Magnesium Sulphate In Preterm Labour

Magnesium Sulphate In Preterm Labour – Magnesium sulfate is an acceptable intervention for fetal neuroprotection. Some differences have been observed in international recommendations regarding the use of magnesium sulfate for neuroprotective protection of the fetus during preterm labor.

This systematic review analyzes the available clinical guidelines for the use of magnesium sulfate for fetal neuroprotection and compares the guidelines by assessing the quality of the guidelines. It provides consensus, differences, and explores areas for future collaborative research We searched databases from PUBMED, EMBASE, COCHRANE, WebScience, LILACS; and includes national and international medical treatment guidelines We’ve included seven recommendations from 227 search results We assessed the quality of guidelines using the Tool for Research and Evaluation of Guidelines (AGREE II) to derive guidelines, recommendations, and the supporting evidence base.

Magnesium Sulphate In Preterm Labour

Five recommendations are of high quality and two of medium quality One method scored above 80% in all domains of the AGREE II instrument All guidelines recommend the use of magnesium sulfate for neuroprotective fetal protection. However, there are differences in other recommendations such as higher gestational age, age, duration, repeated treatments and use of additional tocolytics.

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Future guidelines should include recommendations on all aspects of magnesium sulfate therapy for fetal neuroprotection. Future research and international collaboration should focus on areas where there is no international consensus.

Preterm birth, both spontaneous and iatrogenic, is associated with a greater risk of neonatal morbidity and mortality. Although the survival rate of preterm infants has increased, there is still a risk of medical complications and neurodevelopmental impairment. The higher the gestational age, the greater the risk Intrauterine insults such as infection, inflammation, hypoxic ischemic encephalopathy and low birth weight are other risk factors associated with neurodevelopmental defects [3], [4], [5]. The most relevant neurological outcomes are cerebral palsy and cognitive impairment Infants born before 30 weeks have a 30-80 times increased risk of cerebral palsy compared to term infants [4], [6], [7]. Other neurodegenerative diseases include blindness, deafness, gross motor disorders, learning difficulties and developmental delays [6], [8], [9].

Several clinical studies and systematic reviews have evaluated the benefits and harms of prenatal administration of magnesium sulfate for fetal neuroprotection [5], [10], [11], [12], [13], [14], [15], [16]. , 17, 18, 19, 20. However, benefits, maternal and fetal side effects, appropriate dosage and duration of administration, and appropriate gestational age at which interventions are beneficial [21], [22]

Guidelines are systematically developed statements based on the best available evidence Evidence-based guidelines are developed to help health care providers achieve optimal outcomes for their patients Development of effective guidelines requires authors to follow standard development methods and strong methodological quality The purpose of this systematic review is to critically evaluate and systematically evaluate national and international clinical guidelines for the use of magnesium sulfate antenatal neuroprotective therapy and to compare the guidelines, evidence base, and assess the quality of the guidelines. This will help identify international consensus, differences and areas for future collaborative research

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An objective protocol, guideline selection criteria and outcome assessment methods were registered with PROSPERO (International Prospective Register of Systematic Reviews) (Centre for Review and Dissemination; CRD42017071491, University of York, UK). This review was reported in accordance with the Required Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [26], [27].

The first literature search was conducted by the clinical librarian (KN), and then the validity of the search was compared independently by the first and second authors (PJ and MM). Electronic databases of PUBMED, EMBASE, COCHRANE, LILACS and Web of Science databases were searched for relevant guidelines using the keywords “preterm”, “magnesium sulfate”, “fetal neuroprotection” and “guideline”. In addition, guideline websites such as National Guidelines Clearhouse, National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network and Association of Obstetrics and Gynecology or American College of Obstetrics and Gynecology professional associations, Royal College of Obstetricians Specialists and gynecologists, the Canadian Association of Obstetricians and Gynecologists, the American Academy of Family Physicians (AAFP), the Belgian Center for Healthcare Knowledge and the World Health Organization asked for more guidance.

All titles and abstracts were independently screened by two authors (PJ and MM) to select relevant guidelines according to specific title criteria, and group consensus was reached by two lead authors (PJ and MM) for joint guidelines. Two primary reviewers then independently screened the full content of all selected guidelines and rigorously assessed them for eligibility according to the inclusion and exclusion criteria below. Disagreements between examiners were resolved through discussion

Multidisciplinary clinical guidelines on the use of magnesium sulfate for fetal neuroprotection purposes were included with the following criteria and exclusions.

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Each recommendation was followed by a detailed analysis to describe common features and recommendations Selected guidelines were reviewed for general characteristics such as year of publication, update if they were part of a previous guideline or part of a separate guideline, number of guidelines, level of evidence for the guideline, and classification of the guideline [28].

The following predefined guideline domains include: use of magnesium sulfate for fetal neuroprotection, high gestational age for magnesium sulfate use, recommended dose and duration, use of magnesium sulfate regardless of cause of preterm birth and quality, recommended dose. If the patient does not deliver within 24 hours, discontinuation of other tocolytics containing magnesium sulfate is recommended and management of adverse effects is recommended. A recently published systematic review on preterm birth guidelines included international, national and regional guidelines and assessed all general aspects of preterm birth. Regarding the use of magnesium sulfate, a previously published review contained only one question: “If magnesium sulfate is not or is not recommended prenatally for fetal neuroprotection”. This current systematic review aimed at an in-depth evaluation of national and international guidelines, with a specific focus on the use of magnesium sulfate for fetal neuroprotection, which is an important and current issue. We reviewed 9 recommendations in each overall recommendation

The Assessment of Research Guidelines and Evaluation (AGREE II) was used to assess the methodological quality of each guideline [30], [31]. Appraisals were conducted on the online appraisal tool per the AGREE II guidelines (http://www.agreetrust.org/appraisal). Each of the 23 items in the six domains of the AGREE II instrument was rated on a seven-point response scale based on critical methodological principles. A score of 1 indicates that there is no information or that the concept is very poorly reported A score of 7 means that the quality of the report is exceptional, and that all criteria and considerations specified in the user manual are met. A score between 2 and 6 indicates that the Agree II items do not meet reporting criteria or are considered incomplete. The percentage of maximum score in each domain was calculated The guidelines were reviewed and scored by two authors (PJ and MM) and any differences were resolved by consensus and discussion with the senior author (SL).

Recommendation scores are determined by completing pre-defined domains and criteria Using the deterministic equation Guidelines were classified as low quality (0–33%), moderate quality (34–66%) and high quality (67–100%).

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A literature search of electronic databases and websites of relevant professional organizations yielded 227 results. After screening, titles and abstracts were reviewed against inclusion and exclusion criteria and the exclusion of nine full papers. Two were excluded because they were committee opinions or had no recommendations for magnesium sulfate for fetal neuroprotection [32], [33]. The systematic review included seven recommendations All this

Three of the seven guidelines (ANZ, SOGC, RCPI) have separate guidelines on the use of magnesium sulfate for fetal neuroprotection. In the remaining four guidelines, magnesium sulfate for fetal neuroprotection is included in general guidelines for prevention and management of preterm birth. Publication years range from 2010 to 2017 RCPI Guidelines are the only version (2013). All recommendations are from professional bodies Details of instructional characteristics are presented in Table 1

All seven guidelines reviewed recommend the use of magnesium sulfate for fetal neuroprotection during early labor. The recommendation to use magnesium sulfate is the first of all recommendations Level 1 of evidence and GRADE recommendation is level A, in three guidelines (SOGC, ANC, CNGOF), intermediate level of evidence and strong recommendation is reported by WHO and high level of evidence and strong recommendation is given. KCE. Other guidelines do not report levels of evidence and GRADE for guidelines Recommendation number varies from 1 to 11 Two recommendations with one recommendation are recommendations for magnesium sulfate use, maximum gestational age, and duration of use. Of the six guidelines, the maximum gestational age for magnesium sulfate use is 32 weeks, while the NICE guidelines recommend giving up to 29 weeks + 6 days.

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