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Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Therapy.Magnesium sulfate is the drug of choice to treat eclampsia and prevent recurrent convulsions, as it is associated with maternal and fetal/neonatal benefits compared to all interventions against which it has been tested. The standard intravenous regimen widely used in many countries consists in a loading dose of 4 g, followed by an infusion of 1 g/hour [95]. Increasing the loading dose to 6 g and the infusion rate to 2 g/hour has also been suggested [94].
Preterm Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Intravenous magnesium sulfate is administered with a loading dose of 4–6 g infused for 20–30 minutes, followed by a maintenance infusion of 1–2 g/hour [27]. If delivery has not occurred after 12 hours and is no longer considered imminent (e.g. if the patient is not having regular uterine contractions), the infusion should be discontinued and resumed when delivery is deemed imminent again (e.g. when contractions develop). If at least 6 hours have passed since the discontinuation of the magnesium sulfate, another loading dose should be given. Administration of magnesium sulfate for prevention of cerebral palsy should not delay the delivery.
The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
This tocolytic agent can cause a reduction in uterine contractility in vitro and in vivo (313). Magnesium hyperpolarizes the cellular membrane and inhibits myosin light-chain kinase activity by competing with intracellular calcium (314–316). Despite its wide utilization in the United States, the largest randomized clinical trial in which magnesium sulfate was compared with placebo concluded that magnesium sulfate was not effective in prolonging pregnancy (317). Meta-analyses of randomized trials in which magnesium was compared with placebo or other agents do not show differences in prolongation of pregnancy for 48 hours (318). Maternal and neonatal side effects of magnesium sulfate are well known since this drug is used to prevent seizures in pre-eclampsia. Common side effects include nausea and vomiting, a metallic taste in the mouth, lethargy, and hot flashes. Pulmonary edema has been reported in patients receiving this drug. Since magnesium crosses the placenta, prolonged administration can lead to hypermagnesemia in the neonate. A systematic review reported by Crowther et al. (318) in which more than 2000 women were included in 23 trials concluded that magnesium was not effective in preventing preterm delivery and was associated with an increased risk ofdeath (fetal and pediatric) (RR 2.8; 95% CI, 1.20–6.62). Grimes and Nanda have called for a discontinuation of magnesium sulfate as a tocolytic agent (319). There is no evidence that oral magnesium administration can prevent preterm birth or is effective for maintenance of tocolysis.
Effect of magnesium levels on mean tissue perfusion during and after bariatric surgeries: A randomised control trial
Published in Egyptian Journal of Anaesthesia, 2023
Ahmed Yahya Ibrahim Ahmed, Mounir Kamal Mohamed Ahmed Afifi, Emad Abdelmoenam Elmonem Arida, Mohamed Mahmoud Abdelhady
Early and adequate analgesia speeds up mobilization in morbidly obese patients, reduces hospital stay, lowers the risk of complications, lowers costs, and improves patient comfort [4–6]. Nevertheless, opioid-based analgesia in obese individuals is linked to dangerous side effects including drowsiness, bradypnea, hypoxemia, vomiting, ileus, delayed mobilization, and mortality. Additionally, if there is a comorbid OSA, psychiatric disorders, cardiorespiratory diseases, and chronic opioid use, these complications become worse [7,8]. Utilizing opioids in the smallest dosage possible has the benefit of minimizing those negative side effects [9,10]. Magnesium sulfate is being used as an adjuvant for postoperative analgesia in numerous procedures, including obstetric, orthopedic, and cardiovascular procedures [11].
Anesthetic management of obstetric patients with COVID-19: A scoping review
Published in Egyptian Journal of Anaesthesia, 2022
Radwa Hamdi Bakr Mohamed, Waad Al-Ghamdi, Aldanah Al-Marri, Bayan Al-Abdullah, Nebras Al-Hajji, Alkawthar Al-Shaybe
Several drugs are often indicated to manage conditions and complications that may arise in the peripartum period. The safety of these drugs in obstetric patients infected with COVID- 19 was discussed by several of the reviewed articles. D’Souza et al., (2021) suggested that magnesium sulfate may be used for seizure prophylaxis, fetal neuroprotection, or for women with respiratory distress [9]. Similarly, Bauer et al., (2020) considered MgSO4 to be beneficial in preventing respiratory depression and for its nervous system impacts [8]. Ring et al., (2020) and D’Souza et al., (2021) recommended phenylephrine for intraoperative hypotension in pregnant women with COVID-19 [5,9] while Alyamani et al., (2020) recommended not using Hydroxyethyl starches in resuscitation for these patients [18]. Furthermore, 4 out of 19 articles supported avoiding the use of dexamethasone because of the risk of immunosuppression, while D’Souza et al., (2021) recommended dexamethasone for the treatment of pregnant patients with COVID-19 under mechanical ventilation or needing supplemental oxygen [9]. Additionally, Harenberg et al., (2020) advised using prophylactic antiemetics to avoid the risk of aerosolization caused by vomiting [19] and D’Souza et al., (2021) suggested that the use of low-dose aspirin to inhibit placental complications was safe [9].
Status epilepticus in pregnancy: a literature review and a protocol proposal
Published in Expert Review of Neurotherapeutics, 2022
Roberta Roberti, Morena Rocca, Luigi Francesco Iannone, Sara Gasparini, Angelo Pascarella, Sabrina Neri, Vittoria Cianci, Leonilda Bilo, Emilio Russo, Paola Quaresima, Umberto Aguglia, Costantino Di Carlo, Edoardo Ferlazzo
Supportive care (airway patency, ensuring oxygenation, and avoiding aspiration) should be given.Magnesium sulfate is the treatment of choice.If SE persists, a second IV bolus of magnesium sulfate should be given.If SE continues, IV BDZ bolus is recommended.If SE persists, IVADs are needed are needed.Induction of labor may be scheduled if feto/maternal conditions are stable and patient is well alert and oriented.