Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Obstestrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.
J Matern Fetal Neonatal Med. 2022 Oct;35(20):3853-3859. doi: 10.1080/14767058.2020.1841162. Epub 2020 Nov 12.
Magnesium sulfate is standard of care for prevention of eclampsia in women with preeclampsia with severe features. The American College of Obstetrics and Gynecology endorses its use throughout labor, delivery and the immediate postpartum period. Some providers pause magnesium sulfate infusion preoperatively due to concern for increased risk of uterine atony and postpartum hemorrhage. Using a non-inferiority analysis, we investigated the effect of interrupted versus continuous infusion of magnesium sulfate on postpartum hemorrhage in women with preeclampsia with severe features undergoing cesarean delivery.
Retrospective non-inferiority cohort study of women with preeclampsia with severe features treated with magnesium sulfate undergoing cesarean delivery with singleton pregnancies at tertiary care hospital from 2013 to 2018. The primary outcome was postpartum hemorrhage. Secondary outcomes included estimated blood loss, change in hematocrit and a composite of postpartum hemorrhage severity, including transfusion of blood products, use of more than one uterotonic and additional surgical interventions.
Of 249 women, magnesium sulfate infusion was interrupted in 171 (69%) and continued in 78 (31%). Women with interrupted magnesium sulfate infusion were more likely to be Caucasian (73% vs 67%, = .024), have chronic hypertension (23% vs 1%, < .001), labor prior to cesarean delivery (84% vs 55%, < .001), undergo primary cesarean delivery (86% vs 67%, = .005), and experience shorter surgical time (50 vs 55 min, = .026). The rate of postpartum hemorrhage for those receiving interrupted magnesium sulfate infusion (9.9%) and continuous magnesium sulfate infusion (10.2%) was similar, falling within the non-inferiority margin (absolute difference 0.3%, 95% CI -7.8 to 8.4%, = .88). There were no significant differences in the secondary outcomes.
Interrupted magnesium sulfate infusion is non-inferior to continued magnesium sulfate infusion for rates of postpartum hemorrhage in women with preeclampsia with severe features undergoing cesarean delivery.
硫酸镁是子痫前期严重特征妇女子痫预防的标准治疗方法。美国妇产科医师学会支持在整个分娩、分娩和产后立即使用硫酸镁。由于担心子宫收缩乏力和产后出血的风险增加，一些提供者在术前暂停硫酸镁输注。通过非劣效性分析，我们研究了间断与连续输注硫酸镁对行剖宫产术的子痫前期严重特征妇女产后出血的影响。
这是一项回顾性非劣效性队列研究，纳入了 2013 年至 2018 年在三级保健医院接受硫酸镁治疗并接受单胎剖宫产术的子痫前期严重特征妇女。主要结局是产后出血。次要结局包括估计失血量、血细胞比容变化以及产后出血严重程度的综合指标，包括输血、使用一种以上的子宫收缩剂和额外的手术干预。
在 249 名妇女中，171 名（69%）中断了硫酸镁输注，78 名（31%）继续输注。中断硫酸镁输注的妇女更有可能是白人（73%比 67%， = .024），患有慢性高血压（23%比 1%， < .001），在剖宫产前临产（84%比 55%， < .001），行原发性剖宫产（86%比 67%， = .005），手术时间更短（50 比 55 分钟， = .026）。接受间断硫酸镁输注（9.9%）和连续硫酸镁输注（10.2%）的妇女产后出血率相似，均在非劣效性范围内（绝对差值 0.3%，95%CI-7.8 至 8.4%， = .88）。次要结局无显著差异。
在接受剖宫产术的子痫前期严重特征妇女中，间断输注硫酸镁与连续输注硫酸镁相比，产后出血发生率无显著差异。
