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Antenatal magnesium sulfate for both tocolysis and fetal neuroprotection in premature rupture of the membranes before 32 weeks' gestation.

Author(s) Jung, E.Jung; Byun, J.Mi; Kim, Y.Nam; Lee, K.Bok; Sung, M.Su; Kim, K.Tae; Shin, J.Beom; Jeong, D.Hoon
Journal J Matern Fetal Neonatal Med
Date Published 2018 Jun

OBJECTIVE: We aimed to assess the impact of antenatal MgSOtherapy given to women with PPROM before 32 weeks' gestation on latency, maternal outcomes, perinatal outcomes, and neurodevelopmental outcomes.

METHODS: We undertook a retrospective cohort observational study of 184 singleton pregnancies complicated by PPROM at 23°-31 weeks who were hospitalized and received magnesium therapy for tocolysis (MgSOgroup) or did not receive tocolytic therapy (no MgSOgroup) between 2005 and 2013. Furthermore, patients were subdivided into two groups based on the gestational age at the onset of PPROM (23°-27weeks' gestation and 28°-31weeks' gestation).

RESULTS: We included 184 women, of whom 143 received magnesium therapy and 41 did not. The latency period was significantly longer in the MgSOgroup compared with no MgSOgroup (7.9 ± 9.0 versus 4.0 ± 6.0 days, p = .0017). Antenatal magnesium therapy was significantly associated with decreased stillbirth (1.4% versus 14.6%, p = .0012) and perinatal mortality (7% versus 19.5%, p = .0375) without significant increase in the risk of neonatal morbidities and chorioamnionitis. However, neonates who were exposed to antenatal MgSOwere associated with higher Mg levels (3.63 ± 1.05 mg/dl versus 2.13 ± 0.48 mg/dl, p < .0001) and phosphate levels (6.90 ± 1.36 mg/d versus 6.40 ± 1.01 mg/dl, p = .0459) than those who were not exposed. Neonates who were exposed to MgSOshowed significantly reduced risks of IVH (20.4% versus 58.3%; RR, 0.35; 95%CI, 0.17-0.71) and PVL (27.8% versus 58.3%; RR, 0.48; 95%CI, 0.25-0.91) in the subgroup of 23°-27weeks' gestation. And the incidence of developmental delay in the subgroup of 23°-27weeks' gestation was significantly lower in the MgSOgroup (6.5% versus 36.4%; RR, 0.18; 95%CI, 0.05-0.69). However, there were no significant differences in the development of IVH, PVL, and developmental delay between the two groups for patients in the subgroup of 28°-31weeks' gestation. A similar trend was observed for cerebral palsy, with 22.2% of unexposed children affected compared with only 7.0% of exposed children (RR, 0.31; 95%CI, 0.10-1.00).

CONCLUSIONS: Antenatal magnesium therapy in women with PPROM before 32 weeks' gestation could prolong latency period, allowing for corticosteroid benefit. Moreover, MgSOshowed fetal neuroprotective effects for neonatal IVH and PVL, and for developmental delay in infancy while prolonging latency. However, these benefits were primarily limited to the subgroup of 23°-27weeks' gestation and prolonged in utero exposure to MgSOwas associated with bone mineralization in the neonates.

DOI 10.1080/14767058.2017.1317743
ISSN 1476-4954
Citation Jung EJ, Byun JM, Kim YN, Lee KB, Sung MS, Kim KT, et al. Antenatal magnesium sulfate for both tocolysis and fetal neuroprotection in premature rupture of the membranes before 32 weeks' gestation. J Matern Fetal Neonatal Med. 2018;31(11):1431-1441.

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