456: The effect of magnesium sulfate administration for neuroprotection on latency in women with preterm premature rupture of membranes

Horton, Amanda

doi:10.1016/j.ajog.2011.10.474

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Overall, 8 studies investigated the incidence of chorioamnionitis among parturient that received MgSO 4 and control patients [ 21 – 27 ]. Of those, 5 had a randomized design and 4 were observational studies.…”

Section: Resultsmentioning

confidence: 99%

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Pergialiotis,

Sapantzoglou,

Rodolaki

et al. 2023

Arch Gynecol Obstet

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Purpose Magnesium sulfate (MgSO4) has been widely used in obstetrics as a mean to help decrease maternal and neonatal morbidity in various antenatal pathology. As a factor, it seems to regulate immunity and can, thus, predispose to infectious morbidity. To date, it remains unknown if its administration can increase the risk of chorioamnionitis. In the present meta-analysis, we sought to accumulate the available evidence. Methods We systematically searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search along with the reference lists of electronically retrieved full-text papers. Results Eight studies were included that investigated the incidence of chorioamnionitis among parturient that received MgSO4 and control patients. Magnesium sulfate was administered in 3229 women and 3330 women served as controls as they did not receive MgSO4. The meta-analysis of data revealed that there was no association between the administration of magnesium sulfate and the incidence of chorioamnionitis (OR 0.98, 95% CI 0.73, 1.32). Rucker’s analysis revealed that small studies did not significantly influence the statistical significance of this finding (OR 1.12, 95% CI 0.82, 1.53). Trial sequential analysis revealed that the required number to safely interpret the primary outcome was not reached. Two studies evaluated the impact of MgSO4 in neonates delivered in the setting of chorioamnionitis. Neither of these indicated the presence of a beneficial effect in neonatal morbidity, including the risk of cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, stillbirth, or neonatal death. Conclusion Current evidence indicates that magnesium sulfate is not associated with an increased risk of maternal chorioamnionitis. However, it should be noted that its effect on neonatal outcomes of offspring born in the setting of chorioamnionitis might be subtle if any, although the available evidence is very limited.

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Section: Resultsmentioning

confidence: 99%

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Pergialiotis,

Sapantzoglou,

Rodolaki

et al. 2023

Arch Gynecol Obstet

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“…The total group of 1259 women was divided into a cohort that received magnesium sulfate and a placebo group, and no significant differences were observed between the two groups in case of delivery < 48 h (22.2 and 20.7%, p = 0.51), delivery < 7 days (55.4 and 51.4%, p = 0.16). The benefit of magnesium sulphate turns out to be a significant decrease in the rate of IVH (grades 3 or 4) compared with placebo (0.7 vs. 2.2%; odds ratio [OR], 0.31; 95% CI 0.10–0.96) [ 29 ]. Romanian guidelines recommend magnesium sulphate in case of spontaneous rupture of membranes < 32 GA, being included in tocolytic medication [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Expectant Management of PPROM Improves Neonatal Outcome—A Retrospective Study of 562 Patients

Bohîlțea

Cioca

Dima

et al. 2021

JCM

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Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities. Material and methods: We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications. Result: The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28–31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32–34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%). Conclusion: Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period.

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“…For patients who present with PPROM before 34 weeks, 70% to 80% will deliver within 1 week of membrane rupture. 35 The risks of expectant management after PPROM include placental abruption, intra-amniotic infection, cord prolapse, and fetal demise. 10 Although there is strong evidence to suggest increased risk of neonatal sepsis and chorioamnionitis in gestations less than 29 weeks, increased gestational age is inversely related to incidence rates for these variables.…”

Section: Complications Of Increased Latencymentioning

confidence: 99%

“…Latency is defined at the interval between PPROM and the initiation of labor. For patients who present with PPROM before 34 weeks, 70% to 80% will deliver within 1 week of membrane rupture 35 . The risks of expectant management after PPROM include placental abruption, intra-amniotic infection, cord prolapse, and fetal demise 10 .…”

Section: Complications Of Increased Latencymentioning

confidence: 99%

Management of Preterm Premature Rupture of Membranes in the Late Preterm Period

Freeman

Denoble

Kuller

et al. 2022

Obstetrical &Amp; Gynecological Survey

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Importance: For patients who present with prelabor rupture of membrane (PROM) in the late preterm period (34 to 36 6/7 weeks), management remains unclear due to lack of consensus. However, recent guidelines have suggested that shared decision-making may be used and expectant management can be considered up to 37 0/7 weeks.Objective: In this article, we review the contemporary studies comparing the risks and benefits of immediate delivery versus expectant management for patients with late preterm prelabor rupture of membranes (PPROM).Evidence Acquisition: Original research articles, review articles, and guidelines on management of late PPROM.Results: Three randomized clinical trials and 2 meta-analyses comparing expectant management and immediate delivery outcomes in late PPROM showed no significant difference in neonatal sepsis rates between groups. Expectant management increased the likelihood that pregnancies reached term while decreasing the rate of cesarean delivery. However, data suggest an increased risk of antepartum hemorrhage among patients in the expectant management groups, as well as higher rates of histologic chorioamnionitis.Conclusions and Relevance: We recommend that clinicians offer expectant management as an alternative to immediate delivery in the setting of late PPROM through a shared decision-making process that clearly outlines the risks and benefits.Target Audience: Obstetricians and gynecologists, family physicians.Learning Objectives: After participating in this activity, the provider should be better able to summarize current evidence regarding fetal, maternal, and obstetric outcomes between immediate delivery and expectant management of patients with PPROM in the late preterm period; describe clinical evaluation of women who present with PPROM in the late preterm period; and plan adequate counseling on the risk and benefits of immediate delivery or expectant management to women who present with PPROM in the later preterm period.Preterm prelabor rupture of membrane (PPROM) is defined as membrane rupture before the onset of labor that occurs before 37 weeks of gestation. Annually, PPROM complicates 2% to 3% of all pregnancies in the United States and is strongly associated with fetal mortality and morbidity. 1 For patients who experience PROM at term (37 weeks or beyond), there is good evidence to support immediate delivery. 2 By contrast, expectant management is advised for patients at very premature gestations (gestational age less than 34 weeks), because the risk of serious neonatal complications such as intraventricular hemorrhage or death increases with increasing prematurity. 3 However, for patients with late Sarah W. Freeman has disclosed that the U.S. Food and Drug Administration has not approved the use of any drugs or devices for the treatment of preterm prelabor rupture of membrane as discussed in this article. Please consult the product's labeling for approved information.All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations...

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456: The effect of magnesium sulfate administration for neuroprotection on latency in women with preterm premature rupture of membranes

Cited by 7 publications

References 12 publications

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Expectant Management of PPROM Improves Neonatal Outcome—A Retrospective Study of 562 Patients

Management of Preterm Premature Rupture of Membranes in the Late Preterm Period

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