Interrupted versus continuous magnesium sulfate and blood loss at cesarean delivery

• Published in: The journal of maternal-fetal & neonatal medicine 2022-10, Vol.35 (20), p.3853-3859
• Main Authors: Pippen, Jessica L., Adesomo, Adebayo A., Gonzalez-Brown, Veronica M., Schneider, Patrick D., Rood, Kara M.
• Format: Article
• Language: English
• Subjects: blood loss; Magnesium sulfate; postpartum hemorrhage; preeclampsia
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2020.1841162

Magnesium sulfate is standard of care for prevention of eclampsia in women with preeclampsia with severe features. The American College of Obstetrics and Gynecology endorses its use throughout labor, delivery and the immediate postpartum period. Some providers pause magnesium sulfate infusion preoperatively due to concern for increased risk of uterine atony and postpartum hemorrhage. Using a non-inferiority analysis, we investigated the effect of interrupted versus continuous infusion of magnesium sulfate on postpartum hemorrhage in women with preeclampsia with severe features undergoing cesarean delivery. Retrospective non-inferiority cohort study of women with preeclampsia with severe features treated with magnesium sulfate undergoing cesarean delivery with singleton pregnancies at tertiary care hospital from 2013 to 2018. The primary outcome was postpartum hemorrhage. Secondary outcomes included estimated blood loss, change in hematocrit and a composite of postpartum hemorrhage severity, including transfusion of blood products, use of more than one uterotonic and additional surgical interventions. Of 249 women, magnesium sulfate infusion was interrupted in 171 (69%) and continued in 78 (31%). Women with interrupted magnesium sulfate infusion were more likely to be Caucasian (73% vs 67%, p = .024), have chronic hypertension (23% vs 1%, p