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BMC Pregnancy and Childbirth Jun 2024To establish the population pharmacokinetics (PPK) of magnesium sulfate (MgSO)in women with preeclampsia (PE), and to determine the key covariates having an effect in...
OBJECTIVE
To establish the population pharmacokinetics (PPK) of magnesium sulfate (MgSO)in women with preeclampsia (PE), and to determine the key covariates having an effect in magnesium pharmacokinetics in Chinese PE.
METHODS
Pregnant women with PE prescribed MgSO4 were enrolled in this prospective study from April 2021 to April 2023. On the initial day of administration, the patients were administered a loading dose of 5 g in conjunction with 10 g of magnesium sulfate as a maintenance dose. On the second day, only the maintenance dose was administration, and maternal blood samples were taken at 0, 4, 5, and 12 h after the second day's 10 g maintenance dose. The software Phoenix was used to estimate PPK parameters of MgSO4, such as clearance (CL) and volume of distribution (V), and to model PPK models with patient demographic, clinical, and laboratory covariates.
RESULTS
A total of 199 blood samples were collected from 51 women with PE and PPK profiles were analyzed. The PPK of MgSO is consistent with to a one-compartment model. The base model adequately described the maternal serum magnesium concentrations after magnesium administration. The population parameter estimates were as follows: CL was 2.98 L/h, V was 25.07 L. The model predictions changed significantly with covariates (BMI, creatinine clearance, and furosemide). Furosemide statistically influences V. The creatinine clearance, BMI and furosemide jointly affects CL. Monte Carlo simulation results showed that a loading dose combined with a maintenance dose would need to be administered daily to achieve the therapeutic blood magnesium concentrations. For the non-furosemide group, the optimal dosing regimen was a 5 g loading dose combined with a 10 g maintenance dose of MgSO4. For the furosemide group, the optimal dosing regimen was a 2.5 g loading dose combined with a 10 g maintenance dose of MgSO4.
CONCLUSIONS
The magnesium PPK model was successfully developed and evaluated in Chinese preeclampsia population, and the dose optimization of MgSO was completed through Monte Carlo simulation.
Topics: Humans; Female; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Adult; Prospective Studies; China; Young Adult; Dose-Response Relationship, Drug; East Asian People
PubMed: 38872116
DOI: 10.1186/s12884-024-06620-x -
PloS One 2024In low-resource settings, magnesium sulphate (MgSO4) for preeclampsia is administered majorly through an injection into the gluteal muscles 4-hourly for 24 hours. The... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
INTRODUCTION
In low-resource settings, magnesium sulphate (MgSO4) for preeclampsia is administered majorly through an injection into the gluteal muscles 4-hourly for 24 hours. The repeated injections are very painful and may lead to infection, abscess formation, and reduced compliance.
OBJECTIVE
To determine the acceptability of Springfusor® pump for the administration of Magnesium Sulphate in preeclampsia and eclampsia.
DESIGN
Randomized Open Label Clinical Trial.
METHODS
The study was conducted at Kawempe National Referral Hospital. Eligible women had a systolic blood pressure of ≥140mmHg and or diastolic blood pressure >90mmHg, proteinuria ≥+1, and the physician's decision to start on MgSO4. Four-hundred-ninety-six participants were randomized to a Springfusor® pump group (n = 248) or control (standard of care) (n = 248) administration of MgSO4. Intervention group had a loading dose (4gm of 50% MgSO4 intravenously over 20 minutes) and maintenance therapy (1gm of 50% MgSO4 intravenously per hour for 24 hours) administered using the Springfusor®. The standard of care (SOC) group received a loading dose of 4gm of 20% MgSO4 IV over 15-20 minutes, followed by 10gm of 50% MgSO4 intramuscular (5gm in each buttock) and a maintenance dose of 5gm of 50% MgSO4 was administered IM every 4 hours for 24 hours. Both arms received the rest of the care for preeclampsia/eclampsia as per the hospital guidelines. Acceptability of the method of administration was assessed using a Likert scale (1-5; 1 and 2: acceptable and 3-5: unacceptable). Pain at the site of MgSO4 administration was assessed using a Visual Analogue Scale 1-7, (1 minimal pain and 7 worst pain). Comparisons were assessed with the Chi-square test, Mann Whitney-Wilcoxon test, and Students' t-test.
RESULTS
Intervention arm; was more acceptable than the standard of care arm, (95.3% vs70.3%; p<0.001), had a lower median pain score, (2(CI: 2-2), vs 4(CI: 4-5) p<0.001), and fewer side effects. Maternal mortality was comparable between groups (0.8% in the intervention arm vs 1.2% in the IM arm).
TRIAL REGISTRATION
Trial No PACTR201712002887266 (https://pactr.samrc.ac.za/).
Topics: Humans; Magnesium Sulfate; Female; Pre-Eclampsia; Pregnancy; Eclampsia; Adult; Standard of Care; Young Adult; Injections, Intramuscular
PubMed: 38865319
DOI: 10.1371/journal.pone.0286361 -
Cureus May 2024Despite advances in obstetric care, postpartum eclampsia continues to be a major cause of morbidity and mortality among mothers. Although the most common treatment for...
Despite advances in obstetric care, postpartum eclampsia continues to be a major cause of morbidity and mortality among mothers. Although the most common treatment for eclampsia during the postpartum phase is magnesium sulfate (MgSO4), a small percentage of individuals show resistance to this approach. Clinical challenges arise from MgSO4 resistance, which calls for different approaches to care to avoid unfavorable consequences for mothers. In this case study, we provide a thorough clinical description of a 19-year-old primigravida who gave birth at 37 weeks and developed postpartum eclampsia and did not improve with MgSO4 treatment. This case thus highlights the significance of accurate clinical diagnosis of patients and prompt use of alternative therapy modalities. We also discuss possible approaches to treating this uncommon but serious illness.
PubMed: 38854206
DOI: 10.7759/cureus.60047 -
Brazilian Journal of Anesthesiology... Jun 2024Prior research has established the effectiveness of magnesium in relieving postoperative pain. This article aims to evaluate magnesium sulfate for perioperative... (Review)
Review
BACKGROUND
Prior research has established the effectiveness of magnesium in relieving postoperative pain. This article aims to evaluate magnesium sulfate for perioperative analgesia in adults undergoing general abdominal surgery under general anesthesia.
OBJECTIVE
The primary aim was to assess pain scores at 6 and 24 hours postoperatively in patients receiving magnesium sulfate vs. the control group. Secondary outcomes were postoperative opioid consumption, perioperative complications, and time to rescue analgesia.
METHODS
A comprehensive database search identified studies comparing magnesium sulfate with control in adults undergoing general anesthesia for general abdominal surgery. Using random-effects models, data were presented as mean ± Standard Deviation (SD) or Odds Ratios (OR) with corresponding 95% Confidence Intervals (95% CI). A two-sided p-value < 0.05 was considered statistically significant.
RESULTS
In total, 31 studies involving 1762 participants met the inclusion criteria. The magnesium group showed significantly lower postoperative pain scores at both early (within six hours) and late (up to 24 hours) time points compared to the control group. The early mean score was 3.1 ± 1.4 vs. 4.2 ± 2.3, and the late mean score was 2.3 ± 1.1 vs. 2.7 ± 1.5, resulting in an overall Mean Difference (MD) of -0.72; 95% CI -0.99, -0.44; p < 0.00001. The magnesium group was associated with lower rates of postoperative opioid consumption and shivering and had a longer time to first analgesia administration compared to the saline control group.
CONCLUSION
Magnesium sulfate administration was linked to reduced postoperative pain and opioid consumption following general abdominal surgery.
PubMed: 38848810
DOI: 10.1016/j.bjane.2024.844524 -
Annals of Medicine and Surgery (2012) Jun 2024Pre-eclampsia and eclampsia are medical conditions that can cause severe complications, such as maternal and foetal morbidity and mortality. This study aimed to assess...
The silent threat: investigating the incidence and clinical characteristics of pre-eclampsia and eclampsia in women from tertiary care hospitals of the Democratic Republic of Congo.
BACKGROUND
Pre-eclampsia and eclampsia are medical conditions that can cause severe complications, such as maternal and foetal morbidity and mortality. This study aimed to assess the incidence and characteristics of pre-eclampsia and eclampsia.
METHODS
From July 2021 to July 2022, the authors conducted a retrospective, cross-sectional, descriptive study in the Department of Obstetrics and Gynaecology of a tertiary care hospital in the Democratic Republic of the Congo (DR Congo). Out of 1236 total deliveries, 40 patients aged 18-35 years with pre-eclampsia and/or eclampsia with complete data in medical records were studied.
RESULTS
In the studied group, 3.23% of women (40 cases) experienced pre-eclampsia or eclampsia, with the majority (75%, 30 cases) occurring before childbirth. Among these, 62.5% (25 cases) were first-time mothers. The main complications observed in the mothers included HELLP syndrome and placental abruption, whereas their newborns frequently exhibited delayed in-utero growth. Caesarean delivery was the prevalent birthing method, and the treatments most often used for effective management were magnesium sulfate and nicardipine.
CONCLUSION
The research highlights the common occurrence of eclampsia among patients in the DRC and stresses the critical need for prompt detection of hypertensive complications during pregnancy, aiming to reduce negative health impacts on both mothers and their children.
PubMed: 38846848
DOI: 10.1097/MS9.0000000000002087 -
Medical Science Monitor : International... Jun 2024BACKGROUND Severe pre-eclampsia (sPE) and postpartum hemorrhage (PPH) in pregnancy have serious impact on maternal and fetal health and life. Co-occurrence of sPE and...
BACKGROUND Severe pre-eclampsia (sPE) and postpartum hemorrhage (PPH) in pregnancy have serious impact on maternal and fetal health and life. Co-occurrence of sPE and PPH often leads to poor pregnancy outcomes. We explored risk factors associated with PPH in women with sPE. MATERIAL AND METHODS This retrospective study included 1953 women with sPE who delivered at the Women's Hospital of Nanjing Medical University between April 2015 and April 2023. Risk factors for developing PPH in sPE were analyzed, and subgroups were analyzed by delivery mode (cesarean and vaginal). RESULTS A total of 197 women with PPH and 1756 women without PPH were included. Binary logistic regression results showed twin pregnancy (P<0.001), placenta accreta spectrum disorders (P=0.045), and placenta previa (P<0.001) were independent risk factors for PPH in women with sPE. Subgroup analysis showed risk factors for PPH in cesarean delivery group were the same as in the total population, but vaginal delivery did not reduce risk of PPH. Spinal anesthesia reduced risk of PPH relative to general anesthesia (P=0.034). Vaginal delivery group had no independent risk factors for PPH; however, magnesium sulfate (P=0.041) reduced PPH incidence. CONCLUSIONS Women with twin pregnancy, placenta accreta spectrum disorders, placenta previa, and assisted reproduction with sPE should be alerted to the risk of PPH, and spinal anesthesia should be preferred in cesarean delivery. Magnesium sulfate should be used aggressively in women with sPE; however, the relationship between magnesium sulfate and PPH risk needs further investigation.
Topics: Humans; Female; Pregnancy; Risk Factors; Postpartum Hemorrhage; Retrospective Studies; Adult; Pre-Eclampsia; Cesarean Section; China; Placenta Previa; Delivery, Obstetric; Pregnancy, Twin; Placenta Accreta; Pregnancy Outcome; Logistic Models; Incidence
PubMed: 38845159
DOI: 10.12659/MSM.943772 -
Scientific Reports Jun 2024Optimizing the injection water salinity could present a cost-effective strategy for improving oil recovery. Although the literature generally acknowledges that...
Optimizing the injection water salinity could present a cost-effective strategy for improving oil recovery. Although the literature generally acknowledges that low-salinity improves oil recovery in laboratory-scale experiments, the physical mechanisms behind it are controversial. While most experimental low-salinity studies focus on brine composition, this study investigated the influence of carbonate rock material on surface charge change, wettability alteration, and spontaneous imbibition behavior. Zeta potential measurements showed that each tested carbonate rock material exhibits characteristic surface charge responses when exposed to Formation-water, Seawater, and Diluted-seawater. Moreover, the surface charge change sensitivity to calcium, magnesium, and sulfate ions varied for the tested carbonate materials. Spontaneous imbibition tests led to high oil recovery and, thus, wettability alteration towards water-wet conditions if the carbonate-imbibing brine system's surface charge decreased compared to the initial zeta potential of the carbonate Formation-water system. In the numerical part of the presented study, we find that it is essential to account for the location of the shear plane and thus distinguish between the numerically computed surface charge and experimentally determined zeta potential. The resulting model numerically reproduced the experimentally measured calcium, magnesium, and sulfate ion impacts on zeta potential. The spontaneous imbibition tests were history-matched by linking surface charge change to capillary pressure alteration. As the numerical simulation of the laboratory-scale spontaneous imbibition tests is governed by molecular diffusion (with a time scale of weeks), we conclude that molecular diffusion-driven field scale wettability alteration requires several hundred years.
PubMed: 38844778
DOI: 10.1038/s41598-024-63317-z -
Pakistan Journal of Medical Sciences 2024To compare the response between different doses of nebulized magnesium sulphate along with Salbutamol in children between two to 12 years of age with status asthmaticus.
OBJECTIVES
To compare the response between different doses of nebulized magnesium sulphate along with Salbutamol in children between two to 12 years of age with status asthmaticus.
METHODS
This single blinded, randomized clinical trial was carried out at the Department of Pediatrics, Dr. Ziauddin University Hospital, Karachi, Pakistan during October 2021 to September 2022. A total of 104 children aged between 2-12 years, with the diagnosis of asthma having "Pediatric Rapid Assessment Measure (PRAM)" score>4 and with reactive airways were included. Children either received three back-to-back nebulization with salbutamol solution only (n=50) or salbutamol and MgSO4 with three different doses (250mg, 500mg or 750mg) after every 20 minutes for 60 minutes. The PRAM score was used as an assessment tool to clinically score asthma.
RESULTS
In a total of 104 children, 53 (51.0%) were girls. The mean age was 5.25±2.86 years. No statistically significant difference was found in PRAM scores at baseline (p=0.448) and at 20-minutes (p=0.072) but significant differences were observed at 40-minutes (p=0.009), 60-minutes (p=0.011), 120-minutes (p=0.010), 6-hours (=0.034), 12-hours (p=0.018), 18-hours (p=0.033) and at 24-hours (p=0.029). The reduction in PRAM scores from baseline to 24-hours following treatment among Salbutamol, Salbutamol+ MgSo4 250mg, Salbutamol+ MgSo4 500mg and Salbutamol+ MgSo4 750mg group were 6.53±1.09, 7.22±1.09, 6.85±1.43 and 7.57±1.06 respectively (p=0.007).
CONCLUSION
While children with status asthmaticus managed using salbutamol, with or without nebulized MgSO4, showed improved clinical outcomes, combining salbutamol with higher dosages of nebulized MgSO4 resulted in even greater clinical improvement. https://clinicaltrials.gov/ct2/show/NCT04929626.
PubMed: 38827880
DOI: 10.12669/pjms.40.5.7682 -
Pakistan Journal of Medical Sciences 2024To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate.
OBJECTIVE
To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate.
METHODS
A retrospective analysis was conducted on the clinical data of 80 patients with severe preeclampsia admitted to Hefei Second People's Hospital, China from January 2019 to December 2020. Treatment records showed that 40 cases received magnesium sulfate treatment (single group), and 40 cases received enoxaparin sodium combined with magnesium sulfate treatment (combination group). Levels of D-dimer, soluble fms-like tyrosine kinase 1 (sFlt-1), (PLGF), Apgar scores of newborns delivered before and after treatment were compared. Gestation weeks and incidence of adverse reactions were analyzed.
RESULTS
After treatment, levels of D-dimer, sfit-1 and adverse reactions in the combination group were significantly lower than those in the single group (<0.05), and the level of PLGF, newborn Apgar score and length of gestation were significantly higher than those in the single group (<0.05).
CONCLUSION
Compared to magnesium sulfate alone, the combination of enoxaparin sodium and magnesium sulfate in the treatment of pregnant women with severe preeclampsia can more effectively regulate the cytokine level of patients, improve pregnancy outcome, and improve neonatal Apgar score. The incidence of adverse reactions is low, making it a safe and efficient treatment modality.
PubMed: 38827871
DOI: 10.12669/pjms.40.5.9001 -
Experimental and Therapeutic Medicine Jul 2024Models of inflammation, oxidative stress, hyperoxia and hypoxia have demonstrated that magnesium sulfate (MgSO), a commonly used drug in obstetrics, has neuroprotective...
Models of inflammation, oxidative stress, hyperoxia and hypoxia have demonstrated that magnesium sulfate (MgSO), a commonly used drug in obstetrics, has neuroprotective potential. In the present study, the effects of MgSO treatment on inflammation, oxidative stress and fetal brain histopathology were evaluated in an experimental rat model following sevoflurane (Sv) exposure during the mid-gestational period. Rats were randomly divided into groups: C (control; no injections or anesthesia), Sv (exposure to 2.5% Sv for 2 h), MgSO (administered 270 mg/kg MgSO intraperitoneally) and Sv + MgSO (Sv administered 30 min after MgSO injection). Inflammatory and oxidative stress markers were measured in the serum and neurotoxicity was investigated histopathologically in fetal brain tissue. Short-term mid-gestational exposure to a 1.1 minimum alveolar concentration of Sv did not significantly increase the levels of any of the measured biochemical markers, except for TNF-α. Histopathological evaluations demonstrated no findings suggestive of pathological apoptosis, neuroinflammation or oxidative stress-induced cell damage. MgSO injection prior to anesthesia caused no significant differences in biochemical or histopathological marker levels compared to the C and Sv groups. The present study indicated that short-term exposure to Sv could potentially be considered a harmless external stimulus to the fetal brain.
PubMed: 38827470
DOI: 10.3892/etm.2024.12574