Intrapartum magnesium sulfate exposure and obstetric hemorrhage risk

The gold standard intrapartum treatment for preeclampsia with severe features is magnesium sulfate in order to provide prophylaxis against eclampsia. However, though magnesium sulfate is known to have a relaxant effect on uterine muscle, there have been variable reports in the literature in regard t...

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Bibliographic Details
Published in:The journal of maternal-fetal & neonatal medicine 2022-12, Vol.35 (25), p.10036-10043
Main Authors: Young, Sara, Wang, Michelle J., Srivastava, Akanksha, Abbas, Diana, Alexander, Megan, Claus, Lindsey, Tummala, Swetha, Yarrington, Christina, Comfort, Ashley
Format: Article
Language:English
Subjects:
delivery mode
hypertensive disease of pregnancy
magnesium sulfate
Obstetric hemorrhage
quantitative blood loss
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Summary:The gold standard intrapartum treatment for preeclampsia with severe features is magnesium sulfate in order to provide prophylaxis against eclampsia. However, though magnesium sulfate is known to have a relaxant effect on uterine muscle, there have been variable reports in the literature in regard to the association between magnesium and obstetric hemorrhage (OBH). We aim to compare OBH incidence in patients with hypertensive disease of pregnancy (HDP) with or without exposure to intrapartum magnesium sulfate. We performed a retrospective cohort study of all deliveries at our institution associated with a diagnosis of hypertensive disease of pregnancy (HDP) (e.g. chronic and gestational hypertension, preeclampsia with or without severe features, eclampsia, or HELLP) from January 1, 2018 to December 31, 2019. The category of HDP diagnosis was determined by a detailed chart review by trained chart abstractors. The primary outcome was total quantitative blood loss (QBL) and the rate of obstetric hemorrhage. Secondary outcomes included a composite of obstetric hemorrhage-related maternal morbidity outcomes (OBH-M), the individual composite components and the incidence of additional hemorrhage-related interventions (e.g. uterotonics and surgical interventions). We also examined the same primary and secondary outcomes in a stratified analysis based on delivery mode (i.e. vaginal deliveries only and cesarean deliveries only). Of 791 patients with a diagnosis of HDP, 411 patients received magnesium sulfate for eclampsia prophylaxis and 380 patients did not receive magnesium sulfate. For all delivery modes, there was a significantly higher QBL (p 
ISSN:1476-7058
1476-4954
DOI:10.1080/14767058.2022.2086796