Title

Magnesium for Fetal Neuroprotection: Should it be Started When Delivery is Not Imminent in PPROM? [12D]

Document Type

Article

Publication Date

4-27-2018

Publication Title

Obstetrics and Gynecology

Volume

131

Issue

p

First page number:

44S

Abstract

INTRODUCTION: Magnesium sulfate may decrease moderate to severe cerebral palsy or death when administered to women at risk for imminent delivery < 32 weeks. Research guidelines included restarting magnesium for fetal neuroprotection up to 34 weeks. Our purpose was to determine whether a magnesium bolus should be given to stable patients admitted with preterm premature ruptured membranes (PPROM) <34 weeks, or whether it can be delayed until delivery appears imminent. METHODS: Recent PPROM patients at a single, University hospital were retrospectively evaluated. Maternal demographics, delivery outcomes, and neonatal outcomes were analyzed. RESULTS: From January 2013 to May 2016, a total of 10,565 deliveries occurred. The incidence of PPROM <34 weeks was 0.5% (n=52). The mean gestational age of those who received magnesium was 28 6/7 weeks compared to 31 2/7 weeks in those with no magnesium (P<0.004). Precipitous deliveries for labor or fetal compromise prevented re-administration of magnesium in 83%. An unexpected trend for decreased intraventricular hemorrhage was seen in patients with PPROM receiving magnesium (1/26 = 3.8%) versus those not receiving magnesium (4/26 = 15.4%) P = .35. CONCLUSION: Few recent studies have investigated the timing of magnesium sulfate for fetal neuroprotection in patients with PPROM. Our data supports immediate administration of magnesium to all patients admitted with PPROM <34 weeks, including those deemed stable on admission. Further prospective studies are indicated to assess the neuroprotective benefits of magnesium for neuroprotection at 32-34 weeks in PPROM.

Disciplines

Obstetrics and Gynecology

Language

English

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