1. Magnesium Sulfate • Perinatal Neuroprophylaxis
Preeclampsia Update 2006
11/13/2018
Magnesium Sulfate • Perinatal Neuroprophylaxis
Thomas R. Easterling, MD
Professor
Maternal-Fetal Medicine
University of Washington
Seattle, WA

2. Preeclampsia Update 2006
11/13/2018

3. Preeclampsia Update 2006
11/13/2018

4. Preeclampsia Update 2006
11/13/2018
Long Term Survival

5. Impaired Work Capacity
Preeclampsia Update 2006
11/13/2018
Cerebral Palsy
Term Rate
Impaired Work Capacity
Term Rate

6. Preeclampsia Update 2006
11/13/2018
Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial
Lancet, 1995;345

7. Antenatal Steroids Reduce the Incidence Of Cerebral Palsy
Preeclampsia Update 2006
11/13/2018
Cerebral Palsy
All trials 6.4% vs. 10.2% OR 0.59 ( )
Antenatal Steroids
Reduce the Incidence
Of Cerebral Palsy

8. • < 30 weeks’ Gestation • MgSO4 - 4 g Bolus - 1 g per Hour
Preeclampsia Update 2006
11/13/2018
• < 30 weeks’ Gestation
• MgSO g Bolus
- 1 g per Hour
• 2 Year Follow-up

9. Preeclampsia Update 2006
11/13/2018

10. Preeclampsia Update 2006
11/13/2018

11. • < 24-31 weeks’ Gestation • MgSO4 - 4 g Bolus - 2 g per Hour
Preeclampsia Update 2006
11/13/2018
• < weeks’ Gestation
• MgSO g Bolus
- 2 g per Hour
• 2 Year Follow-up

12. Preeclampsia Update 2006
11/13/2018

17. Preeclampsia Update 2006
11/13/2018

18. • < 33 weeks’ Gestation • MgSO4 - 4 g Bolus - no maintenance
Preeclampsia Update 2006
11/13/2018
• < 33 weeks’ Gestation
• MgSO g Bolus - no maintenance
• At Hospital Discharge

19. WMI - white matter injury
Preeclampsia Update 2006
11/13/2018
WMI - white matter injury

20. • 5 Clinical Trial with 6145 Babies
• Cerebral Palsy (RR) 0.68 CI (0.54 to 0.87)
• Gross Motor Dysfunction (RR) 0.61 CI (0.44 to 0.85)
“The neuroprotective role for antenatal magnesium sulfate … is now established.”
The number of women to treat to benefit one baby is 63; 95% CI (43 to 155).

22. Cerebral Palsy

23. Gross Motor Dysfunction

24. Pediatric Mortality

25. Preeclampsia Update 2006
11/13/2018

26. Preeclampsia Update 2006
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28. Preeclampsia Update 2006
11/13/2018

29. Mg++ Neuroprophylaxis Mechanism NMDA - (N-methyl-D-aspartate)
Preeclampsia Update 2006
11/13/2018
Mg++ Neuroprophylaxis Mechanism
CNS
NMDA - (N-methyl-D-aspartate)
Hypoxia
• activation of NMDA and non-NMDA receptors by the excitatory neurotransmitter, glutamine
• increased intracellular Ca++
• intracellular Ca++
- free radical generation and cell death

30. Preeclampsia Update 2006
11/13/2018

31. Mg++ Neuroprophylaxis Mechanism Microvascular Stabilization
Preeclampsia Update 2006
11/13/2018
Mg++ Neuroprophylaxis Mechanism
non-CNS
Microvascular Stabilization
Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial
Lancet, 1995;345

32. Magnesium Sulfate for Neuroprotection Final Recommendations - draft
Preeclampsia Update 2006
11/13/2018
Magnesium Sulfate for Neuroprotection
Final Recommendations - draft
• Indication
Imminent preterm delivery
Not limited by cause of risk (eg. PROM, PTL, preeclampsia, bleeding…)
• Gestational Age
< 28 weeks gestation – recommended
28-34 weeks gestation - offered with counseling
• Dose
4 gm bolus, followed by 1gm/hour infusion.
Mg levels not indicated without renal complications.
• Discontinuation
undelivered in 12 hours
• Restart
recurrent risk for preterm delivery
>3 hours from d/c - rebolus
• Urgent delivery should not be delayed to wait for MgSO4

33. Impaired Work Capacity
Preeclampsia Update 2006
11/13/2018
Cerebral Palsy
Term Rate
Impaired Work Capacity
Term Rate

34. Magnesium Sulfate for Neuroprotection Final Recommendations - draft
Preeclampsia Update 2006
11/13/2018
Magnesium Sulfate for Neuroprotection
Final Recommendations - draft
• Indication
Imminent preterm delivery
Not limited by cause of risk (eg. PROM, PTL, preeclampsia, bleeding…)
• Gestational Age
< 28 weeks gestation – recommended
28-34 weeks gestation - offered with counseling
• Dose
4 gm bolus, followed by 1gm/hour infusion.
Mg levels not indicated without renal complications.
• Discontinuation
undelivered in 12 hours
• Restart
recurrent risk for preterm delivery
>3 hours from d/c - rebolus
• Urgent delivery should not be delayed to wait for MgSO4