Magnesium sulphate and

glucocorticoids
 Magnesium Sulphate
Mechanism of action
• Decreases acetylcholine release and its
sensitivity at the motor end plate.
• Direct depressant effect on uterine muscle
• Causes vasodilatation , increases cerebral,
uterine & renal blood flow.
• Decreases intracranial oedema
 Magnesium sulphate- uses
Maternal Fetal
 Eclampsia  in preterm fetuses for
 Severe preeclampsia prevention of
 Impending eclampsia intraventricular
hemorrhage, NEC
 As Tocolytics to arrest
preterm labor
Available as
• 50% solution
• 2ml vial
• 2ml contains 1 gm
MgSO4

Route
• im
• Iv
Excreted via renal
excretion
 Use as anticonvulsant
Pritchard regimen
Loading Dose (total 14gm)
• 4gm IV (20% solution) over 3-4 mins
• 10gm(50% solution)deep IM (5gm in each buttock)
Maintenance dose
• 5gm 50% im in alternate buttock every 4 hrly till 24
hours after delivery or after fits whichever is last
• If seizure occurs in between, 2 gm 50% iv slowly
How to make 20% MgSO4 from 50% MgSO4
 Cont…..
• Maternal side effects: Flushing, Perspiration,
Headache, muscle weakness, pulmonary
edema
• Neonatal side effects: Lethargy, hypotonia,
rarely respiratory depression
• C.I: Myasthenia Gravis & Impaired renal
function
Other regimen of MgSO4
 Magnesium Sulphate
• Drug of choice is magnesium sulphate for
eclampsia
– Magnesium sulfate was significantly more effective than
either diazepam or phenytoin
 
– Lower cost, ease of administration , and less sedation
and depression than either diazepam or phenytoin.

– Magnesium selectively increase cerebral blood flow and

oxygen consumption in preeclampsia.
 Magnesium Sulfate
• Is not a hypotensive agent
• Works as a centrally acting anticonvulsant
• Also blocks neuromuscular conduction by
decreasing the acetylcholine release
• Vasodilator effect in cerebral vessel.
• Serum levels: 6-8 mg/dL
 Magnesium sulphate

Monitor of magnesium toxicity

• Urine output at least 30 ml/hr
• Deep tendon reflexes should be present
• Respiration rate >14/min
• Pulse oximetry >96%

I.V calcium gluconate is the anti dote.

 Magnesium sulphate

Serum Mgso4 Clinical Findings

(mg/dL)
• 4-8 Therapeutic range
• 9-12 Loss of patellar reflex
• 15-17 Muscular paralysis, respiratory
arrest
• 30-35 Cardiac arrest
 Magnesium sulphate

• Respiratory depression and hyporeflaxia

observed in newborn

• Decreases FHR variability

• Enhance the hypotensive effect of Calcium

Channel Blockers
 Use as tocolytics
• Loading dose: 4-6 g (10-20%) IV over 20
minutes; maintenance: 2-4 g/hr IV for 12-24
hours as tolerated after contractions cease
• Do not exceed 5-7 days of continuous
treatment
• longer treatment duration may lead to
hypocalcemia in developing fetus resulting in
neonates with skeletal abnormalities related to
osteopenia
CORTICOSTEROIDS
 Role of Glucocorticoids therapy
• Maternal administration of glucocorticoids is
advocated in
– Pregnant women between 24-34 wks POG who
are at risk of preterm labour within 7 days.
(RCOG Green Top Guideline oct 2010;ACOG,2011)
• helps in fetal lung maturation so that the
incidence of RDS, IVH and NEC are minimized.
• beneficial when the delivery is delayed beyond
48 hours of the first dose.
 Mechanism of action

• Acts on pneumocytes II and stimulate the

production of surfactant associated proteins
• Increase phospholipid synthesis by enhancing
the activity of phosphotidylcholine
 Types of glucocorticosteroids

Betamethasone: 12mg im 24 hrly 2 doses

Dexamethasone : 6 mg im 12 hrs apart 4 doses

– Both cross the placenta in their active form
– Have nearly identical biologic activity.
– Both lack mineralocorticoid activity
– Have relatively weak immunosuppressive activity with short-term use.
Additional benefit- prevents IVH and NEC in newborn

Regularly scheduled repeat courses or serial courses (more than two) are not currently
recommended ( increased risk of cerebral palsy)f
 Corticosteriods
Should be used judiciously in
– Pregnancy with diabetes
– Evidence of chorioamnionitis