Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece; 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece.
Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece.
Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:158-164. doi: 10.1016/j.ejogrb.2020.11.005. Epub 2020 Nov 10.
Magnesium sulfate (MgSO) is among the most commonly used medications in labor and delivery units. It has been used as a mean to protect against eclampsia and a neuroprotective agent for fetuses at risk of preterm birth. In the present study we investigated its impact in the occurrence of postpartum uterine atony and hemorrhage.
We searched the Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, Clinicaltrials.gov and Google Scholar databases for randomized trials and observational studies. Statistical analysis was performed with the Hartung-Knapp-Sidik-Jonkman model in RStudio using the meta package.
Twelve studies fitted the predetermined criteria and these involved 41,190 women of whom 10,565 (25.6 %) received MgSO The meta-analysis revealed that the risk of postpartum uterine atony was similar among patients that received MgSO and those that did not (OR 1.93, 95 % CI 0.78, 4.81). Estimated blood loss (SMD 0.04, 95 % CI -0.10, 0.18) as well as the risk of postpartum hemorrhage (OR 1.82, 95 % CI 0.99, 3.35) also did not differ. Subgroup analysis revealed that evidence drawn from observational studies indicates a significant effect of MgSO on the odds of postpartum uterine atony and hemorrhage; however, randomized trials do not support this.
The results of our meta-analysis suggest that it is reasonable to consider MgSO4 in women at risk of delivering before the completion of its elimination half-life. However, physicians should be vigilant in cases at risk of postpartum hemorrhage as current data are very heterogeneous and should not be considered as definitive.
硫酸镁（MgSO）是分娩病房中最常用的药物之一。它被用作预防子痫和早产儿神经保护的手段。在本研究中，我们研究了它对产后子宫收缩乏力和出血的影响。
我们在 Medline、Scopus、EMBASE、Cochrane 中央对照试验注册中心（CENTRAL）、Clinicaltrials.gov 和 Google Scholar 数据库中搜索了随机试验和观察性研究。统计分析在 RStudio 中使用 meta 包通过 Hartung-Knapp-Sidik-Jonkman 模型进行。
12 项研究符合预定标准，涉及 41190 名妇女，其中 10565 名（25.6%）接受了 MgSO。Meta 分析显示，接受 MgSO 的患者与未接受 MgSO 的患者产后子宫收缩乏力的风险相似（OR 1.93，95%CI 0.78，4.81）。估计失血量（SMD 0.04，95%CI-0.10，0.18）和产后出血的风险（OR 1.82，95%CI 0.99，3.35）也没有差异。亚组分析表明，来自观察性研究的证据表明 MgSO 对产后子宫收缩乏力和出血的可能性有显著影响；然而，随机试验并不支持这一点。
我们的荟萃分析结果表明，对于那些在硫酸镁消除半衰期结束前分娩风险较高的妇女，考虑使用硫酸镁是合理的。然而，对于有产后出血风险的病例，医生应该保持警惕，因为目前的数据非常不一致，不能被认为是确定的。
