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Magnesium sulfate for preterm labor and preterm birth
Brian M Mercer1, Amy A Merlino,
1From the Department of Obstetrics & Gynecology, MetroHealth Medical Center, Cleveland, Ohio.
Obstetrics and Gynecology
|August 25, 2009
Summary
Magnesium sulfate tocolysis for preterm labor does not improve newborn outcomes. Clinicians can withhold this treatment, as benefits for preterm birth or infant health have not been demonstrated.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Pharmacology
Background:
- Preterm birth affects over 500,000 neonates annually, with half originating from preterm labor.
- Tocolytic therapy is a common intervention for managing preterm labor.
- Magnesium sulfate is frequently used for tocolysis and is being investigated for neonatal neuroprotection.
Purpose of the Study:
- To evaluate the efficacy of magnesium sulfate tocolysis in improving maternal and neonatal outcomes.
- To compare magnesium sulfate with other tocolytic agents regarding newborn morbidities and mortality.
Main Methods:
- Systematic review and meta-analysis of 19 randomized clinical trials.
- Assessment of delivery rates (within 48 hours, 7 days) and early/late preterm birth.
- Evaluation of neonatal morbidities and mortality.
Main Results:
- Magnesium sulfate tocolysis did not significantly reduce the frequency of delivery within 48 hours or 7 days.
- No improvement in early/late preterm birth rates was observed with magnesium sulfate.
- No significant differences in newborn morbidities or mortality were found compared to other tocolytic agents or placebo.
Conclusions:
- Withholding magnesium sulfate or other tocolytic agents for preterm labor is appropriate due to a lack of demonstrated newborn benefit.
- Tocolysis may be used for acute indications like facilitating antenatal corticosteroid administration, then discontinued.
- If magnesium sulfate is administered for neonatal neuroprotection, established trial protocols should be followed.
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