(574) Factors associated with appropriate administration of magnesium sulfate for neuroprotection prior to early preterm birth

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: To evaluate factors associated with appropriate administration of magnesium sulfate (MgSO₄) for fetal neuroprotection prior to preterm birth (PTB) in a large United States university-based health system.

Study Design: Multicenter retrospective cohort of all PTBs between 23 0/7-31 6/7 weeks’ gestation from 1/1/2019 to 12/31/21. Exclusion criteria included patients with hypertensive disorders of pregnancy (to assure only indication for MgSO₄ administration was fetal neuroprotection and not maternal seizure prophylaxis), stillbirths, higher-order multiple gestations, and extramural deliveries. Cases were stratified into two groups based on whether MgSO₄ was administered prior to PTB or not. Maternal characteristics were compared between the two groups using Chi-squared or Mann-Whitney U test with statistical significance set at P < 0.05. A subgroup analysis evaluating reasons for lack of administration in those who did not receive MgSO₄ prior to delivery was also performed.

Results: Of the 527 patients included, 438 (83.1%) received MgSO₄ prior to delivery. Baseline characteristics and delivery outcomes compared between the two groups are displayed in Table 1. Patients who did not receive MgSO₄ prior to delivery were more commonly admitted for fetal status abnormalities and non-obstetric complaints, and had a significant shorter median time interval from arrival to delivery (1.5 hours vs. 59.0 hours, P = < 0.001) (Table 1). Lack of adherence to health system protocol for MgSO₄ administration occurred in 16.9% (15/89, 2.8% of overall study cohort) of patients who did not receive MgSO₄ prior to delivery (Table 2).

Conclusion: The overall adherence to a protocol of MgSO₄ administration for fetal neuroprotection prior to early PTB was high. Admission for fetal status abnormalities and non-obstetric complaints were more common among patients who did not receive MgSO₄ prior to delivery, with most patients who did not receive MgSO₄ either arrived < 2 hours from delivery or had an acute change in maternal/fetal status requiring immediate delivery.

Primary & Presenting Author(s)

Moti Gulersen, MD,MSc
Assistant Professor, Obstetrics and Gynecology
Sidney Kimmel Medical College at Thomas Jefferson University
Philadelphia, Pennsylvania, United States

Coauthor(s)

MB
Matthew J. Blitz, MD
Zucker School of Medicine at Hofstra and Northwell
Manhasset, New York, United States
BR
Burton Rochelson, MD
Chief, Maternal-Fetal Medicine
Zucker School of Medicine at Hofstra and Northwell
Manhasset, New York, United States
FC
Frank A. Chervenak, MD
Zucker School of Medicine at Hofstra and Northwell
Hempstead, New York, United States
Eran Bornstein, MD
Vice Chair of Obstetrics
Zucker School of Medicine at Hofstra and Northwell
Manhasset, New York, United States