The source of this article is : Magnesium sulfate use in
obstetrics. Committee Opinion No. 652. American College
of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e52–3.
The U.S. Food and Drug Administration advises against the
use of magnesium sulfate injections for more than 5–7 days to stop preterm
labor in pregnant women.
Based on this, the category of the drug was changed from ‘A’
to ‘D’ recently, when it was used for more than 5-7 days to prevent preterm
labor in pregnant women.
Concerns for fetal and neonatal bone demineralization and
fractures associated with long-term in utero exposure to magnesium sulfate
prompted this change.
These concerns were based on reports to the FDA’s Adverse
Event Reporting System and results from a number of epidemiologic analyses,
although these studies have important limitations in designs.
In these population based studies the average use of prenatal Magnesium Sulphate was for 9.6 weeks
and the dose was 3,700 g, a much longer
duration and much higher dose than is currently recommended. The sample size in
these studies were also small leading to bias and confounding in the conclusion
drawn.
A total 18 cases were reported of fetal and neonatal long
bone demineralization and fractures.
So this change of category addresses an unindicated and
nonstandard use of magnesium sulfate in obstetric care.
So, the use of Magnesium Sulphate that is appropriate in
clinical practice is:
- Prevention and treatment of seizures in women with preeclampsia or eclampsia and fetal neuroprotection before anticipated early preterm (less than 32 weeks of gestation) delivery.
- Short-term prolongation of pregnancy (up to 48 hours) to allow for the administration of antenatal corticosteroids in pregnant women who are at risk of preterm delivery within 7 days.
- Tocolysis is not recommended beyond 34 weeks of gestation, and is generally not recommended before 24 weeks of gestation but may be considered based on individual circumstances.
References:
No comments:
Post a Comment