Magnesium sulphate for preventing preterm birth in threatened preterm labour

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Abstract
Magnesium sulphate has been used in some settings as a tocolytic agent to inhibit uterine activity in women in preterm labour with the aim of preventing preterm birth. To assess the effects of magnesium sulphate therapy given to women in threatened preterm labour with the aim of preventing preterm birth and its sequelae. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (last searched 31 January 2014). Randomised controlled trials of magnesium sulphate as the only tocolytic, administered by any route, compared with either placebo, no treatment or alternative tocolytic therapy (not magnesium sulphate) to women considered to be in preterm labour. At least two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. The 37 included trials (total of 3571 women and over 3600 babies) were generally of moderate to high risk of bias. Antenatal magnesium sulphate was compared with either placebo, no treatment, or a range of alternative tocolytic agents. For the primary outcome of giving birth within 48 hours after trial entry, no significant differences were seen between women who received magnesium sulphate and women who did not (whether placebo/no alternative tocolytic drug, betamimetics, calcium channel blockers, cox inhibitors, prostaglandin inhibitors, or human chorionic gonadotropin) (19 trials, 1913 women). Similarly for the primary outcome of serious infant outcome, there were no significant differences between the infants exposed to magnesium sulphate and those not (whether placebo/no alternative tocolytic drug, betamimetics, calcium channel blockers, cox inhibitors, prostaglandin inhibitors, human chorionic gonadotropin or various tocolytic drugs) (18 trials; 2187 babies). No trials reported the outcome of extremely preterm birth. In the seven trials that reported serious maternal outcomes, no events were recorded. In the group treated with magnesium sulphate compared with women receiving antenatal placebo or no alternative tocolytic drug, a borderline increased risk of total death (fetal, neonatal, infant) was seen (risk ratio (RR) 4.56, 95% confidence interval (CI) 1.00 to 20.86; two trials, 257 babies); none of the comparisons between magnesium sulphate and other classes of tocolytic drugs showed differences for this outcome (10 trials, 991 babies). The outcomes of neonatal and/or infant deaths and of fetal deaths did not show differences between magnesium sulphate and no magnesium sulphate, whether compared with placebo/no alternative tocolytic drug, or any specific class of tocolytic drug. For most of the other secondary outcomes, there were no significant differences between magnesium sulphate and the control groups for risk of preterm birth (except for a significantly lower risk with magnesium sulphate when compared with barbiturates in one trial of 65 women), gestational age at birth, interval between trial entry and birth, other neonatal morbidities, or neurodevelopmental outcomes. Duration of neonatal intensive care unit stay was significantly increased in the magnesium sulphate group compared with the calcium channel blocker group, but not when compared with cox inhibitors or prostaglandin inhibitors. No maternal deaths were reported in the four trials reporting this outcome. Significant differences between magnesium sulphate and controls were not seen for maternal adverse events severe enough to stop treatment, except for a significant benefit of magnesium sulphate compared with betamimetics in a single trial. Magnesium sulphate is ineffective at delaying birth or preventing preterm birth, has no apparent advantages for a range of neonatal and maternal outcomes as a tocolytic agent and its use for this indication may be associated with an increased risk of total fetal, neonatal or infant mortality (in contrast to its use in appropriate groups of women for maternal, fetal, neonatal and infant neuroprotection where beneficial effects have been demonstrated). Le sulfate de magnésium pour la prévention de la prématurité quand un travail prématuré menace Le sulfate de magnésium est utilisé pour inhiber l'activité utérine chez les femmes menacées par un travail prématuré, afin de prévenir la prématurité. Évaluer l'efficacité et l'innocuité du traitement de sulfate de magnésium administré aux femmes menacées par un travail prématuré, dans le but de prévenir la prématurité et ses séquelles. Nous avons effectué une recherche dans le registre d’essais cliniques du groupe Cochrane sur la grossesse et la naissance (mai 2002) et le registre Cochrane des essais contrôlés (The Cochrane Library, numéro 2, 2002). Types de participantes : Des femmes supposées être en travail prématuré. Types d’interventions : Le sulfate de magnésium en tant que seul tocolytique, administré par voie intraveineuse ou orale, comparé à un placebo, à l'absence de traitement ou à un autre traitement tocolytique. Types de critères de jugement : Mesures d'efficacité, complications, satisfaction des femmes quant aux soins reçus et utilisation des services de santé. L'évaluation de l'éligibilité et de la qualité des essais et l'extraction des données ont été effectuées par au moins deux auteurs de la revue. Plus de 2 000 femmes avaient été recrutées dans les 23 essais inclus. Seuls neuf essais ont été jugés de bonne qualité pour l'assignation secrète. Dans la comparaison sulfate de magnésium versus contrôle (toutes les études) aucune différence n'avait été observée pour le risque de naissance dans les premières 48 heures de traitement, avec utilisation d'un modèle à effets...

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