Background
Methods
Study design
Collected data
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lack of knowledge on the subject
-
lack of scientific evidence
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expected benefit/risk balance not in favor of the use of MgSO4
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lack of local experience
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no written protocol in the department
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reluctance of obstetricians or anaesthetists or paediatricians or all three.
Data analysis
Results
Speciality | Center n/N (%) | |||||
---|---|---|---|---|---|---|
Anaesthetists n/N (%) | Obstetricians n/N (%) | Paediatricians n/N (%) | Total n/N (%) |
P
| ||
Number of respondents | 34/63 (54) | 48/63 (76) | 56/63 (89) | 138/138 (100) | <.001 | 63/63 (100) |
University Hospital | 25/41 (61) | 32/41 (78) | 36/41 (88) | 93/123 (76) | .66 | 41/63 (65) |
Non-university Hospital | 9/22 (41) | 16/22 (73) | 20/22 (91) | 45/66 (68) | 22/63 (35) | |
Annual number of births | ||||||
<3000 | 17/36 (47) | 23/36 (64) | 33/36 (92) | 73/108 (68) | .49 | 36/63 (57) |
>3000 | 17/27 (63) | 25/27 (93) | 23/27 (85) | 65/81 (80) | 27/63 (43) | |
Familiar with the neuroprotective value of MgSO4
| 30/34 (88) | 44/48 (92) | 51/56 (91) | 125/138 (91) | .76 | N/A |
Had read at least one article on this topic | 24/34 (71) | 40/48 (83) | 45/56 (80) | 109/138 (79) | .36 | N/A |
MgSO4 indications | n/N (%) |
Pre-eclampsia | 46/63 (73) |
Neuroprotection | 38/63 (60) |
Pre-eclampsia and neuroprotection | 37/63 (59) |
None | 17/63 (27) |
Written protocol for indication and administration | 36/38 (95) |
Maximum gestational age | |
34 | 3/38 (8) |
33 | 7/38 (18) |
32 | 27/38 (71) |
31 | 0/38 (0) |
30 | 0/38 (0) |
29 | 0/38 (0) |
28 | 1/38 (3) |
MgSO4 regimen | |
Loading dose of 4 g then maintenance with 1 g/h for 12 h | 35/38 (92) |
Loading dose of 4 g then maintenance with 2 g/h for 12 h | 1/38 (3) |
Only maintenance with 1 g/h for 12 h | 2/38 (5) |
Repeat MgSO4 if birth does not occur after the first course of MgSO4
| 33/38 (87) |
Minimum interval between 2 treatments | |
< 24 h | 10/38 (26) |
24 to 48 h | 6/38 (16) |
> 48 h | 3/38 (8) |
Not specified by protocol | 19/38 (50) |
Maximum number of treatments | |
2 | 7/38(18) |
3 | 1/38 (3) |
No maximum number | 1/38 (3) |
Not specified by the protocol | 29/38 (76) |
Start of MgSO4 administration in the case of imminent delivery < 4 h (without delaying obstetric management) | 34/38 (90) |
Coprescription of calcium channel blockers | 33/38 (87) |
Contraindications | n/N (%) |
Renal failure | 33/38 (87) |
Electrolyte disorders | 19/38 (50) |
Cardiovascular disease | 27/38 (71) |
Respiratory distress | 2/38 (5) |
Myasthenia gravis | 23/38 (61) |
Delivery <30 min | 18/38 (47) |
Digitalis interaction | 22/38 (58) |
MgSO4 intolerance | 1/38 (3) |
Stop the infusion if | |
Oliguria <120 mL/4 h | 2/38 (5) |
Oliguria <100 mL/4 h | 29/38 (76) |
Hemodynamic instability | 31/38 (82) |
Respiratory rate < 12/min | 6/38 (16) |
Respiratory rate < 10/min | 28/38 (74) |
Hyporeflexia | 35/38 (92) |
Disorders of consciousness | 33/38 (87) |
Other | 4/38 (1) |
Place of administration | |
Delivery room | 37/38 (97) |
Recovery room | 19/38 (50) |
Intensive care unit | 9/38 (24) |
Obstetrics unit | 8/38 (21) |
Speciality | Center n/N (%) | |||||
---|---|---|---|---|---|---|
Anaesthetists n/N (%) | Obstetricians n/N (%) | Paediatricians n/N (%) | Total n/N (%) |
P
a
| ||
Lack of knowledge | 0/4 | 2/12 (17) | 4/21 (19) | 6/37 (16) | .95 | 6/25 (24) |
Lack of scientific evidence | 0/4 | 2/12 (17) | 2/21 (10) | 4/37 (11) | .55 | 3/25 (12) |
Lack of guidelines | 0/4 | 4/12 (33) | 11/21 (52) | 15/37 (41) | .29 | 13/25 (52) |
Benefit-risk balance | 0/4 | 2/12 (17) | 3/21 (14) | 5/37 (14) | .85 | 5/25 (20) |
Lack of experience | 0/4 | 7/12 (58) | 10/21 (48) | 17/37 (46) | .55 | 17/25 (68) |
Lack of written protocol | 0/4 | 7/12 (58) | 9/21 (43) | 16/37 (43) | .39 | 13/25 (52) |
Reluctance of obstetricians | 0/4 | 2/12 (17) | 2/21 (10) | 4/37 (11) | .55 | 3/25 (12) |
Reluctance of anesthesiologists | 0/4 | 2/12 (17) | 3/21 (14) | 5/37 (14) | .85 | 5/25 (20) |
Reluctance of pediatricians | 0/4 | 2/12 (17) | 2/21 (10) | 4/37 (11) | .55 | 4/25 (16) |