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The role of Magnesium Sulphate

in Obstetrics

By Sneha Sehrawat
M.Ṣc Nursing Ist Year
Introduction
• Magnesium is an essential constituent of many
enzyme systems particularly those involved in
energy generation, the largest store are in the
skeleton.
• Magnesium salts are not well absorbed from the
GIT which explains its use as an osmotic
laxative.
• Magnesium is mainly excreted by the kidneys,
and is therefore retained in renal failure causing
muscle weakness and arrhythmias.
• Magnesium sulphate is use as
- a tocolytic agent as in Preterm labour
and Premature rupture of membranes.
- as an anticonvulsant in Severe Pre-
eclampsia and Eclampsia
Tocolysis

• The exact mechanism of action of


magnesium sulphate is not known but it
appears to inhibit calcium uptake into
smooth muscle cells, reducing uterine
contractility.
• Apparently less effective than ritodrine,
salbutamol or terbutaline but better
tolerated than beta-mimetics and as a
result, has become the first-line agent.
• Side effects of beta- mimetic adreneric
agents which limits there use include:-
-pulmonary oedema
-ARDS
-elevated systolic and reduced diastolic
blood pressure
-both maternal and fetal tachycardia
-Hyperglycaemia
-Hypokalemia
-Cardiac arrhythmias
• Dosage
-IV magnesium sulphate 4g start. To be
given slowly to prevent flushing or
vomiting.
-Then continuous infusion should be
started at 2g per hour using 5% dextrose.
-The infusion can be titrated up by
increments of 0.5g per hour to a maximum
of 4.0g per hour until adequate tocolysis is
achieved.
-Reduce the rate of infusion if magnesium
toxicity is observed.
Anti-convulsant effect

• Magnesium sulphate is a safe and effective


agent to prevent and treat convulsions in Severe
pre-eclampsia/Eclampsia.
• Can be given by the IM or IV route.
• The mechanism of action is twofold:-
-It interferes with transmission at
neuromuscular junction.
-Also has central nervous system effect
. The hypotensive effect is transient and related to
bolus administration and rapid infussion. A
continuous infusion will not maintain
hypotension’.
Magnesium sulphate regimens for
women with pre-eclampsia and eclampsia
• Zuspan regimen
-Intravenous
-Start with a loading dose of 4g
• Sibai regimen
-Intravenous
-Start with a loading dose of 6g
• Pritchard regimen
-Intramuscular/Intravenous
-Start with a loading dose of 14g
in which 4g given as intravenous
and 10g given as intramuscular
Intravenous(iv)
magnesium sulphate regimen cont
• Sibai regimen
• Loading dose
-6g iv over 20 mins
• Maintenance therapy
- 2-3g per hour
Monitoring during magnesium
sulphate therapy contd
• Loss of patellar reflexes is the first sign of
magnesium sulphate toxicity.
• Respiratory paralysis is the next. (<12/min)
• Renal failure. (<30mls/hr)
• If a seizure occurs within 20minutes after the
loading dose, convulsion is usually short, no
treatment.
• If the seizure occurs more than 20minutes after
the loading dose, an additional 2-4g is given.
Magnesium sulphate blood levels

Blood level Symptoms and signs

4-8mg/dl Therapeutic
9-12mg/dl Nausea, vomiting, flushing,
double vision, slurred speech,
weakness, loss of patellar reflexes,
somnolence, feeling of warmth
15-17mg/dl Muscular paralysis and respiratory
arrest
30-35mg/dl Cardiac arrest
• Anticonvulsant therapy for eclampsia

Magnesium sulphate is inexpensive and


its administration and monitoring are
relatively straightforward without a need
for expensive equipment. Intramuscular
administration can be used when staff with
experience in intravenous administration
and monitoring is not available.
Conclusion
• Magnesium sulfate more than halves the
risk of eclampsia, and probably reduces
the risk of maternal death. A quarter of
women have side-effects, notably flushing.
The lack of clarity on what constitutes
severe pre-eclampsia may render this
intervention difficult to implement. Women
at low risk of pre-eclampsia may not be
suitable candidates for treatment with
magnesium sulfate.