Role of magnesium sulfate in pregnancy

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Pregnant women are subjects that need constant care throughout pregnancy. For decades, magnesium sulfate has been used in obstetrics by thousands of women before giving birth to prevent preterm birth and decrease uterine tone.

1. What is magnesium sulfate?

Magnesium sulfate (MgSO4) is an inorganic salt of magnesium, in medicine this medicine is prepared in 2 forms as follows:
White oral tablet: It has laxative and biliary effects, so it is often used to treat constipation and cholecystitis. In addition, magnesium sulfate is also very effective in cleansing the intestines before diagnostic procedures or poisoning cases; Solution for intravenous or intramuscular injection: Used to lower blood pressure and vasodilatation, besides having a diuretic effect, helping to excrete less fluid from the body. When it comes to magnesium sulfate in obstetrics, this drug is also known for its effectiveness in reducing uterine tone, anticonvulsant in blood poisoning, treatment of premature birth, and hypomagnesemia.

2. The role of magnesium sulfate in pregnancy

The American College of Obstetricians and Gynecologists (ACOG) and the Medical Association of Mothers have long advocated the short-term use of magnesium sulfate (usually less than 48 hours) in the treatment and care of pregnant women based on the suitable conditions and times. Specifically, intravenous drip magnesium sulfate is indicated when pregnant women experience the following symptoms:
Increased uterine tone; Hypertension ; Seizures associated with preeclampsia and eclampsia; Edema; Blood clot ; Affected by sedatives; Hypomagnesemia; Pregnant women are at risk of preterm birth before 32 weeks of gestation.

In addition to its primary role in the prevention and treatment of seizures in women with pre-eclampsia or eclampsia, medical professionals suggest that magnesium sulfate may have a neuroprotective effect on the fetus when preterm birth is predicted (below). 32 weeks of pregnancy). Specifically, magnesium sulfate can reduce the risk of cerebral palsy and gross motor dysfunction in children by 30-40%. In particular, magnesium sulfate also helps prolong pregnancy up to 48 hours, so that prenatal corticosteroid therapy can be applied in women with a gestational age of about 24-34 weeks who are at risk of premature birth within 7 days.

3. Does Magnesium Sulfate Have Any Side Effects?

In general, magnesium salts should only be used for a short time from 3 to 7 days because if the treatment is prolonged, the drug has the risk of accumulating in the mother's body and causing respiratory failure as well as hypoxemia in the mother. fetus. In addition, magnesium sulfate is not recommended during the first trimester of pregnancy.
Pregnant women should also stop taking magnesium sulfate before labor because magnesium can pull calcium out of bone tissues. Therefore, long-term exposure to magnesium sulfate while in utero will cause the bones of the fetus and newborn to become weaker and more prone to fracture during labor. According to results from several epidemiological analyzes, there were 18 cases of fetal and neonatal long-bone fractures with an average of 9.6 weeks of prenatal magnesium sulfate exposure, with a mean total maternal dose of 3,700 g. However, these long durations and dosages both exceed the recommended levels for the use of magnesium sulfate in obstetrics.
In addition, the US Food and Drug Administration (FDA) states that if magnesium sulfate injection is used for longer than 5-7 days, there is a risk of premature birth in pregnant women. For this reason, the safety level of magnesium sulfate in obstetrics has been changed from Group A to Group D and new warning information has been added on the packaging.

Meanwhile, a drug used to inhibit premature labor called Toccytics is not recommended before 24 weeks and after 34 weeks of pregnancy. Furthermore, prolonged use of magnesium sulfate is never indicated. As a result, health experts say magnesium sulfate should still be used because the FDA's reclassification is unproven and substandard.

4. Contraindications to the use of magnesium sulfate in pregnancy

The contraindications of magnesium sulfate in obstetrics are similar to those in prevention of eclampsia. In particular, pregnant women should not use magnesium sulfate, including:
Hypersensitivity to the components of the drug; Myasthenia ; Severe liver disease; Fetal malformations; Genetic abnormalities. In the case of pregnant women with renal impairment, the dose should be reduced and the magnesium level in the blood should be monitored.

5. Monitor pregnant women when using magnesium sulfate

When using magnesium sulfate in obstetrics, factors that need to be monitored in the mother include:
Blood pressure; Heartbeat; Breathing; Deep tendon (tea cake); Reflex; Excrete. Although magnesium sulfate in obstetrics and gynecology is a fairly common form of treatment, it should only be used by prescription and requires caution. Undesirable effects that occur to mother and baby depend on the dose and do not comply with the indications in time. There is currently enough evidence to support the use of magnesium sulfate in obstetrics to help tone the uterus, limit seizures associated with pregnancy complications, and reduce the risk of fetal cerebral palsy due to preterm birth.
If you have unusual symptoms, you should be examined and consulted with a specialist.

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Reference source: acog.org