Repeat administration of magnesium for an exacerbation of postpartum preeclampsia: a national survey.

چکیده اصلی

OBJECTIVE: Magnesium (Mg) infusion is the first-line agent for seizure prophylaxis in patients with preeclampsia with severe features (PESF). However, no guidance exists regarding utility of an additional course of Mg for patients with an exacerbation of PESF (defined as an acute worsening of clinical status) who already completed an initial course of Mg. We aimed to determine the national trend among academic institutions for administration of a second course of Mg in patients with an exacerbation of PESF. STUDY DESIGN: A REDCap survey, developed to identify institutional protocols and anticipated response to clinical scenarios related to Mg administration, was sent to Maternal-Fetal Medicine program directors (or surrogate if no response) using publicly available contact information. Participants received a $10 incentive. RESULTS: Responses were received from 66 of 95 institutions (69%), representing all 12 ACOG districts. A standard institutional protocol for postpartum Mg was reported by 70% (N = 46) of respondents, with 85% (N = 56) routinely administering Mg for 24 h. Overall, 68% (N = 45) would give a second course of Mg for an exacerbation of PESF, with no geographic variation (p = 0.969). When faced with specific clinical scenarios, most would administer a second course of Mg if the patient had a headache (N = 52, 79%) or hypertensive urgency with systolic blood pressure (BP) ≥180 mmHg and/or diastolic BP ≥120 mmHg (N = 35, 53%). The decision for a second course of Mg was not influenced by worsening laboratory values, gestational age at delivery, latency from delivery, or maternal demographics. CONCLUSION: Although there are no standardized guidelines for seizure prophylaxis in the setting of postpartum exacerbations of PESF, this national survey suggests that most academic programs favor giving a second course of Mg, especially in patients with headache or severe BP. A randomized trial comparing outcomes in patients who did or did not receive an additional course of Mg is warranted.

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