The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Dwight J. Rouse - One of the best experts on this subject based on the ideXlab platform.
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association of duration of neuroprotective Magnesium Sulfate infusion with neonatal and maternal outcomes
Obstetrics & Gynecology, 2014Co-Authors: Jessica A Mcpherson, Dwight J. Rouse, William A Grobman, Anna Palatnik, David M StamilioAbstract:OBJECTIVE:To evaluate the association of duration of Magnesium Sulfate infusion with stillbirth or death, cerebral palsy, and select adverse maternal and neonatal outcomes.METHODS:This is a secondary cohort analysis of women randomized to receive Magnesium Sulfate within a previously reported Matern
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Magnesium Sulfate as a tocolytic agent.
Seminars in Perinatology, 2001Co-Authors: Patrick S. Ramsey, Dwight J. RouseAbstract:Although Magnesium Sulfate is widely used as a tocolytic agent in the hope of preventing spontaneous preterm birth, there is a paucity of data from large well-designed randomized, clinical studies demonstrating the efficacy of Magnesium Sulfate therapy. Given the potential for untoward side effects and the inherent risks of Magnesium Sulfate therapy, a thorough understanding of the potential risks and benefits of this agent is needed. To accomplish this understanding we have provided a detailed, review the history, pharmacology, physiology, maternal/fetal side effects, and tocolytic efficacy of Magnesium Sulfate.
Bahaeddine M Sibai - One of the best experts on this subject based on the ideXlab platform.
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Magnesium Sulfate prophylaxis in preeclampsia lessons learned from recent trials
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Bahaeddine M SibaiAbstract:In the US, the routine use of Magnesium Sulfate for seizure prophylaxis in women with preeclampsia is an ingrained obstetric practice. During the past decade, several observational studies and randomized trials have described the use of various regimens of Magnesium Sulfate to prevent or reduce the rate of seizures and complications in women with preeclampsia. There are only 2 double-blind, placebo-controlled trials evaluating the use of Magnesium Sulfate in mild preeclampsia. There were no instances of eclampsia among 181 women assigned to placebo, and there were no differences in the percentage of women who progressed to severe preeclampsia (12.5% in Magnesium group vs 13.8% in the placebo group, relative risk [RR] 0.90; 95% CI 0.52-1.54). However, the number of women enrolled in these trials is too limited to draw any valid conclusions. There are 4 randomized controlled trials that compare the use of no Magnesium Sulfate, or a placebo vs Magnesium Sulfate, to prevent convulsions in patients with severe preeclampsia. The rate of eclampsia was 0.6% among 6343 patients assigned to Magnesium Sulfate vs 2.0 % among 6330 patients assigned to a placebo or control (RR 0.39; 95% CI 0.28-0.55). However, the reduction in the rate of eclampsia was not associated with a significant benefit in either maternal or perinatal outcome. In addition, there was a higher rate of maternal respiratory depression among those assigned Magnesium Sulfate (RR 2.06; 95% CI 1.33-3.18). The evidence to date confirms the efficacy of Magnesium Sulfate in reduction of seizures in women with eclampsia and severe preeclampsia; however, this benefit does not affect overall maternal and perinatal mortality and morbidities. The evidence regarding the benefit-to-risk ratio of Magnesium Sulfate prophylaxis in mild preeclampsia remains uncertain, and does not justify its routine use for that purpose.
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Magnesium Sulfate therapy in preeclampsia and eclampsia.
Obstetrics & Gynecology, 1998Co-Authors: Andrea G. Witlin, Bahaeddine M SibaiAbstract:OBJECTIVE: To review the available evidence regarding efficacy, benefits, and risks of Magnesium Sulfate seizure prophylaxis in women with preeclampsia or eclampsia. DATA SOURCES: The English-language literature in MEDLINE was searched from 1966 through February 1998 using the terms "Magnesium Sulfate," "seizure," "preeclampsia," "eclampsia," and "hypertension in pregnancy." Reviews of bibliographies of retrieved articles and consultation with experts in the field provided additional references. METHODS OF STUDY SELECTION: All relevant English-language clinical research articles retrieved were reviewed. Randomized controlled trials, retrospective reviews, and observational studies specifically addressing efficacy, benefits, or side effects of Magnesium Sulfate therapy in preeclampsia or eclampsia were chosen. TABULATION, INTEGRATION, AND RESULTS: Nineteen randomized controlled trials, five retrospective studies, and eight observational reports were reviewed. The criteria used for inclusion were as follows: randomized controlled trials evaluating use of Magnesium Sulfate in eclampsia, preeclampsia, and hypertensive disorders of pregnancy; nonrandomized studies of historical interest; "classic" observational studies; and recent retrospective studies evaluating efficacy of Magnesium Sulfate therapy, using relative risk and 95% confidence intervals where applicable. Magnesium Sulfate therapy has been associated with increased length of labor, increased cesarean delivery rate, increased postpartum bleeding, increased respiratory depression, decreased neuromuscular transmission, and maternal death from overdose. A summary of randomized, controlled trials in women with eclampsia reveals recurrent seizures in 216 (23.1%) of 935 women treated with phenytoin or diazepam, compared with recurrent seizures in only 88 (9.4%) of 932 Magnesium-treated women. Randomized controlled trials in women with severe preeclampsia collectively revealed seizures in 22 (2.8%) of 793 women treated with antihypertensive agents, compared with seizures in only seven of 815 (0.9%) Magnesium-treated women. CONCLUSION: The evidence to date confirms the efficacy of Magnesium Sulfate therapy for women with eclampsia and severe preeclampsia. However, there is a need for a randomized controlled trial to determine efficacy of Magnesium Sulfate therapy for women with mild preeclampsia and gestational hypertension.
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Magnesium Sulfate is the ideal anticonvulsant inpreeclampsia-eclampsia
American Journal of Obstetrics and Gynecology, 1990Co-Authors: Bahaeddine M SibaiAbstract:Summary The pathogenesis of eclamptic convulsions is unknown. A review of the world literature indicatesconsiderable controversy regarding the ideal anticonvulsant to prevent or control these convulsions. Parenteral Magnesium Sulfate is the drug of choice to control eclamptic convulsions in North America, but it is rarely used for this purpose overseas. The efficacy and safety of Magnesium Sulfate in the treatment of preeclampsia-eclampsia have been well documented during the past 60 years. During the same time period, numerous anticonvulsant drugs have been used overseas; however, the ideal drug is yet to be found. Recently phenytoin has been recommended as an alternative for Magnesium Sulfate; however, comprehensive data regarding its safety and efficacy are lacking. The evidence in the literature indicates that Magnesium Sulfate is the ideal anticonvulsant in preeclampsia-eclampsia.
Stephane Marret - One of the best experts on this subject based on the ideXlab platform.
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antenatal Magnesium Sulfate and neurologic outcome in preterm infants
Obstetrics & Gynecology, 2009Co-Authors: Lex W. Doyle, Caroline A Crowther, Philippa Middleton, Stephane MarretAbstract:OBJECTIVE: To systematically review rates of neurologic outcomes reported in childhood for the preterm fetus exposed to antenatal Magnesium Sulfate. DATA SOURCES: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, CENTRAL (The Cochrane Library 2008, Issue 3), relevant references from retrieved articles, and abstracts submitted to major congresses. METHODS OF STUDY SELECTION: We sought all randomized controlled trials (RCTs) of antenatal Magnesium Sulfate with neurologic outcomes reported for the fetus. TABULATION, INTEGRATION, AND RESULTS: Five eligible RCTs with 6,145 fetuses were identified; in four studies (4,446 fetuses) the primary intent was neuroprotection of the fetus. Methods of the Cochrane Collaboration were used to analyze the data. Antenatal Magnesium Sulfate therapy given to women at risk of preterm birth substantially reduced the risk of cerebral palsy in their children (relative risk [RR] 0.69; 95% confidence interval [CI] 0.54-0.87; five trials; 6,145 infants). The number needed to treat to prevent one case of cerebral palsy was 63 (95% CI 43-155). Moreover, there was a significant reduction in the rate of substantial gross motor dysfunction (RR 0.61; 95% CI 0.44-0.85; four trials; 5,980 infants). No statistically significant effect of antenatal Magnesium Sulfate therapy was detected on pediatric mortality (RR 1.01; 95% CI 0.82-1.23; five trials; 6,145 infants), or on other neurologic impairments or disabilities in the first few years of life. There were no significant effects of antenatal Magnesium Sulfate on combined rates of mortality with neurologic outcomes, except in the studies where the primary intent was neuroprotection, where there was a reduction in death or cerebral palsy (RR 0.85; 95% CI 0.74-0.98; four trials; 4,446 infants). CONCLUSION: Antenatal Magnesium Sulfate therapy given to women at risk of preterm birth is neuroprotective against motor disorders in childhood for the preterm fetus.
Kavita Nanda - One of the best experts on this subject based on the ideXlab platform.
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Magnesium Sulfate tocolysis time to quit
Obstetrics & Gynecology, 2007Co-Authors: David A Grimes, Kavita NandaAbstract:Intravenous Magnesium Sulfate tocolysis remains a North American anomaly. This therapy rose to prominence based on poor science and the recommendations of authorities. However, a Cochrane systematic review concluded that Magnesium Sulfate is ineffective as a tocolytic. The review found no benefit in
Lex W. Doyle - One of the best experts on this subject based on the ideXlab platform.
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Antenatal Magnesium Sulfate and neuroprotection.
Current Opinion in Pediatrics, 2012Co-Authors: Lex W. DoyleAbstract:Purpose of reviewAntenatal Magnesium Sulfate may reduce the excessive rates of cerebral palsy in survivors of very preterm birth.Recent findingsThere are five randomized controlled trials of Magnesium Sulfate therapy given to the mother prior to very preterm birth which have reported neurological ou
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antenatal Magnesium Sulfate and neurologic outcome in preterm infants
Obstetrics & Gynecology, 2009Co-Authors: Lex W. Doyle, Caroline A Crowther, Philippa Middleton, Stephane MarretAbstract:OBJECTIVE: To systematically review rates of neurologic outcomes reported in childhood for the preterm fetus exposed to antenatal Magnesium Sulfate. DATA SOURCES: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, CENTRAL (The Cochrane Library 2008, Issue 3), relevant references from retrieved articles, and abstracts submitted to major congresses. METHODS OF STUDY SELECTION: We sought all randomized controlled trials (RCTs) of antenatal Magnesium Sulfate with neurologic outcomes reported for the fetus. TABULATION, INTEGRATION, AND RESULTS: Five eligible RCTs with 6,145 fetuses were identified; in four studies (4,446 fetuses) the primary intent was neuroprotection of the fetus. Methods of the Cochrane Collaboration were used to analyze the data. Antenatal Magnesium Sulfate therapy given to women at risk of preterm birth substantially reduced the risk of cerebral palsy in their children (relative risk [RR] 0.69; 95% confidence interval [CI] 0.54-0.87; five trials; 6,145 infants). The number needed to treat to prevent one case of cerebral palsy was 63 (95% CI 43-155). Moreover, there was a significant reduction in the rate of substantial gross motor dysfunction (RR 0.61; 95% CI 0.44-0.85; four trials; 5,980 infants). No statistically significant effect of antenatal Magnesium Sulfate therapy was detected on pediatric mortality (RR 1.01; 95% CI 0.82-1.23; five trials; 6,145 infants), or on other neurologic impairments or disabilities in the first few years of life. There were no significant effects of antenatal Magnesium Sulfate on combined rates of mortality with neurologic outcomes, except in the studies where the primary intent was neuroprotection, where there was a reduction in death or cerebral palsy (RR 0.85; 95% CI 0.74-0.98; four trials; 4,446 infants). CONCLUSION: Antenatal Magnesium Sulfate therapy given to women at risk of preterm birth is neuroprotective against motor disorders in childhood for the preterm fetus.
