OGCO-C2.10 Magnesium sulphate for fetal neuroprotection

Question 1

What are the indications for magnesium sulphate for fetal neuroprotection?

Answer 1

• Between 24+0 and 29+6 weeks of gestation (cerebral palsy reduction)
• Gestaton 23-24 weeks: MgSO4 can be considerd after discussion with obs and neonatal team if patient wish for active resuscitation for the baby
• Established preterm labor (cervical dilatation 3cm or more with regular contractions)
• Having a planned medically or obstretically indicated preterm delivery within 24 hours
• Ideally MgSO4 should be started 4 hours before birth, however delivery should not be delayed if it is indicated. It is likely that benefit will be seen when administered less than 4 hours before birth.

Question 2

What are the contraindications for magnesium sulphate for fetal neuroprotection?

Answer 2

• Hypersensitivity to magnesium sulphate
• Myasthenia gravis or significant maternal neuromuscular disease
• Known myocardial compromise or cardiac conduction defects
• Respiratory depression
• Severe renal insufficiency
• Consider monitoring maternal serum magnesium levels and dose adjustment

Question 3

What to do with MgSO4 admin if severe preeclampsia?

Answer 3

MgSO4 should be given as specified in pre-eclampsia protocol

Question 4

What is Mx of MgSO4 regimen?
What to monitor for Mg toxicity?

Answer 4

Question 5

What are the maternal AE or toxicity of MgSO4?

Answer 5

Question 6

What are fetal/neonatal AE of MgSO4?

Answer 6

Neonatal hyper-magnesemia may produce hyporeflexia leading to poor sucking and respiratory depression. This effect can last for up to 24 hours following birth.
To inform the neonatologists that the mother has been receiving MgSO4 and to standby at delivery.