Implementation of antenatal magnesium sulfate for fetal neuroprotection in the third-level teaching university hospital : The retrospective analysis in period 2012-2016

Abstract

The risk for a very preterm child to develop cerebral palsy is significantly higher than for child born at term or later than 32 weeks of gestation. Doyle et al. published an updated systematic review of five RCT's in 2009 in which they proved, that antenatal magnesium sulfate administration markedly decreased the risk of cerebral palsy and substantial gross motor dysfunction in preterm infants. In a research of Magee et al. it was noted, that the NNT to prevent 1 CP or death was 43 and NNT to prevent one CP only was 50 at 32 weeks of gestation. The use of antenatal magnesium sulfate for fetal neuroprotection was launched in HUCH on June 7 th, 2012. After the pilot period of approximately two months, the implementation was evaluated and the decision to set-up the upper gestational age of 31+6 weeks for the fetal neuroprotection has been done (August 21st, 2012). Our main objective was to compare the implementation of antenatal magnesium sulfate for fetal neuroprotection, the proximity of the magnesium exposure to delivery and the determination of the delivery-related blood loss in those that received MgSO4 compared to the cohort of the same gestational age that have not received MgSO4. Pregnancy characteristics and fetal neuroprotection data were collected retrospectively and retrieved from the hospital records. The overall implementation rate during both periods was 83,7%. The rate of 86.2% in period 2012-2016 was higher than expected with an increase of 8,56% compared to the period A. To determine the accurate implementation rate (83,0%) we excluded those with elective CS. The implementation rate was found very successful and higher than that in any of the previous published study. Mean duration of magnesium administration was 7,13 hours and mean dose of MgSO4 was 17,61g. There was a decrease of 33% in women who did not receive magnesium sulfate even though indicated from period A to period B. The decrease of 77,9% from period A to period B with those who did not receive magnesium sulfate for an unknown reason is a huge accomplishment. We found the proximity of the magnesium exposure to delivery to be on a very satisfying level. Altogether 68,0% of women gave birth <12 hours after the exposure to MgSO4 had ceased, and as much as 58,4% delivered <6 hours after the exposure to magnesium. With 29,6% of those eligible for magnesium treatment, magnesium administration time was miscalculated (maintenance dose shorter 30 minutes). This non-adherence to the local guidelines has been noted and an auditing with midwives will be made. In conclusion, MgSO4 administration for fetal neuroprotection has been successfully and safely implemented in our institution