OJOG  Vol.4 No.2 , February 2014
Strategies to prevent preterm birth and cerebral palsy: Compliance with current recommendations
ABSTRACT

Objective: Magnesium sulfate (MgSO4) administration to patients with preterm delivery has been associated with a decrease in cerebral palsy. At our institution, a protocol was established regarding the administration of magnesium sulfate for patients in preterm labor at less than 32 weeks of gestation. Despite this protocol, not all eligible patients received this therapy. The purpose of this study was to investigate potential barriers to MgSO4 administration. Methods: A retrospective chart review was performed of those patients who received the diagnosis of “Early Onset Delivery” or “preterm labor” from January through December of 2010, to see what therapies were offered and received. Results: 119 patients met initial criteria. Of those, 68 patients had preterm labor less than 32 weeks. 15 of the 68 patients (22%) received MgSO4. Of those patients that did not receive MgSO4, only 6 delivered <32 weeks. Five were considered eligible. One patient had a relative contraindication to therapy. There were no demographic differences between those patients that received MgSO4, and those that were eligible and did not. Potential barriers included short time frame from presentation to delivery, treatment not considered by healthcare provider, and unanticipated delivery. No patient declined therapy. Conclusions: At our institution, the rate of MgSO4 administration for neuroprotection to eligible candidates was 75%. The subgroup of patients where MgSO4 was not administered in eligible candidates was unanticipated delivery (4), and premature rupture of membranes (1). A 4 gram load of MgSO4 should be attempted prior to delivery of eligible patients, as this strategy has also been shown to be of benefit.


Cite this paper
Meyer, A. , Cipparrone, N. , Buras, A. and Parilla, B. (2014) Strategies to prevent preterm birth and cerebral palsy: Compliance with current recommendations. Open Journal of Obstetrics and Gynecology, 4, 71-74. doi: 10.4236/ojog.2014.42013.
References
[1]   Rouse, D.J., Hirtz, D.G., Thom, E., et al. (2008) A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. The New England Journal of Medicine, 359, 895.
http://dx.doi.org/10.1056/NEJMoa0801187

[2]   Crowther, C.A., Hille, J.E., Doyle, L.W. and Haslam, R.R. (2003) Effect of magnesium sulfate given for neuroprotection before preterm birth: A randomized controlled trial. JAMA, 290, 2669-2676.
http://dx.doi.org/10.1001/jama.290.20.2669

[3]   Marret, S., Marpeau, L., Follet-Bouhamed, C., et al. (2008) Effect of magnesium sulphate on morality and neurologic morbidity of the very-preterm newborn (of less than 33 weeks) with two-year neurological outcome: Results of the prospective PREMAG trial. Gynécologie Obstétrique & Fertilité, 36, 278-288. http://dx.doi.org/10.1016/j.gyobfe.2008.01.012

[4]   Costantine, M.M. and Weiner, S.J. (2009) Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Effects of antenatal exposure to magnesium sulfate of neuroprotection and mortality in preterm infants: A meta-analysis. Obstetrics & Gynecology, 114, 354. http://dx.doi.org/10.1097/AOG.0b013e3181ae98c2

[5]   American College of Obstetricians and Gynecologists (2010) Magnesium sulfate before anticipated preterm birth for neuroprotection. Committee Opinion No. 455. Obstetrics & Gynecology, 115, 669-671. http://dx.doi.org/10.1097/AOG.0b013e3181d4ffa5

[6]   Reeves, S.A., Gibbs, R.S. and Clark, S.L. (2011) Magnesium for fetal neuroprotection. American Journal of Obstetrics & Gynecology, 204, e1-4.

[7]   Rouse, D.J. (2008) Magnesium sulfate (MgSO4) dose and timing, and umbilical cord Mg++ concentration: Relationship to cerebral palsy (CP). American Journal of Obstetrics & Gynecology, 199.

[8]   Food and Drug Administration (2013) FDA recommends against prolonged use of magnesium sulfate to stop preterm labor due to bone changes in exposed babies. FDA Drug Safety Communication. Silver Springs, FDA. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM353335.pdf

 
 
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