Feto-maternal outcome with early preterm labor after magnesium sulfate administration

The goal of a study was to evaluate the efficacy of magnesium sulfate as a neuroprotective measure during early preterm labor (28 to 32 weeks) and to assess any adverse effects on maternal and fetal outcomes post-administration of magnesium sulfate.

This was a hospital-based prospective observational study that selected 72 pregnant women experiencing preterm labor and planned preterm delivery due to either maternal or fetal indications – within the gestational age range of 28-32 weeks. This study comprised 35 women in the magnesium sulfate group (Group A) and 35 women in the control group (Group B), who did not receive magnesium sulfate. Both groups received corticosteroid treatment.

It was observed that infants in the magnesium sulfate group had a significantly lower incidence (3/35, 8.6%) of intraventricular hemorrhage (IVH) compared to the non-magnesium sulfate group (5/35, 14.3%). In the non-magnesium sulfate group, 8.6% extremely low birth weight (ELBW) babies and 5.7% very low birth weight (VLBW) babies developed IVH. In contrast, in the magnesium sulfate group, 5.7% ELBW babies and 2.9% VLBW babies experienced IVH. 

Infants born between 28-30 weeks gestation in the non-magnesium sulfate group exhibited a higher rate of requiring intubation (20%) compared to those in the magnesium sulfate group (11.4%). Moreover, delayed milestones were observed in 5.7% of infants born between 30-32 weeks gestation in the non-magnesium sulfate group, whereas none in the magnesium sulfate group displayed such delays.

Hence, antenatal magnesium sulfate administration reduces the need for invasive mechanical ventilation, ongoing respiratory support, and the incidence of IVH across various preterm gestational ages. Its potential in preventing cerebral palsy and reducing fetal or infant mortality risk is notable. 

Following substantial randomized controlled trials, antenatal magnesium sulfate has been recognized as a valuable neuroprotective agent, applicable irrespective of the cause of preterm birth or gestational age. Due to its affordability, accessibility, and storage convenience, magnesium sulfate holds promise for implementation in resource-limited settings. Integrating magnesium sulfate into national guidelines for preterm infant care could substantially enhance prognosis without significant maternal side effects, thereby constituting a crucial element of prenatal prophylactic interventions for preterm infants.

Source: Medhi R, Das I, Boro RC, Naznin W. New Indian J OBGYN. 2023;10(1):39-45.