The effect of magnesium sulfate in delaying delivery in premature rupture of membrane and its fetal complications

Document Type : Original Article

Authors

Abstract

Introduction: Using Tocolytics such as magnesium sulphate is one of the regular treatments to prevent preterm labor due to PPROM. However, there is a little clinical evidence about its beneficial effects on improving pregnancy outcomes, but however, in many centers it is used as first-line therapy. This study was performed with aim to investigate the effects of magnesium sulfate in delaying labor in women with PROM and prevention of its subsequent fetal complications.
Methods: This two-blind clinical trial was conducted in the Mahdieh Medical Centre, Tehran between March 2010 and August 2012. Patients were allocated into two groups; intervention (magnesium sulphate, n=46) and control (placebo, n=46). Logistic regression analysis with Backward Stepwise method was used to evaluate the effect of independent variables on maternal and neonatal outcomes. The SPSS software version 20 was used for data analysis.
Results: Administration of magnesium sulfate has not been seen to associate with adverse effects in pregnancy outcomes. Also, the positive effect of this drug has been seen in relation to the increased duration of delay in delivery (P<0.001) in women with premature rupture of membrane and reducing respiratory distress syndrome in their neonates (P<0.002). Considering the affecting variables on active phase of labor, the logistic regression test showed that delay in the onset of the active phase of labor because of magnesium sulfate in the intervention group was 7.2 times that of the control group (OR=7.2, 95% CI:2.45-10.1). Also, administration of this drug has no effect on the incidence of fetal mortality, sepsis, intraventricular hemorrhage, and need for NICU in the studied subjects.
Conclusion: magnesium sulphate increased the delay duration in reaching active phase in mothers with premature rupture of membrane and no evidence of adverse foetal outcomes was not observed.

Keywords


  1. Mercer BM. Preterm premature rupture of the membranes. Obstetrics & Gynecology 2003; 101(1):178-93.
  2. Danforth DN, Gibbs RS. Danforth's obstetrics and gynecology: Lippincott Williams & Wilkins; 2008.
  3. Park JS, Yoon BH, Romero R, Moon JB, Oh S-Y, Kim JC, et al. The relationship between oligohydramnios and the onset of preterm labor in preterm premature rupture of membranes. American journal of obstetrics and gynecology 2001; 184(3):459-62.
  4. Sanginabadi M, Seifrabie MA. A Comparative evaluation of maternal & Neonatal complications in women between outpatients & Inpatients with Preterm Premature Rupture of the membranes. Scientific Journal of Hamadan Nursing & Midwifery Faculty 2014; 22(2):26-32.
  5. Ananth CV, Oyelese Y, Srinivas N, Yeo L, Vintzileos AM. Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption. Obstetrics & Gynecology 2004;104(1):71-7.
  6. Guinn DA, Goldenberg RL, Hauth JC, Andrews WW, Thom E, Romero R. Risk factors for the development of preterm premature rupture of the membranes after arrest of preterm labor. American journal of obstetrics and gynecology 1995;173(4):1310-5.
  7. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics 24/E. 24th ed.NewYork:  McGraw Hill Professional; 2014.
  8. Creasy RK, Resnik R, Iams JD. Maternal-fetal medicine: principles and practice. Torento: Saunders; 1984.
  9. Martius JA, Steck T, Oehler MK, Wulf KH. Risk factors associated with preterm (< 37+ 0 weeks) and early preterm birth (< 32+ 0 weeks): univariate and multivariate analysis of 106 345 singleton births from the 1994 statewide perinatal survey of Bavaria. European Journal of Obstetrics & Gynecology and Reproductive Biology 1998; 80(2):183-9.
  10. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development neonatal research network, January 1995 through December 1996. Pediatrics 2001; 107(1):e1.
  11. Mittendorf R, Dambrosia J, Pryde PG, Lee KS, Gianopoulos JG, Besinger RE, et al. Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants. American journal of obstetrics and gynecology  2002; 186(6):1111-8.
  12. Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, et al. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. New England Journal of Medicine 2008; 359(9):895-905.
  13. Katz VL, Farmer RM. Controversies in tocolytic therapy. Clinical obstetrics and gynecology 1999; 42(4):802.
  14. Allen SR. Tocolytic therapy in preterm PROM. Clinical obstetrics and gynecology 1998; 41(4):842-8.
  15. Berkman ND, Thorp Jr JM, Lohr KN, Carey TS, Hartmann KE, Gavin NI, et al. Tocolytic treatment for the management of preterm labor: a review of the evidence. Am J Obstet Gynecol 2003; 188(6):1648-59.
  16. Sanchez-Ramos L, Kaunitz AM, Gaudier FL, Delke I. Efficacy of maintenance therapy after acute tocolysis: a meta-analysis. American journal of obstetrics and gynecology 1999; 181(2):484-90.
  17. Tan T, Devendra K, Tan L, Tan H. Tocolytic treatment for the management of preterm labour: a systematic review. Singapore medical journal 2006; 47(5):361-66.
  18. Hasanzadeh M, Yousefi Z, Malakoti H. Preterm Premature Rupture of Membranes: Aggressive Tocolysis Versus Expectant Management. Kowsar Medical Journal 2005; 10(3):217-22.
  19. Gehan EA. Clinical trials in cancer research. Environmental health perspectives 1979;32:31-8.
  20. Garite T, Keegan K, Freeman R, Nageotte M. A randomized trial of ritodrine tocolysis versus expectant management in patients with premature rupture of membranes at 25 to 30 weeks of gestation. American journal of obstetrics and gynecology 1987; 157(2):388-93.
  21. Mittendorf R, Covert R, Boman J, Khoshnood B, Lee KS, Siegler M. Is tocolytic magnesium sulphate associated with increased total paediatric mortality?. The Lancet  1997; 350(9090):1517-18.
  22. Ramsey PS, Nuthalapaty FS, Lu G, Ramin S, Nuthalapaty ES, Ramin KD. Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers. American journal of obstetrics and gynecology 2004; 191(4):1497-502.
  23. Nikbakht R, Moghadam MT, Ghane’ee H. Nifedipine compared to magnesium sulfate for treating preterm labor: A randomized clinical trial. Iranian journal of reproductive medicine 2014; 12(2):145.
  24. Papatsonis D, Flenady V, Cole S, Liley H. Oxytocin receptor antagonists for inhibiting preterm labour. Cochrane Database Syst Rev. 2005; 3(6).
  25. Weiner CP, Renk K, Klugman M. The therapeutic efficacy and cost-effectiveness of aggressive tocolysis for premature labor associated with premature rupture of the membranes. American journal of obstetrics and gynecology 1988; 159(1):216-22.
  26. Conde-Agudelo A, Romero R. Antenatal magnesium sulfate for the prevention of cerebral palsy in preterm infants less than 34 weeks' gestation: a systematic review and metaanalysis. American journal of obstetrics and gynecology 2009; 200(6):595-609.
  27. Pasquier JC, Picaud JC, Rabilloud M, Claris O, Ecochard R, Moret S, et al. Neonatal outcomes after elective delivery management of preterm premature rupture of the membranes before 34 weeks' gestation (DOMINOS study). European Journal of Obstetrics & Gynecology and Reproductive Biology 2009; 143(1):18-23.
  28. Grether JK, Hoogstrate J, Selvin S, Nelson KB. Magnesium sulfate tocolysis and risk of neonatal death. American journal of obstetrics and gynecology 1998; 178(1):1-6.
  29. Scudiero R, Khoshnood B, Pryde PG, Lee KS, Wall S, Mittendorf R. Perinatal death and tocolytic magnesium sulfate. Obstetrics & Gynecology  2000; 96(2):178-82.
  30. Zangooei M, Sharifzadeh GR, Karimi A, Gheytas H. The effect of Antibiotic, Corticosteroid and Tocolytic in patient with PPROM on neonatal outcomes. Modern Care Journal 2011; 8(1):19-24.
  31. How HY, Cook CR, Cook VD, Miles DE, Spinnato JA. Preterm premature rupture of membranes: aggressive tocolysis versus expectant management. Journal of Maternal-Fetal and Neonatal Medicine 1998; 7(1):8-12.
  32. Du J, Li L, Dou Y, Li P, Chen R, Liu H. Diagnostic Utility of Neutrophil CD64 as a Marker for Early-Onset Sepsis in Preterm Neonates. PloS one  2014; 9(7):e102647.
  33. Hassan Zadeh M YZ, Malakouti H. Preterm premature rupture of membranes: Aggressive Tocolysis versus expectant management. Kowsar Medical Journal 2005; 10(3):217-22.
  34. Jazayeri A, Jazayeri MK, Sutkin G. Tocolysis does not improve neonatal outcome in patients with preterm rupture of membranes. American journal of perinatology 2003; 20(04):189-94.