Shennan Andrew, Suff Natalie, Jacobsson Bo, Simpson Jo Leigh, Norman Jane, Grobman William A., Bianchi Ana, Mujanja Stephen, Valencia Catalina M., Mol Ben W.
Department of Women and Children's Health, King's College, London, UK
Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Int J Gynaecol Obstet. 2021 Oct;155 Suppl 2(1):31-532. doi: 10.1002/ijgo.13884.
In women at risk of early preterm imminent birth, from viability to 30 weeks of gestation, use of MgSO4 for neuroprotection of the fetus is recommended. In pregnancies below 32–34 weeks of gestation, the use of MgSO4 for neuroprotection of the fetus should be considered. MgSO4 should be administered regardless of the cause for preterm birth and the number of babies in utero. MgSO4 should be administered when early preterm birth is planned or expected within 24 h. When birth is planned, MgSO4 should commence as close as possible to 4 h before birth. If delivery is planned or expected to occur sooner than 4 h, MgSO4 should be administered, as there is still likely to be an advantage from administration within this time. The optimal regimen of MgSO4 for fetal neuroprotection is an intravenous loading dose of 4 g (administered slowly over 20–30 min), followed by a 1 g per hour maintenance dose. This regimen should continue until birth but should be stopped after 24 h if undelivered. When MgSO4 is administered, women should be monitored for clinical signs of magnesium toxicity at least every 4 h by recording pulse, blood pressure, respiratory rate, and deep tendon (for example, patellar) reflexes.
对于有早期早产即将分娩风险的女性，从胎儿可存活至妊娠30周，推荐使用硫酸镁进行胎儿神经保护。对于妊娠32 - 34周以下的孕妇，应考虑使用硫酸镁进行胎儿神经保护。无论早产原因及子宫内胎儿数量如何，均应给予硫酸镁。当计划或预计在24小时内发生早期早产时，应给予硫酸镁。当计划分娩时，硫酸镁应在分娩前尽可能接近4小时开始使用。如果计划或预计分娩时间早于4小时，仍应给予硫酸镁，因为在此时间段内给药仍可能有益。用于胎儿神经保护的硫酸镁最佳方案是静脉负荷剂量4克（在20 - 30分钟内缓慢给药），随后每小时维持剂量1克。该方案应持续至分娩，但如果未分娩，24小时后应停药。使用硫酸镁时，应至少每4小时通过记录脉搏、血压、呼吸频率和深腱反射（如髌反射）监测女性镁中毒的临床症状。
