
- Maranda Sullivan
- Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, PA, USA
| | - Kendall Cunningham
- Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, PA, USA
| | - Kajal Angras
- Department of Maternal Fetal Medicine, Geisinger Medical Center, Danville, PA, USA
| | - A Dhanya Mackeen
- Department of Maternal Fetal Medicine, Geisinger Medical Center, Danville, PA, USA
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16
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Ma S, Zhang Y, Li Q. Magnesium sulfate reduces postoperative pain in women with cesarean section: A meta-analysis of randomized controlled trials. Pain Pract 2021; 22:8-18. [PMID: 33896098 DOI: 10.1111/papr.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The use of magnesium sulfate (MgSO4 ) as an adjunct in different anesthetic regimens for cesarean section (CS) delivery often reports conflicting results. This study aimed to review the effectiveness of MgSO4 on improving postoperative analgesia after CS systematically. METHODS PubMed, Embase, and the Cochrane library were searched for randomized controlled trials (RCTs) published from inception to February 2020. RESULTS A total of 880 women were included (440 in each group). MgSO4 had a statistically significant effect compared to the control group on the highest VAS (weighted mean difference [WMD] = -0.74, 95% confidence interval [CI] = -1.03 to -0.46, p < 0.001, I2 = 91.7%, pheterogeneity < 0.001) and the last VAS (WMD = -0.47, 95% CI = -0.71 to -0.23, p < 0.001, I2 = 95.0%, pheterogeneity < 0.001). MgSO4 prolonged the time to the first use of analgesia compared to the control group (standardized mean difference [SMD] = -3.03 min, 95% CI = -4.32 to -1.74, p < 0.001, I2 = 96.3%, pheterogeneity < 0.001). MgSO4 decreased the consumption of analgesia compared to the control group (SMD = -3.20 mg of IV morphine equivalent, 95% CI: -5.45 to -0.95, p = 0.005, I2 = 97.6%, pheterogeneity < 0.001). DISCUSSION MgSO4 decreases the highest VAS in women who underwent general anesthesia, spinal anesthesia, or epidural for CS (all p < 0.05). Additional MgSO4 significantly reduces postoperative pain in women undergoing CS.
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Affiliation(s)
- Siguang Ma
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
| | - Yanju Zhang
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
| | - Qian Li
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
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17
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D'Souza R, Ashraf R, Rowe H, Zipursky J, Clarfield L, Maxwell C, Arzola C, Lapinsky S, Paquette K, Murthy S, Cheng MP, Malhamé I. Pregnancy and COVID-19: pharmacologic considerations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:195-203. [PMID: 32959455 PMCID: PMC7537532 DOI: 10.1002/uog.23116] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
In this review, we summarize evidence regarding the use of routine and investigational pharmacologic interventions for pregnant and lactating patients with coronavirus disease 2019 (COVID-19). Antenatal corticosteroids may be used routinely for fetal lung maturation between 24 and 34 weeks' gestation, but decisions in those with critical illness and those < 24 or > 34 weeks' gestation should be made on a case-by-case basis. Magnesium sulfate may be used for seizure prophylaxis and fetal neuroprotection, albeit cautiously in those with hypoxia and renal compromise. There are no contraindications to using low-dose aspirin to prevent placenta-mediated pregnancy complications when indicated. An algorithm for thromboprophylaxis in pregnant patients with COVID-19 is presented, which considers disease severity, timing of delivery in relation to disease onset, inpatient vs outpatient status, underlying comorbidities and contraindications to the use of anticoagulation. Nitrous oxide may be administered for labor analgesia while using appropriate personal protective equipment. Intravenous remifentanil patient-controlled analgesia should be used with caution in patients with respiratory depression. Liberal use of neuraxial labor analgesia may reduce the need for emergency general anesthesia which results in aerosolization. Short courses of non-steroidal anti-inflammatory drugs can be administered for postpartum analgesia, but opioids should be used with caution due to the risk of respiratory depression. For mechanically ventilated pregnant patients, neuromuscular blockade should be used for the shortest duration possible and reversal agents should be available on hand if delivery is imminent. To date, dexamethasone is the only proven and recommended experimental treatment for pregnant patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen. Although hydroxycholoroquine, lopinavir/ritonavir and remdesivir may be used during pregnancy and lactation within the context of clinical trials, data from non-pregnant populations have not shown benefit. The role of monoclonal antibodies (tocilizumab), immunomodulators (tacrolimus), interferon, inhaled nitric oxide and convalescent plasma in pregnancy and lactation needs further evaluation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R. D'Souza
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
- Lunenfeld‐Tanenbaum Research InstituteTorontoCanada
| | - R. Ashraf
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
| | - H. Rowe
- Neonatal and Pediatric PharmacySurrey Memorial Hospital, Fraser HealthSurreyCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
| | - J. Zipursky
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
- Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
| | - L. Clarfield
- Faculty of MedicineUniversity of TorontoTorontoCanada
| | - C. Maxwell
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
| | - C. Arzola
- Department of Anesthesiology and Pain MedicineMount Sinai Hospital, University of TorontoTorontoCanada
| | - S. Lapinsky
- Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
| | - K. Paquette
- Division of NeonatologyMontreal Children's HospitalMontrealCanada
- Department of PediatricsMcGill UniversityMontrealCanada
- Research Institute of the McGill University Health CentreMontrealCanada
| | - S. Murthy
- Division of Critical Care, Department of PaediatricsUniversity of British ColumbiaVancouverCanada
- BC Children's Hospital and Sunny Hill Health CentreVancouverBCCanada
| | - M. P. Cheng
- Research Institute of the McGill University Health CentreMontrealCanada
- Divisions of Infectious Diseases and Medical Microbiology, Department of Medicine, McGill University Health CentreMcGill UniversityMontrealCanada
- McGill Interdisciplinary Initiative in Infection and ImmunityMontrealCanada
| | - I. Malhamé
- Research Institute of the McGill University Health CentreMontrealCanada
- Division of General Internal Medicine, Department of Medicine, McGill University Health CentreMcGill UniversityMontrealCanada
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18
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Saldanha IJ, Cao W, Bhuma MR, Konnyu KJ, Adam GP, Mehta S, Zullo AR, Chen KK, Roth JL, Balk EM. Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review. Headache 2021; 61:11-43. [PMID: 33433020 DOI: 10.1111/head.14041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. OBJECTIVE We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. METHODS We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. RESULTS We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single-group study and 11 SRs; low-to-moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low-dose aspirin may not be (indirect evidence; low-to-moderate SoE). We found insufficient evidence regarding non-pharmacologic treatments. CONCLUSIONS For prevention of primary headache, calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects. For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine. Triptans and low-dose aspirin may not be associated with fetal/child adverse effects. Future research should identify effective and safe interventions in pregnancy and postpartum.
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Affiliation(s)
- Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Monika Reddy Bhuma
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kristin J Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Gaelen P Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Shivani Mehta
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth K Chen
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Julie L Roth
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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19
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Wang Y, Bao J, Peng M. Effect of magnesium sulfate combined with labetalol on serum sFlt-1/PlGF ratio in patients with early-onset severe pre-eclampsia. Exp Ther Med 2020; 20:276. [PMID: 33200001 PMCID: PMC7664615 DOI: 10.3892/etm.2020.9406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/24/2020] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the therapeutic effect of magnesium sulfate combined with labetalol on the early-onset severe pre-eclampsia (ES-PE) and explore the role of soluble fms-like tyrosine kinase-1 (sFlT-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio in the treatment. A total of 164 ES-PE patients admitted to the Maternity and Child Health Care Hospital of Hubei (Wuhan, China) were assigned to this observational study. Among them, 83 patients were enrolled in group A and treated with magnesium sulfate combined with labetalol hydrochloride, and 81 patients were enrolled in group B and treated with magnesium sulfate. The therapeutic effect, adverse reactions and pregnancy outcomes in the two groups were analyzed. Serum sFlt-1 and PlGF concentrations, before and after treatment, were measured by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of pre-treatment serum sFlt-1/PlGF ratio for the clinical outcome. The effective rate was significantly higher in group A than that in group B. Group A presented superior pregnancy outcomes over group B. The serum sFlt-1 concentration and sFlt-1/PlGF ratio after treatment were significantly lower than those before treatment in groups A and B, whereas PlGF concentration was significantly higher after treatment in both groups. After treatment, group A had markedly lower serum sFlt-1 concentration and sFlt-1/PlGF ratio than group B, and markedly higher PlGF concentration than group B. The area under curve (AUC) of serum sFlt-1/PlGF ratio before treatment for the prediction of the clinical efficacy was 0.737. In conclusion, magnesium sulfate combined with labetalol could be effectively used for the treatment of ES-PE. The results of ELISA revealed that the balance of sFlT-1 and PlGF was improved after treatment and the sFlT-1/PlGF ratio was decreased. The assessment of sFlt-1/PlGF ratio before treatment was shown to have a certain predictive value for the efficacy of ES-PE treatment.
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Affiliation(s)
- Ying Wang
- Department of Obstetrics, Maternity and Child Health Care Hospital of Hubei, Wuhan, Hubei 430000, P.R. China
| | - Jing Bao
- Department of Obstetrics, Maternity and Child Health Care Hospital of Hubei, Wuhan, Hubei 430000, P.R. China
| | - Min Peng
- Department of Obstetrics, Maternity and Child Health Care Hospital of Hubei, Wuhan, Hubei 430000, P.R. China
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20
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Conway J, Friedman B. Intravenous Magnesium Sulfate for Acute Asthma Exacerbation in Adults. Acad Emerg Med 2020; 27:1061-1063. [PMID: 32574392 DOI: 10.1111/acem.14066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Affiliation(s)
- John Conway
- From the Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY USA
| | - Benjamin Friedman
- From the Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY USA
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21
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Seshiah V, Balaji V, Banerjee S, Sahay R, Divakar H, Jain R, Chawla R, Das AK, Gupta S, Krishnan D. Diagnosis and principles of management of gestational diabetes mellitus in the prevailing COVID-19 pandemic. Int J Diabetes Dev Ctries 2020; 40:329-334. [PMID: 32929316 PMCID: PMC7480657 DOI: 10.1007/s13410-020-00860-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Limited medical facilities are available due to Covid-19 pandemic. Nevertheless, all efforts should be made in planning judicial and possible methods of delivering health care, particularly to pregnant woman with GDM. GDM may play a crucial role in the increasing prevalence of diabetes and obesity and also may be the origin of cardiometabolic diseases. METHODS It is mandatary to diagnose and care pregnant woman with GDM. The test suggested to diagnose GDM has to be evidence based and in this regard "a single test procedure" evaluated meets this requirement. This doable test has been accepted by the Diabetes in Pregnancy Study Group India (DIPSI) and approved by MHFW-GOI, WHO, International Diabetes Federation, and International Federation of Obstetricians and Gynecologists. MHFW-GOI also recommends testing at first antenatal visit and then at 24-28 weeks of gestation. This opportunity can also be utilized for performing ultrasonography for assessing fetal development. RESULT The first-line management is MNT and life style modifications. Non-responders may require insulin or OHA. The target glycemic control is FPG ~ 5.0 mmol/dl (90 mg/dl) and 2 h PPPG ~ 6.7 mmol/dl (120 mg/dl). The goal is to obtain newborns birth weight appropriate for gestational age between 2.5 and 3.5 kg, a step to prevent offspring developing diabetes. CONCLUSION The essential precaution required during COVID pandemic is to wear face mask, avoid crowded places, and maintain social distancing. Finally, the economical and evidence based "single test procedure" of DIPSI is most appropriate for screening during the COVID pandemic.
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Affiliation(s)
- Veeraswamy Seshiah
- Dr. Balaji Diabetes Care Center and Dr. Seshiah Diabetes Research Institute, Chennai, 600029 India
| | - Vijayam Balaji
- Dr. Balaji Diabetes Care Center and Dr. Seshiah Diabetes Research Institute, Chennai, 600029 India
| | - Samar Banerjee
- Vivekananda Institute of Medical Sciences, Calcuta, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College & Osmania General Hospital, Hyderabad, India
| | | | | | - Rajeev Chawla
- Diabetes in Pregnancy Study Group India, Delhi, India
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Sunil Gupta
- Diabetes in Pregnancy Study Group India, Nagpur, India
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22
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Stefanovic V. COVID-19 infection during pregnancy: fetus as a patient deserves more attention. J Perinat Med 2020; 48:438-440. [PMID: 32401226 DOI: 10.1515/jpm-2020-0181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/03/2020] [Indexed: 01/08/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic is causing concern also for the management and outcome of COVID-19-positive pregnant women and their offspring, as reported cases are rare. Current evidence suggests the association of COVID-19 infection in pregnancy with both severe maternal morbidity requiring intensive care and perinatal complications (preterm birth with consequent neonatal morbidity and even perinatal death). Most of the reported cases focused specifically on the maternal outcomes and possible vertical transmission, but less attention has been paid to fetus as a patient in such pregnancies. The use of antenatal steroids and fetal neuroprotection with magnesium sulfate is clearly underreported. Several recently issued guidelines suggest lowering the upper gestational age for antenatal steroid administration and also advocate extreme caution or even restraining from the use of magnesium sulfate. Also, the rate of cesarean deliveries among COVID-19 women is unacceptably high. Here we provide arguments for NOT changing the existing guidelines and caution against cesarean delivery that was the prevalent delivery mode in the reported cases and case series.
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Affiliation(s)
- Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetom ternal Medical Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland
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23
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Yifu P, Lei Y, Yujin G, Xingwang Z, Shaoming L. Shortened postpartum magnesium sulfate treatment vs traditional 24h for severe preeclampsia: a systematic review and meta-analysis of randomized trials. Hypertens Pregnancy 2020; 39:186-195. [PMID: 32338165 DOI: 10.1080/10641955.2020.1753067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: This meta-analysis aimed to compare the benefits and risks of shortened magnesium sulfate with traditional 24 h for severe postpartum preeclampsia.Methods: We systematically searched the Cochrane, Embase, Web of science and Pubmed database from inception till May 15 2019. Studies included type is limited to randomized controlled trial (RCT). Pooled risks difference (RDs), odds risks (ORs), mean difference (MD), standard mean difference (SMD) and 95% confifidence intervals (CIs) were used to summarize the effect sizes.Results: Totally studies included are 7 randomized controlled trials (RCTs). Shortened magnesium sulfate treatment has the same risk as eclampsia (RD 0.00, 95%CI-0.01-0.01) and total complications (OR 0.78, 95% CI 0.53-1.15), however, significant difference was observed in both groups pertaining to flushing (OR 0.40, 95% CI 0.20-0.82), and the need for prolonged treatment (RD 0.05, 95% CI 0.01 - 0.1), Others factors,namely the benefits of shortened magnesium sulfate treatment,showed differences in both groups.Conclusions: Shortened postpartum magnesium sulfate treatment was as effective as traditional 24 h magnesium sulfate in seizure prevention and total complications. But flushing and needed for prolonged treatment in the shortened groups warrants further research.
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Affiliation(s)
- Pu Yifu
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
| | - Yan Lei
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China.,School of Medicine, Shandong University, Jinan, China
| | - Guo Yujin
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
| | - Zhu Xingwang
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
| | - Lu Shaoming
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
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24
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Lamont RF, Jørgensen JS. Safety and Efficacy of Tocolytics for the Treatment of Spontaneous Preterm Labour. Curr Pharm Des 2020; 25:577-592. [PMID: 30931850 DOI: 10.2174/1381612825666190329124214] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Attempts to reduce the burden may be proactive using biochemical or biophysical prediction and preventative measures. If these efforts fail, then the approach may have to be reactive using tocolytics to inhibit spontaneous preterm labour. OBJECTIVE We have reviewed the evidence concerning the safety and efficacy of various classes of tocolytic agents. RESULTS The evidence to support the use of magnesium sulfate or nitric oxide donors as a tocolytic is poor. Compared to placebo or no treatment, there is evidence to support the efficacy of calcium channel blockers (mainly nifedipine), prostaglandin synthetase inhibitors (mainly indomethacin and sulindac), oxytocin receptor antagonists (mainly atosiban) and β2-agonists (mainly ritodrine, terbutaline, salbutamol and fenoterol). Maternal safety concerns have reduced the use of β2-agonists. Fetal safety and gestational age restrictions have largely condemned prostaglandin synthetase inhibitors to second-line therapy. First-line therapy in Europe and other parts of the world outside the USA and Australia is limited to calcium channel blockers and oxytocin receptor antagonists. With respect to efficacy, atosiban and nifedipine are similar, but the robustness of the evidence favours atosiban. With respect to safety, atosiban is clearly the safest tocolytic as there are fetomaternal concerns with nifedipine, particularly in high daily doses. CONCLUSION The perfect tocolytic that is uniformly effective and safe does not exist. Cost, licensing and informed consent are considerations involved in the choice. Efforts continue to develop and introduce other or better agents, including novel compounds such as progesterone, PGF2α antagonists and statins.
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Affiliation(s)
- Ronald F Lamont
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Division of Surgery, Northwick Park Institute of Medical Research Campus, University College London, London, United Kingdom
| | - Jan S Jørgensen
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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25
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Unwaha EA, Bello FA, Bello OO, Oladokun A. Intravenous magnesium sulfate in the management of severe pre-eclampsia: A randomized study of 12-hour versus 24-hour maintenance dose. Int J Gynaecol Obstet 2020; 149:37-42. [PMID: 31833059 DOI: 10.1002/ijgo.13082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/10/2019] [Accepted: 12/10/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the effectiveness of a 12-hour versus 24-hour intravenous maintenance dose of magnesium sulfate (MgSO4 ) in women with pre-eclampsia, and the maternal and fetal outcomes. METHODS This was a randomized controlled trial conducted at the labor ward complex of University College Hospital, Ibadan, Nigeria between May and August 2014. Pregnant women with severe pre-eclampsia were randomized to receive a 12-hour versus 24-hour maintenance dose of MgSO4 . Study outcomes were occurrence of seizures, adverse maternal effects, neonatal survival, and admission to the intensive care unit. Data analysis involved descriptive statistics and bivariate analysis using Statistical Package for Social Science (SPSS) version 20. RESULTS There were 80 patients randomized to the 12-hour (n=40) and 24-hour (n=40) groups. The participants in the two groups had comparable demographic features. There was no significant difference (P>0.999) between the satisfactory maternal outcome following the 12-hour maintenance dose and the standard 24-hour regimen (95.0% vs 97.5%). Similarly, there was no significant difference (P=0.276) in perinatal mortality in the 12-hour versus 24-hour arm (17.5% vs 12.5%, respectively). No case of eclampsia and maternal death was recorded. CONCLUSION A 12-hour maintenance dose of intravenous MgSO4 in the management of severe pre-eclampsia is effective and safe when compared with the 24-hour maintenance dose.
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Affiliation(s)
- Emmanuel A Unwaha
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Folasade A Bello
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Oluwasomidoyin O Bello
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Adesina Oladokun
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
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26
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Shepherd E, Salam RA, Manhas D, Synnes A, Middleton P, Makrides M, Crowther CA. Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002988. [PMID: 31809499 PMCID: PMC6897495 DOI: 10.1371/journal.pmed.1002988] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/06/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is widespread, increasing use of magnesium sulphate in obstetric practice for pre-eclampsia, eclampsia, and preterm fetal neuroprotection; benefit for preventing preterm labour and birth (tocolysis) is unproven. We conducted a systematic review and meta-analysis to assess whether antenatal magnesium sulphate is associated with unintended adverse neonatal outcomes. METHODS AND FINDINGS CINAHL, Cochrane Library, LILACS, MEDLINE, Embase, TOXLINE, and Web of Science, were searched (inceptions to 3 September 2019). Randomised, quasi-randomised, and non-randomised trials, cohort and case-control studies, and case reports assessing antenatal magnesium sulphate for pre-eclampsia, eclampsia, fetal neuroprotection, or tocolysis, compared with placebo/no treatment or a different magnesium sulphate regimen, were included. The primary outcome was perinatal death. Secondary outcomes included pre-specified and non-pre-specified adverse neonatal outcomes. Two reviewers screened 5,890 articles, extracted data, and assessed risk of bias following Cochrane Handbook and RTI Item Bank guidance. For randomised trials, pooled risk ratios (RRs) or mean differences, with 95% confidence intervals (CIs), were calculated using fixed- or random-effects meta-analysis. Non-randomised data were tabulated and narratively summarised. We included 197 studies (40 randomised trials, 138 non-randomised studies, and 19 case reports), of mixed quality. The 40 trials (randomising 19,265 women and their babies) were conducted from 1987 to 2018 across high- (16 trials) and low/middle-income countries (23 trials) (1 mixed). Indications included pre-eclampsia/eclampsia (24 trials), fetal neuroprotection (7 trials), and tocolysis (9 trials); 18 trials compared magnesium sulphate with placebo/no treatment, and 22 compared different regimens. For perinatal death, no clear difference in randomised trials was observed between magnesium sulphate and placebo/no treatment (RR 1.01; 95% CI 0.92 to 1.10; 8 trials, 13,654 babies), nor between regimens. Eleven of 138 non-randomised studies reported on perinatal death. Only 1 cohort (127 babies; moderate to high risk of bias) observed an increased risk of perinatal death with >48 versus ≤48 grams magnesium sulphate exposure for tocolysis. No clear secondary adverse neonatal outcomes were observed in randomised trials, and a very limited number of possible adverse outcomes warranting further consideration were identified in non-randomised studies. Where non-randomised studies observed possible harms, often no or few confounders were controlled for (moderate to high risk of bias), samples were small (200 babies or fewer), and/or results were from subgroup analyses. Limitations include missing data for important outcomes across most studies, heterogeneity of included studies, and inclusion of published data only. CONCLUSIONS Our findings do not support clear associations between antenatal magnesium sulphate for beneficial indications and adverse neonatal outcomes. Further large, high-quality studies (prospective cohorts or individual participant data meta-analyses) assessing specific outcomes, or the impact of regimen, pregnancy, or birth characteristics on these outcomes, would further inform safety recommendations. PROSPERO: CRD42013004451.
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Affiliation(s)
- Emily Shepherd
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Rehana A. Salam
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Deepak Manhas
- University of British Columbia, Vancouver, British Columbia,
Canada
| | - Anne Synnes
- University of British Columbia, Vancouver, British Columbia,
Canada
| | - Philippa Middleton
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Caroline A. Crowther
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- Liggins Institute, University of Auckland, Auckland, New
Zealand
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27
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da Costa TX, de Almeida Pimenta Cunha MD, do Vale Bezerra PK, Azeredo FJ, Martins RR, Oliveira AG. Incidence of Adverse Drug Reactions in High-Risk Pregnancy: A Prospective Cohort Study in Obstetric Intensive Care. Eur J Clin Pharmacol 2019; 76:291-298. [PMID: 31768575 DOI: 10.1007/s00228-019-02789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To estimate the cumulative incidence of adverse drug reactions (ADRs) in women with high-risk pregnancy hospitalized in an obstetric intensive care unit, then to describe the medicines involved and to identify major risk factors. METHODS From June 2016 to December 2017, patients admitted to the ICU with high-risk pregnancy were considered eligible in this observational, longitudinal, prospective study. Patients were investigated daily for the occurrence of ADRs through pharmaceutical anamnesis, active search in medical records and questioning of the health team. Suspected ADRs were classified according to Naranjo's algorithm. Written informed consent was obtained from all patients. Univariate and multivariate logistic regression were used to identify risk factors of ADR. RESULTS The study population consisted of 607 high-risk pregnancies from 851 women admitted to the ICU, of whom 244 admitted for non-obstetric conditions, with an ICU stay less than 24 h or readmitted to the ICU were excluded. The mean age was 27.0 ± 7.5 years-old, mean gestational age was 33.8 ± 6.3 weeks. ADR were observed in 165 women (27.2%). No severe ADR was observed and 29.7% were of moderate severity. The most often implicated medicine was magnesium sulphate (25.2%) with 44.5% of patients administered that substance experiencing ADRs consisting of somnolence (68.6%), absent patellar reflex (21.6%) and hypotension (9.8%). Risk factors of ADR were blood pressure (adjusted odds-ratio (aOR) 1.02), haemoglobin level (aOR 1.21) and body temperature (aOR 0.71). CONCLUSIONS ADRs affect about one third of high-risk pregnancies, mainly due to magnesium sulphate administrations. High blood pressure, lower body temperature, and high haemoglobin concentration on admission were associated with an increased risk of ADR.
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Affiliation(s)
- Tatiana Xavier da Costa
- Postgraduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil. .,Maternity School Januário Cicco, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil. .,Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Marta Danielle de Almeida Pimenta Cunha
- Postgraduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil.,Maternity School Januário Cicco, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | - Rand Randall Martins
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Antonio Gouveia Oliveira
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Jayaram PM, Mohan MK, Farid I, Lindow S. Antenatal magnesium sulfate for fetal neuroprotection: a critical appraisal and systematic review of clinical practice guidelines. J Perinat Med 2019; 47:262-269. [PMID: 30352042 DOI: 10.1515/jpm-2018-0174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/20/2018] [Indexed: 12/27/2022]
Abstract
Background Magnesium sulfate is an accepted intervention for fetal neuroprotection. There are some perceived differences in the international recommendations on the use magnesium sulfate for fetal neuroprotection in preterm labor. Content This systematic review analyses the available clinical guidelines for the use of magnesium sulfate for fetal neuroprotection and compares the recommendations, and assesses the quality of guidelines. This provides the consensus, differences and explores the areas for future collaborative research. We searched databases of PUBMED, EMBASE, COCHRANE, Web of Science, LILACS; and included the national and the international clinical practice guidelines. We included seven guidelines out of 227 search results. We evaluated the methodological quality of guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) tool and systematically extracted guideline characters, recommendation and supporting evidence base. Summary Five guidelines were of high quality and two were of moderate quality. One guideline achieved more than an 80% score in all the domains of AGREE II tool. All guidelines recommend use of magnesium sulfate for fetal neuroprotection. However, there are differences in other recommendations such as upper gestational age, dose, duration, repeating treatment and use of additional tocolytics. Outlook Future guidelines should include recommendations on all aspects of magnesium sulfate therapy for fetal neuroprotection. Future research and international collaboration should focus on areas where there are no international consensual recommendations.
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Affiliation(s)
- Pradeep M Jayaram
- Sidra Medicine, Department of OBGYN, Weill Cornell Medical College-Qatar, Qatar Foundation, PO Box 26999, Doha, Qatar, Tel.: 097430305366
| | - Manoj K Mohan
- Sidra Medicine, Department of OBGYN, Weill Cornell Medical College-Qatar, Qatar Foundation, PO Box 26999, Doha, Qatar
| | - Ibrahim Farid
- Hamad Medical Corporation, Department of OBGYN, Doha, Qatar
| | - Stephen Lindow
- Sidra Medicine, Department of OBGYN, Weill Cornell Medical College-Qatar, Qatar Foundation, PO Box 26999, Doha, Qatar
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29
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Preventing childhood and lifelong disability: Maternal dietary supplementation for perinatal brain injury. Pharmacol Res 2018; 139:228-242. [PMID: 30227261 DOI: 10.1016/j.phrs.2018.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/29/2018] [Accepted: 08/24/2018] [Indexed: 12/30/2022]
Abstract
The majority of brain injuries that lead to cerebral palsy, developmental disability, and mental health disorders have their onset in utero. These lifelong conditions come with great economic and emotional burden as they impact function in nearly all domains of affected individuals' lives. Unfortunately, current therapeutic options are limited. There remains a focus on rescue, rehabilitation, and regeneration after the injury has occurred, rather than aiming to prevent the initial injury. Prevention would imply treating the mother during pregnancy to alter the fetal environment and in turn, treat the fetus. Fear of harming the developing fetus remains as a result of errors of the past such as the release of thalidomide. In this review, we outline evidence from animal studies and clinical trials that have explored maternal dietary supplementation with natural health products (including nutraceuticals and functional foods) for perinatal brain injury prevention. Namely, we discuss magnesium sulphate, creatine, choline, melatonin, resveratrol and broccoli sprouts/sulforaphane. Although clinical trials have only been completed in this realm for magnesium sulphate, results in animal models have been promising, suggesting that this is a productive avenue for further research. Natural health products may provide safe, effective, affordable, and easily accessible prevention of fetal brain injury and resulting lifelong disabilities.
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30
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Han F, Xu L, Huang Y, Chen T, Zhou T, Yang L. Magnesium sulphate can alleviate oxidative stress and reduce inflammatory cytokines in rat placenta of intrahepatic cholestasis of pregnancy model. Arch Gynecol Obstet 2018; 298:631-638. [PMID: 30039470 DOI: 10.1007/s00404-018-4850-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/07/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE In our study, we try to investigate whether magnesium sulphate (MgSO4) could provide protection against oxidative damage and inflammatory response in rat placenta of intrahepatic cholestasis of pregnancy (ICP) model. METHODS The rat model of ICP was established by injecting s.c. 17α-ethinyl estradiol (EE) daily for 5 days. MgSO4, as an therapeutic drug for ICP, was injected i.p. daily for 3 days. Age-matched pregnant rats served as controls. The level of serum total bile acid (TBA) was measured. The data including the number and weight of offsprings on day 20 of pregnancy were collected. We observed ultrastructural changes of mitochondria and endoplasmic reticulum (ER) in placenta by transmission electron microscope. The antioxidant proteins peroxiredoxin-6 (Prdx6) and nuclear factor erythroid 2-related factor-2 (Nrf2) were analyzed by Western Blot. The inflammatory cytokines including IL-1β, TNF-α and IFN-γ were investigated by real-time PCR (RT-PCR) and enzyme-linked immune-sorbent assay (ELISA). RESULTS The weight of offsprings on day 20 of pregnancy increased in ICP rats treated with MgSO4 (ICP + MG group) compared with that in ICP rats (ICP group). However, the level of TBA was not reduced. The damage of mitochondria and ER was observed in placenta, which was much more slighter in ICP + MgSO4 group as compared with that in ICP group. Prdx6 and Nrf2 were increased, while the inflammatory cytokines including IL-1β, TNF-α and IFN-γ were decreased in ICP + MgSO4 group compared with that in ICP group. CONCLUSIONS MgSO4 had beneficial effect on improving growth of offsprings in rat model of ICP. The protective effect of MgSO4 on alleviating oxidative damage and inflammatory response in placenta may play an important role in the process. MgSO4 may improve the function of placenta.
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Affiliation(s)
- Fei Han
- Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Linhao Xu
- Hangzhou Medical College, Hangzhou, 310053, China
| | - Yaqing Huang
- Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Tianqi Chen
- People's Hospital of Shaoxing City, Shaoxing, 312000, China
| | - Tiancheng Zhou
- Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Liwei Yang
- Zhejiang Provincial People's Hospital, Hangzhou, 310014, China.
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Leetheeragul J, Boriboonhirunsarn D, Reesukumal K, Srisaimanee N, Horrasith S, Wataganara T. A retrospective review of on-admission factors on attainment of therapeutic serum concentrations of magnesium sulfate in women treated for a diagnosis of preeclampsia. J Matern Fetal Neonatal Med 2018; 33:258-266. [PMID: 29898629 DOI: 10.1080/14767058.2018.1489531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Introduction: There is little information on the effect of maternal characteristics and on-admission laboratory parameters to the therapeutic serum magnesium sulfate (MgSO4) levels in women with preeclampsia (PE). We sought to identify factors that may predict timely attainment of therapeutic serum magnesium levels after intravenous administration for seizure prophylaxis.Materials and methods: On-admission factors of 360 women with PE who received intravenous MgSO4 (4-g loading and 2-g/h maintenance) for seizure prophylaxis were retrospectively reviewed. Parameters of those who attained therapeutic serum concentrations (4.8-8.4 mg/dL) within 2 h (Group A) and those who did not (Group B) were compared.Results: There was no seizure or magnesium toxicity in this cohort. Median (min-max) level of serum magnesium was 4.3 (2.5-8.4) mg/dL. Women in Group A (n = 105) had lower gestational age, body mass index (BMI), and platelets count, higher blood urea nitrogen (BUN), serum creatinine, uric acid, direct bilirubin, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, prothrombin, and partial thromboplastin times than those in Group B (n = 255) (p < .05). Women with mild PE were less likely to attain therapeutic serum magnesium levels compared with those with severe phenotypes (adjusted OR 23.57, 95% CI 8.20-67.76 versus adjusted OR 14.72, 95% CI 3.56-60.89, respectively; p < .05), which may be explained by their significantly lower serum BUN and uric acid (p < .05).Conclusions: On-admission factors, especially BMI and renal clearance indices, of women with PE may affect timely attainment of therapeutic serum magnesium levels. Validation of its clinical impact requires further study focusing on women with severe PE.
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Affiliation(s)
- Jarunee Leetheeragul
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | | | - Kanit Reesukumal
- Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Nusara Srisaimanee
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Siriluck Horrasith
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Tuangsit Wataganara
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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Charanthimath U, Vidler M, Katageri G, Ramadurg U, Karadiguddi C, Kavi A, Joshi A, Mungarwadi G, Bannale S, Rakaraddi S, Sawchuck D, Qureshi R, Sharma S, Payne BA, von Dadelszen P, Derman R, Magee LA, Goudar S, Mallapur A, Bellad M, Bhutta Z, Naik S, Mulla A, Kamle N, Dhamanekar V, Drebit SK, Kariya C, Lee T, Li J, Lui M, Khowaja AR, Tu DK, Revankar A. The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India. Reprod Health 2018; 15:101. [PMID: 29945662 PMCID: PMC6019995 DOI: 10.1186/s12978-018-0532-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy. METHODS This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software. RESULTS There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy. CONCLUSION Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
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Affiliation(s)
- Umesh Charanthimath
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | | | - Avinash Kavi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Anjali Joshi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Geetanjali Mungarwadi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Sheshidhar Bannale
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Sangamesh Rakaraddi
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Beth A. Payne
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Richard Derman
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Laura A. Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Shivaprasad Goudar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Mrutyunjaya Bellad
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - and the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Zulfiqar Bhutta
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sheela Naik
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Anis Mulla
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Namdev Kamle
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Vaibhav Dhamanekar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sharla K. Drebit
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Chirag Kariya
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Tang Lee
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Jing Li
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Mansun Lui
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Asif R. Khowaja
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Domena K. Tu
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Amit Revankar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
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Chollat C, Marret S. Magnesium sulfate and fetal neuroprotection: overview of clinical evidence. Neural Regen Res 2018; 13:2044-2049. [PMID: 30323118 PMCID: PMC6199933 DOI: 10.4103/1673-5374.241441] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Antenatal administration of magnesium sulfate is an important part of the neuroprotective strategy for preterm infants. Strong evidence from five randomized controlled trials and five meta-analyses has demonstrated that magnesium sulfate, when administered before preterm delivery, significantly reduces the risk of cerebral palsy at two years. Through secondary analyses of randomized controlled trials and other original clinical studies, this state-of-the-art review highlights the absence of serious adverse effects in both pregnant women and neonates, as well as the impact of maternal body mass index and preeclamptic status on the maternal and neonatal magnesium levels, which could influence the magnitude of the neuroprotective effect. Although antenatal magnesium sulfate is a cost-effective strategy, some practice surveys have demonstrated that the use of magnesium sulfate is not sufficient and that its use is heterogeneous, differing among different maternity wards. Since 2010, an increasing number of obstetrical societies have recommended its use to improve the neurological outcomes of preterm infants, especially the International Federation of Gynecology and Obstetrics and World Health Organization in 2015, and France in 2017. Considering the neuroprotective impact of magnesium sulfate when administered before delivery, postnatal administration should be considered, and its effects should be assessed using randomized controlled trials.
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Affiliation(s)
- Clément Chollat
- Institut National de la Santé et de la Recherche Médicale U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Rouen School of Medicine, Normandy University, Caen; Department of Neonatal Intensive Care, Port Royal University Hospital, Paris, France
| | - Stéphane Marret
- Department of Neonatal Intensive Care, Port Royal University Hospital, Paris; Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles-Nicolle University Hospital, Rouen, France
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Neonatal Effects of Maternal Magnesium Sulphate in Late Preterm and Term Pregnancies. J Obstet Gynaecol India 2017; 69:25-30. [PMID: 30814806 DOI: 10.1007/s13224-017-1074-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022] Open
Abstract
Aim To compare the clinical, obstetric and neonatal parameters between patients with > 34-week gestation having severe preeclampsia receiving magnesium sulphate and those with > 34-week gestation with preeclampsia but not receiving magnesium sulphate. Materials and Methods Single-centre prospective study studied 60 patients in each of the two groups. Magnesium sulphate was administered by Pritchard regimen as per standard protocol. Standard obstetric management was followed for both groups. In the severe preeclampsia/eclampsia group, maternal blood sample was analysed for serum magnesium levels. The duration of exposure, the amount of magnesium sulphate received and time elapsed between last dose of magnesium sulphate and delivery were all noted. Neonatal assessment was done. The various parameters including age, parity, blood pressure, mode of termination of pregnancy, NICU admission rate, incidence of hypotonia in the newborn and other neonatal parameters were tabulated and compared. Results The two groups were comparable with respect to age and parity. Need for induction of labour was higher in the group with severe preeclampsia/eclampsia. Rate of LSCS and birth weights were comparable between the two groups. NICU admission rate and incidence of hypotonia were higher in those who received magnesium sulphate. Amount of magnesium sulphate received and total duration of magnesium sulphate did not correlate with NICU admission rates. Conclusions Neonatal morbidity, in terms of higher NICU admission rates and hypotonia, is higher in patients receiving magnesium sulphate.
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Crowther CA, Middleton PF, Voysey M, Askie L, Duley L, Pryde PG, Marret S, Doyle LW. Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: An individual participant data meta-analysis. PLoS Med 2017; 14:e1002398. [PMID: 28976987 PMCID: PMC5627896 DOI: 10.1371/journal.pmed.1002398] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/31/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Babies born preterm are at an increased risk of dying in the first weeks of life, and those who survive have a higher rate of cerebral palsy (CP) compared with babies born at term. The aim of this individual participant data (IPD) meta-analysis (MA) was to assess the effects of antenatal magnesium sulphate, compared with no magnesium treatment, given to women at risk of preterm birth on important maternal and fetal outcomes, including survival free of CP, and whether effects differed by participant or treatment characteristics such as the reason the woman was at risk of preterm birth, why treatment was given, the gestational age at which magnesium sulphate treatment was received, or the dose and timing of the administration of magnesium sulphate. METHODS AND FINDINGS Trials in which women considered at risk of preterm birth (<37 weeks' gestation) were randomised to magnesium sulphate or control treatment and where neurologic outcomes for the baby were reported were eligible for inclusion. The primary outcomes were infant death or CP and severe maternal outcome potentially related to treatment. Studies were identified based on the Cochrane Pregnancy and Childbirth search strategy using the terms [antenatal or prenatal] and [magnesium] and [preterm or premature or neuroprotection or 'cerebral palsy']. The date of the last search was 28 February 2017. IPD were sought from investigators with eligible trials. Risk of bias was assessed using criteria from the Cochrane Collaboration. For each prespecified outcome, IPD were analysed using a 1-stage approach. All 5 trials identified were included, with 5,493 women and 6,131 babies. Overall, there was no clear effect of magnesium sulphate treatment compared with no treatment on the primary infant composite outcome of death or CP (relative risk [RR] 0.94, 95% confidence interval (CI) 0.85 to 1.05, 6,131 babies, 5 trials, p = 0.07 for heterogeneity of treatment effect across trials). In the prespecified sensitivity analysis restricted to data from the 4 trials in which the intent of treatment was fetal neuroprotection, there was a significant reduction in the risk of death or CP with magnesium sulphate treatment compared with no treatment (RR 0.86, 95% CI 0.75 to 0.99, 4,448 babies, 4 trials), with no significant heterogeneity (p = 0.28). The number needed to treat (NNT) to benefit was 41 women/babies to prevent 1 baby from either dying or having CP. For the primary outcome of severe maternal outcome potentially related to magnesium sulphate treatment, no events were recorded from the 2 trials providing data. When the individual components of the composite infant outcome were assessed, no effect was seen for death overall (RR 1.03, 95% CI 0.91 to 1.17, 6,131 babies, 5 trials) or in the analysis of death using only data from trials with the intent of fetal neuroprotection (RR 0.95, 95% CI 0.80 to 1.13, 4,448 babies, 4 trials). For cerebral palsy in survivors, magnesium sulphate treatment had a strong protective effect in both the overall analysis (RR 0.68, 95% CI 0.54 to 0.87, 4,601 babies, 5 trials, NNT to benefit 46) and the neuroprotective intent analysis (RR 0.68, 95% CI 0.53 to 0.87, 3,988 babies, 4 trials, NNT to benefit 42). No statistically significant differences were seen for any of the other secondary outcomes. The treatment effect varied little by the reason the woman was at risk of preterm birth, the gestational age at which magnesium sulphate treatment was given, the total dose received, or whether maintenance therapy was used. A limitation of the study was that not all trials could provide the data required for the planned analyses so that combined with low event rates for some important clinical events, the power to find a difference was limited. CONCLUSIONS Antenatal magnesium sulphate given prior to preterm birth for fetal neuroprotection prevents CP and reduces the combined risk of fetal/infant death or CP. Benefit is seen regardless of the reason for preterm birth, with similar effects across a range of preterm gestational ages and different treatment regimens. Widespread adoption worldwide of this relatively inexpensive, easy-to-administer treatment would lead to important global health benefits for infants born preterm.
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Affiliation(s)
- Caroline A. Crowther
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Australian Research Centre for Health of Women and Babies (ARCH), The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, Australia
- * E-mail:
| | - Philippa F. Middleton
- Australian Research Centre for Health of Women and Babies (ARCH), The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, Australia
- Healthy Mothers Babies and Children, South Australian, Health and Medical Research Institute, Adelaide, Australia
| | - Merryn Voysey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lisa Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Lelia Duley
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Queens Medical Centre, Nottingham, United Kingdom
| | - Peter G. Pryde
- The University of Wisconsin Medical School, Madison, Wisconsin, United States of America
| | - Stéphane Marret
- Department of Neonatal Medicine and Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U 1245, Neovasc team, Perinatal neurological handicap and Neuroprotection IRIB, School of Medicine, Normandy University, Rouen, France
| | - Lex W. Doyle
- Department of Obstetrics and Gynaecology, The Royal Women’s’ Hospital, University of Melbourne, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Marret S, Ancel PY. Protection cérébrale de l’enfant né prématuré par le sulfate de magnésium. ACTA ACUST UNITED AC 2016; 45:1418-1433. [DOI: 10.1016/j.jgyn.2016.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 12/15/2022]
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Magnesium in obstetric anesthesia and intensive care. J Anesth 2016; 31:127-139. [PMID: 27803982 DOI: 10.1007/s00540-016-2257-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/24/2016] [Indexed: 12/14/2022]
Abstract
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 and postoperative 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.
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Clinical trials registries are underused in the pregnancy and childbirth literature: a systematic review of the top 20 journals. BMC Res Notes 2016; 9:475. [PMID: 27769265 PMCID: PMC5073738 DOI: 10.1186/s13104-016-2280-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022] Open
Abstract
Background Systematic reviews and meta-analyses that do not include unpublished data in their analyses may be prone to publication bias, which in some cases has been shown to have deleterious consequences on determining the efficacy of interventions. Methods We retrieved systematic reviews and meta-analyses published in the past 8 years (January 1, 2007–December 31, 2015) from the top 20 journals in the Pregnancy and Childbirth literature, as rated by Google Scholar’s h5-index. A meta-epidemiologic analysis was performed to determine the frequency with which authors searched clinical trials registries for unpublished data. Results A PubMed search retrieved 372 citations, 297 of which were deemed to be either a systematic review or a meta-analysis and were included for analysis. Twelve (4 %) of these searched at least one WHO-approved clinical trials registry or clinicaltrials.gov. Conclusion Systematic reviews and meta-analyses published in pregnancy and childbirth journals do not routinely report searches of clinical trials registries. Including these registries in systematic reviews may be a promising avenue to limit publication bias if registry searches locate unpublished trial data that could be used in the systematic review.
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Lotufo FA, Parpinelli MA, Osis MJ, Surita FG, Costa ML, Cecatti JG. Situational analysis of facilitators and barriers to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil. BMC Pregnancy Childbirth 2016; 16:254. [PMID: 27577571 PMCID: PMC5006565 DOI: 10.1186/s12884-016-1055-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive disorders, including timely access to magnesium sulfate. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system. METHOD A situational analysis was conducted with two components: a documental analysis on information available at the official websites on the policy, regulation and availability of the medication, plus a cross sectional study with field analysis and interviews with local managers of public obstetric health services in Campinas, in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations using specific questionnaires. RESULTS There was no access to magnesium sulfate in primary care facilities, obstetric care was excluded from urgency services and clinical protocols for professional guidance on the adequate use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals. CONCLUSION The lack of processes that promote the integration between urgency/emergency care and specialized obstetric care possibly favors the untimely use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates.
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Affiliation(s)
- Fátima Aparecida Lotufo
- Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil
| | - Mary Angela Parpinelli
- Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil.
| | - Maria José Osis
- Sociologist and Full Professor of the Postgraduate Program on Obstetrics and Gynecology, University of Campinas School of Medicine, Campinas, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil
| | - José Guilherme Cecatti
- Department of Obstetrics and Gynecology of the University of Campinas School of Medicine, Campinas, Brazil
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Lamont CD, Jørgensen JS, Lamont RF. The safety of tocolytics used for the inhibition of preterm labour. Expert Opin Drug Saf 2016; 15:1163-73. [DOI: 10.1080/14740338.2016.1187128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Callum D. Lamont
- Department of Medical Education, Lincoln County Hospital, Lincoln, UK
| | - Jan Stener Jørgensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Ronald F. Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
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Abstract
Pre-eclampsia affects 3-5% of pregnancies and is traditionally diagnosed by the combined presentation of high blood pressure and proteinuria. New definitions also include maternal organ dysfunction, such as renal insufficiency, liver involvement, neurological or haematological complications, uteroplacental dysfunction, or fetal growth restriction. When left untreated, pre-eclampsia can be lethal, and in low-resource settings, this disorder is one of the main causes of maternal and child mortality. In the absence of curative treatment, the management of pre-eclampsia involves stabilisation of the mother and fetus, followed by delivery at an optimal time. Although algorithms to predict pre-eclampsia are promising, they have yet to become validated. Simple preventive measures, such as low-dose aspirin, calcium, and diet and lifestyle interventions, show potential but small benefit. Because pre-eclampsia predisposes mothers to cardiovascular disease later in life, pregnancy is also a window for future health. A collaborative approach to discovery and assessment of the available treatments will hasten our understanding of pre-eclampsia and is an effort much needed by the women and babies affected by its complications.
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Affiliation(s)
- Ben W J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia.
| | - Claire T Roberts
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Laura A Magee
- BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | | | - G Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, University of Fort Hare, and Eastern Cape Department of Health, East London, South Africa
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McNamara HC, Crowther CA, Brown J. Different treatment regimens of magnesium sulphate for tocolysis in women in preterm labour. Cochrane Database Syst Rev 2015; 2015:CD011200. [PMID: 26662716 PMCID: PMC8697562 DOI: 10.1002/14651858.cd011200.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Magnesium sulphate has been used to inhibit preterm labour to prevent preterm birth. There is no consensus as to the safety profile of different treatment regimens with respect to dose, duration, route and timing of administration. OBJECTIVES To assess the efficacy and safety of alternative magnesium sulphate regimens when used as single agent tocolytic therapy during pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies. SELECTION CRITERIA Randomised trials comparing different magnesium sulphate treatment regimens when used as single agent tocolytic therapy during pregnancy in women in preterm labour. Quasi-randomised trials were eligible for inclusion but none were identified. Cross-over and cluster trials were not eligible for inclusion. Health outcomes were considered at the level of the mother, the infant/child and the health service. INTERVENTION intravenous or oral magnesium sulphate given alone for tocolysis.Comparison: alternative dosing regimens of magnesium sulphate given alone for tocolysis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and quality and extracted data. MAIN RESULTS Three trials including 360 women and their infants were identified as eligible for inclusion in this review. Two trials were rated as low risk of bias for random sequence generation and concealment of allocation. A third trial was assessed as unclear risk of bias for these domains but did not report data for any of the outcomes examined in this review. No trials were rated to be of high quality overall.Intravenous magnesium sulphate was administered according to low-dose regimens (4 g loading dose followed by 2 g/hour continuous infusion and/or increased by 1 g/hour hourly until successful tocolysis or failure of treatment), or high-dose regimens (4 g loading dose followed by 5 g/hour continuous infusion and increased by 1 g/hour hourly until successful tocolysis or failure of treatment, or 6 g loading dose followed by 2 g/hour continuous infusion and increased by 1 g/hour hourly until successful tocolysis or failure of treatment).There were no differences seen between high-dose magnesium sulphate regimens compared with low-dose magnesium sulphate regimens for the primary outcome of fetal, neonatal and infant death (risk ratio (RR) 0.43, 95% confidence interval (CI) 0.12 to 1.56; one trial, 100 infants). Using the GRADE approach, the evidence for fetal, neonatal and infant death was considered to be VERY LOW quality. No data were reported for any of the other primary maternal and infant health outcomes (birth less than 48 hours after trial entry; composite serious infant outcome; composite serious maternal outcome).There were no clear differences seen between high-dose magnesium sulphate regimens compared with low-dose magnesium sulphate regimens for the secondary infant health outcomes of fetal death; neonatal death; and rate of hypocalcaemia, osteopenia or fracture; and secondary maternal health outcomes of rate of caesarean birth; pulmonary oedema; and maternal self-reported adverse effects. Pulmonary oedema was reported in two women given high-dose magnesium sulphate, but not in any of the women given low-dose magnesium sulphate.In a single trial of high and low doses of magnesium sulphate for tocolysis including 100 infants, the risk of respiratory distress syndrome was lower with use of a high-dose regimen compared with a low-dose regimen (RR 0.31, 95% CI 0.11 to 0.88; one trial, 100 infants). Using the GRADE approach, the evidence for respiratory distress syndrome was judged to be LOW quality. No difference was seen in the rate of admission to the neonatal intensive care unit. However, for those babies admitted, a high-dose regimen was associated with a reduction in the length of stay in the neonatal intensive care unit compared with a low-dose regimen (mean difference -3.10 days, 95% confidence interval -5.48 to -0.72).We found no data for the majority of our secondary outcomes. AUTHORS' CONCLUSIONS There are limited data available (three studies, with data from only two studies) comparing different dosing regimens of magnesium sulphate given as single agent tocolytic therapy for the prevention of preterm birth. There is no evidence examining duration of therapy, timing of therapy and the role for repeat dosing.Downgrading decisions for our primary outcome of fetal, neonatal and infant death were based on wide confidence intervals (crossing the line of no effect), lack of blinding and a limited number of studies. No data were available for any of our other important outcomes: birth less than 48 hours after trial entry; composite serious infant outcome; composite serious maternal outcome. The data are limited by volume and the outcomes reported. Only eight of our 45 pre-specified primary and secondary maternal and infant health outcomes were reported on in the included studies. No long-term outcomes were reported. Downgrading decisions for the evidence on the risk of respiratory distress were based on wide confidence intervals (crossing the line of no effect) and lack of blinding.There is some evidence from a single study suggesting a reduction in the length of stay in the neonatal intensive care unit and a reduced risk of respiratory distress syndrome where a high-dose regimen of magnesium sulphate has been used compared with a low-dose regimen. However, given that evidence has been drawn from a single study (with a small sample size), these data should be interpreted with caution.Magnesium sulphate has been shown to be of benefit in a wide range of obstetric settings, although it has not been recommended for tocolysis. In clinical settings where health benefits are established, further trials are needed to address the lack of evidence regarding the optimal dose (loading dose and maintenance dose), duration of therapy, timing of therapy and role for repeat dosing in terms of efficacy and safety for mothers and their children. Ongoing examination of different regimens with respect to important health outcomes is required.
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Affiliation(s)
- Helen C McNamara
- The Royal Women's Hospital20 Flemington RoadParkvilleMelbourneVictoriaAustralia3052
| | - Caroline A Crowther
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Julie Brown
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
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Kashanian M, Koohpayehzadeh J, Sheikhansari N, Bararpour F, Sahraian G, Asadolla S. A comparison between the two methods of magnesium sulfate administration for duration of 12 versus 24 h after delivery in patients with severe preeclampsia. J Matern Fetal Neonatal Med 2015; 29:2282-7. [DOI: 10.3109/14767058.2015.1083547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Siwicki K, Bain E, Bubner T, Ashwood P, Middleton P, Crowther CA. Nonreceipt of antenatal magnesium sulphate for fetal neuroprotection at the Women's and Children's Hospital, Adelaide 2010-2013. Aust N Z J Obstet Gynaecol 2015; 55:233-8. [DOI: 10.1111/ajo.12334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 02/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Kasia Siwicki
- Women's and Children's Hospital; Adelaide Australia
- Australian Research Centre for Health of Women and Babies; Robinson Research Institute; School of Paediatrics and Reproductive Health; The University of Adelaide; Adelaide Australia
| | - Emily Bain
- Australian Research Centre for Health of Women and Babies; Robinson Research Institute; School of Paediatrics and Reproductive Health; The University of Adelaide; Adelaide Australia
| | - Tanya Bubner
- Australian Research Centre for Health of Women and Babies; Robinson Research Institute; School of Paediatrics and Reproductive Health; The University of Adelaide; Adelaide Australia
| | - Pat Ashwood
- Australian Research Centre for Health of Women and Babies; Robinson Research Institute; School of Paediatrics and Reproductive Health; The University of Adelaide; Adelaide Australia
| | - Philippa Middleton
- Australian Research Centre for Health of Women and Babies; Robinson Research Institute; School of Paediatrics and Reproductive Health; The University of Adelaide; Adelaide Australia
| | - Caroline A. Crowther
- Australian Research Centre for Health of Women and Babies; Robinson Research Institute; School of Paediatrics and Reproductive Health; The University of Adelaide; Adelaide Australia
- Liggins Institute; The University of Auckland; Auckland New Zealand
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Antenatal magnesium sulfate exposure and acute cardiorespiratory events in preterm infants. Am J Obstet Gynecol 2015; 212:94.e1-7. [PMID: 25046806 DOI: 10.1016/j.ajog.2014.07.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/12/2014] [Accepted: 07/15/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Antenatal magnesium (anteMg) is used for various obstetric indications including fetal neuroprotection. Infants exposed to anteMg may be at risk for respiratory depression and delivery room (DR) resuscitation. The study objective was to compare the risk of acute cardiorespiratory events among preterm infants who were and were not exposed to anteMg. STUDY DESIGN This was a retrospective analysis of prospective data collected in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's Generic Database from April 1, 2011, through March 31, 2012. The primary outcome was DR intubation or respiratory support at birth or on day 1 of life. Secondary outcomes were invasive mechanical ventilation, hypotension treatment, neonatal morbidities, and mortality. Logistic regression analysis evaluated the risk of primary outcome after adjustment for covariates. RESULTS We evaluated 1544 infants <29 weeks' gestational age (1091 in anteMg group and 453 in nonexposed group). Mothers in the anteMg group were more likely to have higher education, pregnancy-induced hypertension, and antenatal corticosteroids, while their infants were younger in gestation and weighed less (P < .05). The primary outcome (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.88-1.65) was similar between groups. Hypotension treatment (OR, 0.70; 95% CI, 0.51-0.97) and invasive mechanical ventilation (OR, 0.54; 95% CI, 0.41-0.72) were significantly less in the anteMg group. CONCLUSION Among preterm infants age <29 weeks' gestation, anteMg exposure was not associated with an increase in cardiorespiratory events in the early newborn period. The safety of anteMg as measured by the need for DR intubation or respiratory support on day 1 of life was comparable between groups.
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Dickinson H, Bain E, Wilkinson D, Middleton P, Crowther CA, Walker DW. Creatine for women in pregnancy for neuroprotection of the fetus. Cochrane Database Syst Rev 2014; 2014:CD010846. [PMID: 25523279 PMCID: PMC10657457 DOI: 10.1002/14651858.cd010846.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Creatine is an amino acid derivative and, when phosphorylated (phosphocreatine), is involved in replenishing adenosine triphosphate (ATP) via the creatine kinase reaction. Cells obtain creatine from a diet rich in fish, meat, or dairy and by endogenous synthesis from the amino acids arginine, glycine, and methionine in an approximate 50:50 ratio. Animal studies have shown that creatine may provide fetal neuroprotection when given to the mother through her diet in pregnancy. It is important to assess whether maternally administered creatine in human pregnancy (at times of known, suspected, or potential fetal compromise) may offer neuroprotection to the fetus and may accordingly reduce the risk of adverse neurodevelopmental outcomes, such as cerebral palsy and associated impairments and disabilities arising from fetal brain injury. OBJECTIVES To assess the effects of creatine when used for neuroprotection of the fetus. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2014). SELECTION CRITERIA We planned to include all published, unpublished, and ongoing randomised trials and quasi-randomised trials. We planned to include studies reported as abstracts only as well as full-text manuscripts. Trials using a cross-over or cluster-randomised design were not eligible for inclusion.We planned to include trials comparing creatine given to women in pregnancy for fetal neuroprotection (regardless of the route, timing, dose, or duration of administration) with placebo, no treatment, or with an alternative agent aimed at providing fetal neuroprotection. We also planned to include comparisons of different regimens for administration of creatine. DATA COLLECTION AND ANALYSIS We identified no completed or ongoing randomised controlled trials. MAIN RESULTS We found no randomised controlled trials for inclusion in this review. AUTHORS' CONCLUSIONS As we did not identify any randomised controlled trials for inclusion in this review, we are unable to comment on implications for practice. Although evidence from animal studies has supported a fetal neuroprotective role for creatine when administered to the mother during pregnancy, no trials assessing creatine in pregnant women for fetal neuroprotection have been published to date. If creatine is established as safe for the mother and her fetus, research efforts should first be directed towards randomised trials comparing creatine with either no intervention (ideally using a placebo), or with alternative agents aimed at providing fetal neuroprotection (including magnesium sulphate for the very preterm infant). If appropriate, these trials should then be followed by studies comparing different creatine regimens (dosage and duration of exposure). Such trials should be high quality and adequately powered to evaluate maternal and infant short and longer-term outcomes (including neurodevelopmental disabilities such as cerebral palsy), and should consider utilisation/costs of health care.
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Affiliation(s)
- Hayley Dickinson
- MIMR‐PHI Institute of Medical ResearchThe Ritchie Centre27‐31 Wright StreetMelbourneVictoriaAustralia3168
| | - Emily Bain
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Dominic Wilkinson
- University of OxfordOxford Uehiro Centre for Practical EthicsOxfordUK
| | - Philippa Middleton
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Caroline A Crowther
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
| | - David W Walker
- MIMR‐PHI Institute of Medical ResearchThe Ritchie Centre27‐31 Wright StreetMelbourneVictoriaAustralia3168
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Gandhi S, Sun D, Park AL, Hladunewich M, Silversides CK, Ray JG. The Pulmonary Edema Preeclampsia Evaluation (PEPE) Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:1065-1070. [DOI: 10.1016/s1701-2163(15)30383-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bain ES, Middleton PF, Yelland LN, Ashwood PJ, Crowther CA. Maternal adverse effects with different loading infusion rates of antenatal magnesium sulphate for preterm fetal neuroprotection: the IRIS randomised trial. BJOG 2014; 121:595-603. [PMID: 24387624 DOI: 10.1111/1471-0528.12535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate a slower (compared with a standard) infusion rate of the loading dose of magnesium sulphate for preterm fetal neuroprotection as a strategy to reduce maternal adverse effects. DESIGN Randomised controlled trial. SETTING South Australian maternity hospital. POPULATION Fifty-one women at <30 weeks of gestation, where birth was planned or expected within 24 hours. METHODS Women received a loading infusion of 4 g of magnesium sulphate over either 60 or 20 minutes (followed by maintenance of 1 g/hour until birth, or for up to 24 hours). MAIN OUTCOME MEASURES Any maternal adverse effects associated with the infusion. RESULTS Overall, 71% of women experienced adverse effects during the first hour of their infusion; the difference between groups was not significant [15/25 (60%) 60-minute loading; 21/26 (81%) 20-minute loading; risk ratio (RR) 0.74; 95% confidence interval (95% CI) 0.51-1.08]. Although no serious maternal complications occurred, adverse effects led to three women ceasing the loading treatment (1/25 in the 60-minute loading group; 2/26 in the 20-minute loading group; RR 0.52; 95% CI 0.05-5.38). Women in the 60-minute loading group experienced significantly less warmth and flushing at 20 minutes into the infusion (7/25 in the 60-minute loading group; 15/26 in the 20-minute loading group; RR 0.49; 95% CI 0.24-0.99). No other differences between groups for maternally reported and clinical adverse effects were shown. CONCLUSIONS A slower rate of administering the loading dose of magnesium sulphate did not reduce the occurrence of maternal adverse effects overall. Flushing and warmth at 20 minutes into the infusion was reduced with a slower infusion.
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Affiliation(s)
- E S Bain
- Australian Research Centre for Health of Women and Babies, Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
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