Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil.
Ana Bezerra University Hospital, Federal University of Rio Grande do Norte, Santa Cruz, Brazil.
BMC Pregnancy Childbirth. 2020 Mar 12;20(1):154. doi: 10.1186/s12884-020-2836-z.
Preeclampsia is a relatively frequent condition during pregnancy and childbirth. The administration of magnesium sulphate as a prophylactic and treatment measure is an evidence-based practice for eclampsia; however, it is not consistently used, compromising the health of pregnant women. This study aimed to assess compliance with recommendations of the International Society for the Study of Hypertension in Pregnancy (ISSHP) for the use of MgSO in pregnant women with preeclampsia, before and after the implementation of the World Health Organization Safe Childbirth Checklist (SCC).
This quasi-experimental study was conducted between July 2015 and July 2016 at a third-level maternity hospital in northeastern Brazil, where the SCC was implemented. Compliance (underuse and overuse of MgSO) was assessed in biweekly samples of 30 deliveries assessed 6 months before and 6 months after SCC implementation, using indicators based on international guidelines. A total of 720 deliveries were assessed over 1 year using an ad hoc application for reviewing medical records. Aggregated adequate use was estimated for the study period, and the time series measurements were compared to a control chart to assess change.
The incidence of preeclampsia was 39.9% (287/720). Among these, 64.8% (186/287) had severe signs or symptoms and needed MgSO. Underuse (no prescription when needed) of MgSO was observed in 74.7% (139/186) of women who needed the drug. Considering all women, non-compliance with the prescription protocol (underuse and overuse) was 20.0% (144/720). After introducing the SCC, the use of MgSO in women with preeclampsia with severe features increased from 19.1 to 34.2% (p = 0.025). Longitudinal analysis showed a significant (p < 0.05) ascending curve of adequate use of MgSO after the SCC was implemented.
Compliance with recommendations for the use of MgSO in preeclampsia was low, but improved after implementation of the SCC. Interventions to improve compliance based on diagnosis and treatment reminders may help in the implementation of this good practice.
子痫前期是妊娠和分娩期间较为常见的病症。硫酸镁作为预防和治疗子痫的手段，是基于证据的实践，但它并未得到一致应用，从而影响了孕妇的健康。本研究旨在评估在实施世界卫生组织安全分娩清单（SCC）前后，国际妊娠高血压学会（ISSHP）推荐使用硫酸镁（MgSO）治疗子痫前期孕妇的建议的依从性。
本准实验研究于 2015 年 7 月至 2016 年 7 月在巴西东北部的一家三级妇产医院进行，该医院实施了 SCC。在 SCC 实施前后的 6 个月内，通过使用基于国际指南的指标，对每两周评估的 30 例分娩中的 30 例进行了 MgSO 用药不足（underuse）和用药过度（overuse）的评估。在 1 年的时间里，使用了专门用于审查病历的应用程序对 720 例分娩进行了评估。对研究期间的总体适当使用进行了估计，并将时间序列测量结果与控制图进行了比较，以评估变化情况。
子痫前期的发病率为 39.9%（287/720）。其中，64.8%（186/287）有严重的症状和体征，需要硫酸镁治疗。在需要该药物的 186 名妇女中，有 74.7%（139/186）出现硫酸镁用药不足（no prescription when needed）。总体而言，不符合处方方案（用药不足和用药过度）的比例为 20.0%（144/720）。在引入 SCC 后，子痫前期伴严重特征的妇女中硫酸镁的使用率从 19.1%增加到 34.2%（p=0.025）。纵向分析显示，在实施 SCC 后，硫酸镁的适当使用率呈现出显著的（p<0.05）上升趋势。
硫酸镁治疗子痫前期的建议的依从性较低，但在实施 SCC 后有所改善。基于诊断和治疗提醒的提高依从性的干预措施可能有助于实施这一良好实践。
