What is the role of magnesium sulfate in the management of premature rupture of membranes (PROM)?

Updated: Oct 05, 2018
  • Author: Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM; Chief Editor: Carl V Smith, MD  more...
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Many large clinical studies have evaluated neuroprotective benefits from exposure to magnesium sulfate in preterm neonates. The studies show a reduction in cerebral palsy in surviving infants who were exposed to magnesium. None of the individual studies found a benefit with regard to their primary outcome. However, available evidence suggests that magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants, [27, 28] Physicians electing to use magnesium sulfate for fetal neuroprotection should develop specific guidelines regarding inclusion criteria, treatment regimens, concurrent tocolysis, and monitoring in accordance with one of the larger trials. [29]

In these studies, 12-24 hours of exposure was used with either a 4- or 6-g bolus and a maintenance dose of 1-2 g. These findings should be discussed with patients undergoing expectant management of PROM. [30]

Note that antenatal administration of magnesium sulfate in preterm children (at risk of being delivered at ≥24.0 weeks' gestation) in the setting of chorioamnionitis does not appear to provide neuroprotection. [31]

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