A Quantitative Investigation of Intrapartum Parenteral Magnesium Sulfate as an Independent Risk Factor for Postpartum Hemorrhage. Journal Article

Local Library Link: Find It @ Loyola

Authors: Dhillon, N; Nashif, S; Holthaus, E; Alrahmani, L; Goodman, JR
Article Title: A Quantitative Investigation of Intrapartum Parenteral Magnesium Sulfate as an Independent Risk Factor for Postpartum Hemorrhage.
Abstract: BACKGROUND: Magnesium sulfate is used for seizure prophylaxis in preeclampsia and for fetal neuroprotection when delivery is anticipated before 32 weeks. Existing risk assessment tools for postpartum hemorrhage (PPH) often identify magnesium as an intrapartum risk factor. Prior studies examining the association between magnesium and PPH have relied largely on qualitative rather than quantitative estimates of blood loss. OBJECTIVE: The aim of this study was to determine if intrapartum magnesium is associated with increased risk of PPH using a quantitative blood loss (QBL) assessment via the use of graduated drapes and weight differences in surgical supplies. STUDY DESIGN: We conducted a retrospective cohort study to test the hypothesis that intrapartum parenteral magnesium is not independently associated with PPH. All deliveries at our tertiary level academic medical center between July 2017 and June 2018 were reviewed. Two categories of PPH were defined: the traditional definition (>500cc for vaginal, >1000cc for cesarean section) and the contemporary definition (>1000cc regardless of delivery mode). Statistical analyses using Chi-squared test, Fisher's exact test, t-test, or Wilcoxon rank sum test were used to compare between patients who did and did not receive magnesium, with regards to rates of PPH, pre and post delivery hemoglobin, and rates of blood transfusion. RESULTS: 1318 deliveries were included, with PPH rates of 12.2% (traditional definition) and 6.2% (contemporary definition). Multivariate logistic regression did not find magnesium an independent risk factor by either definition (OR 1.44, 95% CI 0.87- 2.38; OR 1.34, 95% CI 0.71-2.54). The only significant independent risk factor was cesarean delivery, by both definitions (OR 2.71, 95% CI 1.85-3.98; OR 19.34, 95% CI 8.55-43.72). CONCLUSIONS: In our population, intrapartum magnesium was not found to be an independent risk factor for PPH. Cesarean section was confirmed as an independent risk factor, consistent with previous reports.
Journal Title: American journal of obstetrics gynecology MFM
Publisher: Unknown  
Date Published: 2023