Chakrabarti, Rima

Chandiramani, Manju

Nixon, Danielle

English

UCL Discovery

Evaluating the use of Magnesium Sulphate for Preterm Births before 30weeks, as part of the PRECEPT initiative at a Central London Teaching HospitalR Chakrabarti, M Chandiramani, D NixonIntroductionRecent studies suggest that there is significant variationin the uptake and administration of Magnesium Sulphateacross maternity units for preterm births. As aresult, Guys and St Thomas’ Hospital (GSTT) along withthree other hospital trusts in South London haveimplemented PReCept.The aim of PReCept (Preventing cerebral palsy inpreterm babies) is to increase the use of MagnesiumSulphate to achieve a target of 85% for all womandelivering before 30weeksMethodThis was a retrospective audit with data collected for allwomen who delivered between the gestations of 23+6 to30+0 weeks inclusive between June to October2018. They were identified using the electronic system,Badgernet at GSTT. Both their electronic and handwritten notes were then reviewed to identify,1. If they received neuroprotection,• Was this just the loading dose or both the loadingand infusion dose• The time interval between starting the infusion anddelivery2. If they did not receive neuroprotection,• Was there a specific reason documented in regardsto why it was not givenData was also collected regarding• Singleton or multiple pregnancy• Gestation• Risk factors for preterm birthResults15 patients delivered between 23+6 to 30+0 weeks from Juneto October 2018, with 1 patient being a twin pregnancy.The flowchart below illustrates the breakdown of womenreceiving neuroprotection.012345<1 1-2 2-3 3-4 4-5 5-6Number of hoursInterval between commencing Magnesium and Delivery DiscussionWhile the number of women delivering before30weeks at GSTT over the three month period werequite small, it was motivating to see that we wereachieving the target of 85%.In order to identify areas of development, we lookedmore closely at the women who did not receiveneuroprotection and this was presented along with thefindings of this audit to junior trainees at GSTT. Thisbrought up interesting avenues to explore in terms ofeducation, as well as improving clinical practice. Thismainly concerned the administration of the loading doseof Magnesium Sulphate, as at GSTT this is done over fiveminutes for woman with pre-eclampsia. Following adiscussion with the involvement of the multi-disciplinaryteam, it was decided that the loading dose could begiven over twenty minutes and that cardiac monitoringwould not be required, if it was for neuroprotectiononly. We have also been exploring the logistics of havingprefilled syringes to reduce the time taken to preparethe loading and infusion dose.As part of our ongoing commitment to PReCept, allpreterm deliveries that did not receive neuroprotectionare being prospectively reviewed with individualisedfeedback being given to the health professionalsinvolved in their care. This is vital to ensure that allbabies born before 30weeks are given the best possiblechance, not just for survival but also in terms of theirfuture quality of life.The table below also illustrates the time intervalbetween commencing Magnesium Sulphate and delivery.12 patients received bothLoading and Infusion dose15 patients delivered before 30weeks2 patients did not receive Magnesium Sulphate (13%)13 patients received Magnesium Sulphate (87%)1 patient received only Loading doseFlowchart 1

Evaluating the use of Magnesium Sulphate for Preterm Births before 30weeks, as part of the PRECEPT initiative at a Central London Teaching Hospital

https://discovery.ucl.ac.uk/10143895/1/Evaluating%20the%20use%20of%20Magnesium%20Sulphate%20for%20Preterm%20births%20before%2030weeks-PRECEPT.pdf

Evaluating the use of Magnesium Sulphate for Preterm Births before 30weeks, as part of the PRECEPT initiative at a Central London Teaching Hospital

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