Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Division of Neonatology, Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta Obstet Gynecol Scand. 2023 Dec;102(12):1741-1748. doi: 10.1111/aogs.14673. Epub 2023 Sep 8.
The risk for brain injury manifested as cerebral palsy is higher in very preterm born children than in term. Prenatal administration of magnesium sulfate (MgSO ) has been shown to be neuroprotective and reduces the proportion of very preterm born children later diagnosed with cerebral palsy. A Swedish national clinical practice guideline was implemented in March 2020, stipulating the administration of a single intravenous dose of 6 g MgSO 1-24 h prior to delivery before gestational age 32+0, aiming for 90% treatment coverage. The aim of this study was to evaluate the feasibility of this new clinical practice guideline in the first year of its implementation.
Data on MgSO treatment were collected by reviewing the medical charts of women who gave birth to live born children in gestational age 22+0-31+6 during the period of March 1, 2020 to February 28, 2021, at five Swedish university hospitals. Women with pre-eclampsia, eclampsia, or high elevated liver enzymes low platelets (HELLP) were excluded.
A total of 388 women were eligible and 79% received treatment with MgSO . Of the 21% not receiving treatment, 9% did not receive treatment due to lack of knowledge about the clinical practice guideline, 9% were not possible to treat and 3% had missing data. The proportion treated increased from 72% to 87% from the first to the last 3 months. Of those treated, 81% received the drug within the stipulated timeframe (mean 8.7 h, median 3.4 h).
There was a positive trend over time in the proportion of women receiving MgSO treatment, but the a priori target of 90% was not reached during the first year of implementation. Our findings indicate that this target could be reached with additional information to clinicians.
与足月出生的儿童相比，极早产儿发生脑瘫等脑损伤的风险更高。产前给予硫酸镁（MgSO ）治疗已被证明具有神经保护作用，并降低了极早产儿日后被诊断为脑瘫的比例。2020 年 3 月，瑞典发布了一项全国性的临床实践指南，规定在妊娠 32+0 周前，对胎龄在 22+0-31+6 周的孕妇，在分娩前 1-24 小时内给予单剂 6 g 静脉硫酸镁治疗，目标是实现 90%的治疗覆盖率。本研究旨在评估该新临床实践指南在实施的第一年的可行性。
通过回顾 2020 年 3 月 1 日至 2021 年 2 月 28 日期间在瑞典五所大学医院分娩的胎龄为 22+0-31+6 的活产儿母亲的病历，收集硫酸镁治疗的数据。排除患有子痫前期、子痫或高肝功能酶低血小板（HELLP）的女性。
共有 388 名女性符合条件，其中 79%接受了硫酸镁治疗。在未接受治疗的 21%的女性中，9%由于不了解临床实践指南而未接受治疗，9%因无法治疗，3%因数据缺失而未接受治疗。从第一个月到最后一个月，接受治疗的比例从 72%增加到 87%。在接受治疗的女性中，81%在规定的时间内（平均 8.7 h，中位数 3.4 h）接受了药物治疗。
随着时间的推移，接受硫酸镁治疗的女性比例呈上升趋势，但在实施的第一年未达到 90%的预设目标。我们的研究结果表明，通过向临床医生提供更多信息，可以达到这一目标。
