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FIGO good practice recommendations on magnesium sulfate administration for preterm fetal neuroprotection

Research output: Contribution to journalArticlepeer-review

the FIGO Working Group for Preterm Birth

Original languageEnglish
Pages (from-to)31-33
Number of pages3
JournalInternational Journal of Gynecology and Obstetrics
Volume155
Issue number1
DOIs
PublishedOct 2021

Bibliographical note

Funding Information: Andrew Shennan reports payment/honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Manipal India; support for attending meetings and/or travel from Hologic; leadership or fiduciary roles in the HTA Commissioning Board UK and Action on Pre‐eclampsia charity. Natalie Suff reports no conflicts of interest. Bo Jacobbson reports research grants from Swedish Research Council, Norwegian Research Council, March of Dimes, Burroughs Wellcome Fund and the US National Institute of Health; clinical diagnostic trials on NIPT with Ariosa (completed), Natera (ongoing), Vanadis (completed) and Hologic (ongoing) with expendidures reimbused per patient; clinical probiotic studies with product provided by FukoPharma (ongoing, no funding) and BioGaia (ongoing; also provided a research grant for the specific study); collaboration in IMPACT study where Roche, Perkin Elmer and Thermo Fisher provided reagents to PLGF analyses; coordination of scientific conferences and meetings with commercial partners as such as NNFM 2015, ESPBC 2016 and a Nordic educational meeting about NIPT and preeclampsia screening. Bo Jacobbson is also Chair of the FIGO Working Group for Preterm Birth and the European Association of Perinatal Medicine's special interest group of preterm delivery; steering group member of Genomic Medicine Sweden; chairs the Genomic Medicine Sweden complex diseases group; and is Swedish representative in the Nordic Society of Precision Medicine. Publisher Copyright: © 2021 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

In women at risk of early preterm imminent birth, from viability to 30 weeks of gestation, use of MgSO4 for neuroprotection of the fetus is recommended. In pregnancies below 32–34 weeks of gestation, the use of MgSO4 for neuroprotection of the fetus should be considered. MgSO4 should be administered regardless of the cause for preterm birth and the number of babies in utero. MgSO4 should be administered when early preterm birth is planned or expected within 24 h. When birth is planned, MgSO4 should commence as close as possible to 4 h before birth. If delivery is planned or expected to occur sooner than 4 h, MgSO4 should be administered, as there is still likely to be an advantage from administration within this time. The optimal regimen of MgSO4 for fetal neuroprotection is an intravenous loading dose of 4 g (administered slowly over 20–30 min), followed by a 1 g per hour maintenance dose. This regimen should continue until birth but should be stopped after 24 h if undelivered. When MgSO4 is administered, women should be monitored for clinical signs of magnesium toxicity at least every 4 h by recording pulse, blood pressure, respiratory rate, and deep tendon (for example, patellar) reflexes.

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